Indian women have the highest rate of suicide in the world, committing more than one out of three worldwide, noted a new study published by Lancet Public Health and reviewed by Scientific American in its December issue.
The Lancet Public Health study was written by Indian American Rakhi Dondana, a clinical professor in the department of global health at the University of Washington. Dondana and her colleagues analyzed data from the Global Burden of Disease study to determine suicide death rates in India from 1990 to 2016.
About 230,000 women in India annually die from suicide, concluded Dondana. Her results are much higher than the National Crime Records Bureau of India, which determined – for 2015 – that there were 10.6 suicides per 100,000 residents of India, which is lower than the global average of 11.4 suicide deaths per 100,000 people. The NCRB determined there were 133,623 suicides in India in 2015, much lower than Dondana’s estimates. Under-reporting and mis-classification of suicide deaths in India are common, noted the researchers, attempting to explain the wide disparity between their data and that of the NCRB.
The higher level of suicides among women in India may be related to a clash between women’s aspirations and the rigidity of their social environment, hypothesized Dondana. As India has developed, women have become better educated and more empowered, and arranged marriages have declined. But women still face lower status and barriers to opportunity.
Interestingly, there is a north-south divide: women in southern India are more likely to commit suicide than their north Indian sisters, revealed Dondana. In the South, development and social advances have accelerated, she noted, adding that, conversely, in the north, which is much more traditional and rural, there are fewer suicides, because women there may have “less knowledge that they could actually live a better life.”
“Although there are substantially more suicide deaths in India each year than AIDS-related deaths – 62,000 in 2016 – and maternal deaths – 45,000 in 2015 – suicide prevention has attracted considerably less public health attention,” wrote researchers Gregory Armstrong and Lakshmi Vijayakumar of the Nossal Institute for Global Health at the University of Melbourne, Australia.
The reviewers noted that a public health approach to suicide prevention is gaining momentum in India. The national Mental Health Act of 2017 sought to decriminalize suicide. Vijayakumar and Armstrong advocated for a national suicide prevention plan, which focuses on treatment specific to gender and age. Youth and older age are key risk periods for women, whereas young adulthood, middle age, and older age are key risk periods for men, noted the researchers.
Suicide is the leading cause of death among Indian women ages 15 to 29, responsible for about 26 to 33 deaths per 100,000 women in that range.
“Deaths that occur due to suicide are also a product of the method that is used,” noted Vikram Patel, a professor of global health at Harvard University, who was not involved in the Lancet Public Health study, but was quoted by the Scientific American.
In the West, women attempt suicide more often than men, but men typically use more lethal means, resulting in more deaths. In India, however, Patel said that men and women tend to use the same, more fatal, methods.
Pavan Madan, a child, adolescent and adult psychiatrist practicing in Davis, California, told India-West the rate for Indian American female suicides was much lower: 1.2 deaths per 100,000 people. "Generally, the population that tends to immigrate is healthier," he said.
Suicide rates for all residents of the U.S. is 13 for every 100,000 people.