Need to treat suicide as a public health problem

We now know that suicide is a complex health issue, driven by a combination of serious stress in life, mental health conditions, and other factors. By addressing the underlying causes of suicide and fostering a supportive environment, we can make a meaningful difference in preventing suicides.

For effective prevention, we must closely examine the risk factors.The focus so far has been on mental health issues like depression or anxiety, based on knowledge from western countries. However, it is now well-established that risk factors for suicide in developing countries, including India, encompass a range of social issues in addition to mental health disorders. Financial hardship, fractious family relationships, domestic violence, childhood trauma, bullying, negative peer pressure, substance abuse, and lack of access to health care are among the many challenges that increase the risk of suicide.

While mental health is a crucial aspect of suicide prevention, addressing broader societal issues — such as poverty, social inequality, gender inequity, and intergenerational discord — is essential for effectively reducing suicide deaths. It is important to broaden the scope of suicide prevention in India from the National Mental Health Programme to a larger public health approach, with a whole-of-society engagement, to address the social and economic risk factors leading to suicide deaths in India.

Globally, more men die by suicide than women. While this is also true for India, suicide death rate among Indian women is estimated to be double the global average. It is the leading cause of death among women in the age group of 15-39 years. Suicides among young women often reflect oppressive societal pressures, unmet needs for support, and mental health issues. Women face unique challenges, including gender-based violence, body image issues, and academic or career pressures. These contribute to feelings of hopelessness. Rising rates of suicide in this demographic signal a failure to create supportive environments to address societal factors that disproportionately affect young women.

Media attention in India has highlighted suicides among farmers and students. Besides farmers and students, other groups are vulnerable too. Data suggest that the majority of suicide deaths are in the 15-39 years age group. This encompasses students, people who are working, people who are looking for work, and housewives. It is important to look at the risk factors among all such groups.

To truly understand the burden of suicide and develop effective prevention strategies, we need better data. Our understanding of suicide deaths in India mostly comes from data collected by the police and reported by the National Crimes Record Bureau (NCRB), because suicide deaths are considered unnatural deaths. Such data are not in a standardised format for use in research. However, these data can be improved, through effective collaboration between the police and health departments, to enhance our understanding of the dimensions, determinants and dynamics of suicide in the population. This can guide effective prevention efforts.

In addition to improved data collection, appropriate interpretation of the available data within its limitations is crucial. Reporting on just a few occupational groups provides only a limited understanding of what is happening in the community at large. Even among specific groups such as students, the estimated rate must be for all students. If the problem is serious, disaggregated data analysis will then provide valuable insights into which sections among students are especially vulnerable. Anecdotal reports are alerts, not estimates.

The NCRB report does not allow a direct understanding of risk factors by occupation. It does not reveal if students are taking their lives because of exam pressure, bullying, stress, relationship issues, or something else but assumptions can be made based on the age of the person who died by suicide. Investment is needed for gathering relevant quantitative and qualitative data, to help us identify trends and risk factors, evaluate impact of different interventions, and allocate resources where they are most needed. Without accurate data, we will be fighting this battle in the dark.

One of the most powerful tools in suicide prevention is conversation. Talking openly about suicide can break down the stigma that often surrounds the topic, making it easier for people to seek help. This is especially important within families, where open and honest communication can be lifesaving. Families play a crucial role in providing emotional support, recognising warning signs, and encouraging loved ones to seek help. Creating a supportive family environment where everyone feels safe to express their feelings can make a significant difference in preventing suicide.

Effective suicide prevention requires strong support systems at every level of society. This means improving access to mental health care, providing education and training to those who may be in a position to help (such as teachers, employers, and health care providers), and ensuring that crisis intervention resources are available and accessible to everyone. We also need to strengthen community connections, as social isolation is a significant risk factor for suicide. When people feel connected and supported, they are more likely to reach out for help when they need it. Preventing suicide requires us to be aware of the signs, to reach out to those who may be struggling, and to advocate for better resources and support.

Rakhi Dandona is professor of public health, and K Srinath Reddy is distinguished professor ofpublic health at the Public Health Foundation of India. The views expressed are personal

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