1. CGHR.ORG/SUICIDE Twitter: CGHR_org SUICIDE MORTALITY IN INDIA Vikram Patel, Chinthanie Ramasundarahettige, Lakshmi Vijayakumar, JS Thakur, Vendhan Gajalakshmi, Gopalkrishnan Gururaj, Wilson Suraweera, and Prabhat Jha, for the Million Death Study Collaborators, and in partnership with Centre for Global Health Research (Toronto, Canada) Prabhat.jha@utoronto.ca

2. 2 Key findings About 0.2 million deaths at ages 15 years and older in 2010 were due to suicide. 54% of female and 40% of male suicides occurred at ages 15-29 years. A 15 year old south Indian male had a 3.5% risk of dying from suicide before reaching 80 years, in the absence of the other causes. About half of suicide deaths were due to poisoning. Age standardised suicide death rates at ages 15 years and older were two fold higher in rural areas than urban areas. Suicide death rates vary markedly between states. CGHR.ORG/SUICIDE Twitter: CGHR_org

3. 3 What’s new about this research? Previous suicide estimates have used the National Crime Records Bureau numbers, which are based on police reports These data could under-report suicide, as attempted suicide is a crime in India The Million Death Study provides direct suicide estimates by age, gender, area and method of suicide from a nationally representative sample. CGHR.ORG/SUICIDE Twitter: CGHR_org

4. 4 Crude suicide death rate based on NCRB data CGHR.ORG/SUICIDE Twitter: CGHR_org Year

5. 5 Nationally representative sample (Sample Registration System) 6,671 of these small areas randomly chosen from all parts of India (each with about 1000 people per area) How was the study done? CGHR.ORG/SUICIDE Twitter: CGHR_org

6. 6 How was the study done? 800 Registrar General of India field workers interviewed 122 thousand families of people who had died in 2001-2003 Written reports each coded independently by at least two physicians to attribute a probable cause of death (i.e., suicide) CGHR.ORG/SUICIDE Twitter: CGHR_org Calculated proportion of all suicide deaths by age, gender, and area within the study

7. 7 How was the study done? Combined with national 2010 UN totals of deaths, and 2007- 2009 state-specific SRS death rates Produced national and state estimates of rates and number of suicide deaths for 2010 CGHR.ORG/SUICIDE Twitter: CGHR_org

8. 8 Deaths from all causes in India, 2010

9. 9 Age specific suicide death rates in India and in high-income countries - Men Age standardised suicide death rate at ages 15 years or older (99%CI) India 26.3 (24.5, 28.0) High income 21.8 (21.6, 22.0)

10. 10 Age specific suicide death rates in India and in high-income countries - Women Age standardised suicide death rate at ages 15 years or older (99%CI) India 17.6 (16.1, 19.0) High income 6.8 (6.7, 6.9)

11. 11 Risk of suicide is high among Indians CGHR.ORG/SUICIDE Twitter: CGHR_org

12. 12 Risk of suicide is higher in rural and southern India

13. 13 Risk of suicide deaths for men and women aged 15 years and above

14. 14 Estimated suicide deaths by different regions CGHR.ORG/SUICIDE Twitter: CGHR_org

15. 15 17 of 1000 men will die of suicide 10 of 1000 women will die of suicide Risk of death from Suicide For Indians aged 15 years, the risk of dying before age 80 in the absence of other diseases: Source: Dikshit et al, Lancet 2012 CGHR.ORG/SUICIDE Twitter: CGHR_org

16. 16 Suicide death rates for selected states- aged 15 years or older CGHR.ORG/SUICIDE Twitter: CGHR_org

17. 17 Method of suicide among Indian men – aged 15 years or older CGHR.ORG/SUICIDE Twitter: CGHR_org Poisoning (T=60.2, ASR=13.8) Other (T=8.8, ASR=2.0) Drowning (T=4, ASR=0.8) Burns (T=5, ASR=1.1) Hanging (T=37, ASR=8.3) 49% 8% 4% 35% T = estimated suicide deaths in 1000, ASR = age standardised suicide death rate per 100,000

18. 18 Method of suicide among Indian women – aged 15 years or older CGHR.ORG/SUICIDE Twitter: CGHR_org Poisoning (T=31.5, ASR=7.9) Other (T=5, ASR=1.2) Drowning (T=5.4, ASR=1.3) Burns (T=13.4, ASR=3.3) Hanging (T=17,ASR=4.2) 44% 7% 8% 15% 26% T = estimated suicide deaths in 1000, ASR = age standardised suicide death rate per 100,000

19. 19 Significant risk factors for suicide - Men aged 15 to 69 years CGHR.ORG/SUICIDE Twitter: CGHR_org

20. 20 Significant risk factors for suicide - Women aged 15 to 69 years CGHR.ORG/SUICIDE Twitter: CGHR_org

21. 21 CONCLUSIONS Large proportion of suicide deaths occur between the ages of15 to 29 years. Many suicide death might be prevented by: - restricting access to pesticides - providing community or support services - providing easy access to services for mental illness associated with suicide - reducing binge alcohol drinking through higher taxation on alcohol CGHR.ORG/SUICIDE Twitter: CGHR_org

22. 22 Million Death Study Collaborators