The average suicide rate worldwide is around 14.5 per 100000 population (rates are lower in industrialised countries and higher in less-developed settings). Anuradha Bose from the Christian Medical College, Vellore, India, and colleagues prospectively assessed causes of death among young people (aged 10-19 years) in a rural area of southern India (population 108000).
Suicide rates were much higher than expected, accounting for between half and three-quarters of deaths among young women (a rate of 148 suicides per 100000 young women). Suicide accounted for around a quarter of all deaths among young men (an overall rate of 58 suicides per 100000 young men). Hanging and poisoning with pesticides were the commonest causes of death; possible risk factors for suicide included family conflicts, domestic violence, academic failures, unfulfilled romantic ideals, and mental illness.
Dr Bose comments: "We have identified rates of suicide that are several fold higher than those reported anywhere in the world, especially in young women. We suggest that the reported rates of suicide in other parts of India are low because identification of suicides is difficult owing to inefficient civil registration systems, non-reporting of deaths, variable standards in certifying death, and the legal and social consequences of suicide. We do not believe that our findings are a local aberration. There are no peculiar features in the Tamil Nadu area socially or ecologically that could account for a higher rate there. The system of surveillance and the method of assigning a cause of death in the Vellore study ensure that the coverage is good and the data are gathered prospectively and validated periodically... We believe that the rates reported here are the highest yet. This study should be done in other parts of India. The high suicide rates emphasise the need to recognise adolescent suicide as a major public-health problem, with an urgent need for intervention".
Wun Jung Kim from the Medical College of Ohio, USA, states in an accompanying Commentary (p 1090): "In terms of preventive intervention, there are comprehensive guidelines developed by the American Academy of Child and Adolescent Psychiatry. Depression and substance abuse are well-established risk factors for suicide in both adults and adolescents. The same risk factors were also recognised in India, and China. However, practice guidelines designed for specialists, such as child and adolescent psychiatrists, to assess and treat risk factors (eg, depression) would not be practicable in developing countries. Ganju reported that there are about 1500 psychiatrists and 500 clinical psychologists in India, where the population is over a billion. Access problems of children and adolescents with a psychiatric illness to a specially trained child and adolescent psychiatrist have been well documented, even in the USA. Promotion of training and education of qualified mental-health professionals, including child and adolescent psychiatrists, is justified considering the size of the public-health problems that can lead to suicide".
Contact (Thursday 1 April onwards): Dr Anuradha Bose, Reader of Paediatrics, Community Health Department, Christian Medical College, Vellore, India;
T) 91-416-228-4207 (office, available between 0800 and 1200 H UK time); 91-416-228-4350 (up to 1700 H UK time); 91-94433-655-39 (mobile);
E) abose@cmcvellore.ac.in
Professor Wun Jung Kim, Medical College of Ohio, Toledo, OH 43614, USA;
T) 419-383-3815;
E) wjkim@mco.edu
Journal
The Lancet