Lessons from a decade of suicide surveillance in India: who, why and how?

Background: This paper investigates trends in suicide rate, the reasons for and means of suicide and the occupation of deceased, to prioritize suicide prevention activities in India and to highlight the limitations to data quality for surveillance. Methods: Data available in the public domain from the National Crimes Record Bureau (NCRB) were analysed from 2001 to 2010 at the national and sub-national levels, split by age groups and sex for ages 15 years and above. Results: The reported suicide rate was 14.9 and 15.4 suicides per 100 000 population in 2001 and 2010, respectively. More developed states reported significantly higher suicide rates than the less developed (mean 20.5 versus 8.16), but neither experienced large changes over time. Among males, the reported suicide rate changed slightly (17.8 to 19.5); it remained almost similar for females (11.9 to 11.1). Housewives accounted for the highest proportion of suicide deaths over the decade. Distribution of the reasons for suicide remained almost constant over time; most suicides (33.7%) were due to personal/social reasons, followed by health at 24.3% and unknown reasons at 16.4%; differences were observed between the more and less developed states. Marriage-related suicides were higher for females, and health reasons increased with increasing age. Nationally, poison/overdose with drugs/pesticides was the leading means of suicide through the decade, although the gap between this and hanging decreased over time. The state level data showed considerable heterogeneity in the quality of data across the indicators assessed. Conclusions: These data provide a range of information to identify vulnerable groups, to formulate appropriate suicide prevention strategies. Addressing the limitations in data quality would facilitate further utility of surveillance data to prevent suicides.