Suicides:A major Public Health Hazard

India is witnessing a constant increase in suicides across all sections of society. According to a report in the Lancet, the suicide rate is the highest among the young and well-educated rather than the poor, and is also the cause of about twice as many deaths as HIV-AIDS.

Nitu Shukla (name changed), a 26-year-old daily wage worker was struggling to make ends meet, especially with the added burden of managing her alcoholic husband. Her worries seemed never ending, with difficulties in managing her children’s education. Fights at home were a common scene. Frustration was increasingly making her question her very existence. In the few days prior to the tragic act, she was unable to work due to illness and found it difficult even to afford medicines for her respiratory problem. Unable to get support from any quarter, she thought of ending her life. On the previous night, there was a family fight and soon after she went and cried before her neighbours. Next morning she hung herself when her children were out playing. She was barely breathing when the neighbours arrived, alarmed by the cries and wails of her children. The doctors pronounced her dead after she was rushed to the nearby hospital.

This incident can no longer be considered as a one-off event. Suicide, also known by several terms like completed suicide, attempted suicide, para-suicide, deliberate self-harm, self-assault, self-insult and others is an indicator of the health of society. Prevalent since ancient times, suicides have recently been recognised as a major public health hazard. Suicides, recognised and classified by intent, are on the increase in India. According to a recent study by the medical journal Lancet, suicide has become the second leading cause of death among young Indians. Surprisingly, suicide could soon overtake maternal mortality as the main cause of death among women in the age group of 15–29. The World Health Organisation (WHO) estimates that 190,000 suicides took place in India in 2010. According to a report in the Lancet, the suicide rate is the highest among the young and well-educated rather than the poor, and is also the cause of about twice as many deaths as HIV-AIDS.
Identifying the causes of suicides requires careful research. Since cases of suicides are not investigated thoroughly or completely, obtaining this information from the records is often
difficult. Previous research has shown that the causes for suicide are cumulative, progressive, repetitive and interlinked. The primary mechanism could be due to the presence of risk factors along with the absence of protective factors. Several causes like acute economic crisis, alcohol usage, domestic violence, presence of mental illness (mainly depression and alcohol dependence), and previous suicide attempts are established risk factors.
Simultaneously, protective factors like coping abilities, crisis support systems, communication, family attachment, religiosity, availability of help are found missing in many of the suicide attempters or completers. As per the National Crime Records

Suicide, also known by several terms like completed suicide, attempted suicide, para-suicide, deliberate self-harm, self-assault, self-insult and others is an indicator of the health of society. Prevalent since ancient times, suicides have recently been recognised as a major public health hazard.

Bureau (NCRB) 2007 report, causes were not known for nearly 42 per cent of the completed suicides. Among the others, the causes were general and vague for nearly 50 per cent of the suicides. With such limitations in understanding, prevention of suicides is extremely difficult. Even though studies have shown a clear association with mental health problems, it has been difficult to target interventions due to difficulty in recognising the cases at the early stages of illness.
Since the causes of suicides are multiple, there is no single solution that can prevent all suicides. The prevention programmes need to be tailored for different ages, sexes, causes and settings. Undoubtedly suicides are a leading public health problem affecting people in the younger age brackets. The changing life patterns and increasing stress across all sections of society along with presence of many predisposing factors will contribute to an increasing number of suicides in the days to come. Combined intervention strategies with a defined plan and programme of work are urgently required to reduce the burden of suicides.

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