|BRIEF RESEARCH ARTICLE
|Year : 2013 | Volume
| Issue : 1 | Page : 40-42
Suicide an Emerging Public Health Problem: Evidence from Rural Haryana, India
Harshal Salve1, Rakesh Kumar2, Smita Sinha3, Anand Krishnan4
1 Senior Resident, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
2 ICCIDD, New Delhi, India
3 Senior Resident, School of Public Health Post Graduate Institute of Medical Education & Research, Chandigarh, India
4 Additional Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||4-May-2013|
Senior Resident, Old OT Block, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Analysis of annual mortality data for year 2002-2009 of twenty eight villages in Ballabgarh block of rural Haryana was carried out to calculate suicide rates per 100,000 population. In addition, informal discussions were carried out amongst health providers to understand their perceptions regarding suicides. In a period of 8 years, out of total 4552 deaths, 163 (3.5%) deaths were attributed to suicides giving a suicide rate of 24.4/100,000 population (95% CI 24.1- 24.7). Mean years of productive life lost for males and females were estimated to be 44.4 (SD 1.1) years and 39.9 (SD 1.4) years respectively. Poisoning (41.1%) was the most common mode of suicide followed by hanging (36.8%) and burns (14.7%). Health workers also perceived suicide as major problem in the community and marital confl ict was identifi ed as major cause for suicides. There is need to address the complex issue of suicide by public- health approach at the community level.
Keywords: India, Public-health, Rural, Suicide rate
|How to cite this article:|
Salve H, Kumar R, Sinha S, Krishnan A. Suicide an Emerging Public Health Problem: Evidence from Rural Haryana, India. Indian J Public Health 2013;57:40-2
|How to cite this URL:|
Salve H, Kumar R, Sinha S, Krishnan A. Suicide an Emerging Public Health Problem: Evidence from Rural Haryana, India. Indian J Public Health [serial online] 2013 [cited 2019 Nov 13];57:40-2. Available from: http://www.ijph.in/text.asp?2013/57/1/40/111373
In India, suicide is amongst ten leading causes of death of adults and amongst leading three causes of death in young adult population (16-35 years).  National Crime Record Bureau reports 125017 suicidal deaths with rate of 10.8/100,000 population in the year 2008.  However, the national estimates of suicides in the country are misleading due to poor civil registration system, under-reporting, variable standards in certifying deaths, legal problems, and stigma associated with it.  Many community based studies from different parts of the country reported different suicide rate/100,000 population like 22.8 (Warrangal),  44.7 and 26.8 for males and females respectively (Kerala),  43.4 (West Bengal).  Data on suicides are sparse from northern part of the country particularly from rural regions.
This study used data generated through routine demographic surveillance carried out in the twenty eight villages in rural Haryana under Comprehensive Rural Health Services Project (CRHSP) of All India Institute of Medical Sciences, New Delhi. This study area covers population of 87,007 (year 2009), which is kept under regular demographic surveillance. This study area is served by two Primary Health Centers under CRHSP, Ballabgarh. Health workers of Primary Health Centers in addition to providing the health-care services as per national guidelines also register all vital events viz. births, deaths, marriage, migration etc. These data are entered into database on monthly basis. This database is maintained in the form of Health Management Information System by demographer at CRHSP, Ballabgarh.
Under this process of demographic surveillance, each death occurring under study area is being identified by health workers and verbal autopsy of that death is carried out to know cause of death. Health workers were trained for administration of this standard and validated verbal autopsy tool.  Later on all verbal autopsies were coded by medical officers of two Primary Health Centers separately by using International Classification of Diseases (ICD) classification 10 th edition. In this particular study, we used annual mortality data from the year 2002 to 2009. Information regarding various determinants such as age, sex, place of death, month, and year of deaths were also obtained from database. Data were analysed in SPSS 13.0 version for windows and suicide rates were calculated/100,000 population. Years of productive life lost (YPLL) was calculated by taking estimated life expectancy at birth for rural Haryana in to consideration separately for males and females. 
We also carried out informal discussions with health workers and the village head (Sarpanch) of the village regarding their perceptions. In informal discussions, questions pertaining to various domains related to suicides such as, perception of suicide as public-health problem in the community, probable causes of suicide, its preventable measures that can be taken at the community level and role of the health system in addressing this issue. This study used secondary data generated by routine demographic surveillance and confidentiality of verbal autopsy data were maintained as a part of routine process.
In a period of 8 years (year 2002-2009), out of total 4552 deaths, 163 (3.5%) were attributed to suicides with a suicide rate of 24.4 (95% CI 24.1-24.7) per 100 000 population. Suicide rates over this 8 years in the study area were fluctuating with the lowest being reported for the year 2007 (13/100,000) and the highest for the year 2008 (47.9/100,000) [Table 1]. Suicide rates amongst males and females were 26.5 (95% CI 26.2-26.8) and 21.5 (95% CI 21.2-21.8)/100,000 population respectively. Suicide rates were reported high in males as that in females in all years except for years 2005 and 2008 [Figure 1]. These years were also having the lowest and the highest reported suicides respectively.
|Figure 1: Suicide rates per 100,000 population in villages under study area as per sex (2002-2009)|
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|Table 1: Suicide deaths in villages under Comprehensive Rural Health Services Project Ballabgarh, Haryana (year 2002-2009)|
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Majority (79.1%) of the suicides were reported in economically productive age group (20-49 years) followed by age <20 years (17.8%) and age >49 years (6.1%) Mean age of person committing suicide was 28.6 (± 11.7) years and the mean age for males 31.1 (SD 13.0) years was higher than that of females 25.5 (SD8.7) years. Mean YPLL for males and females were 44.4 (SD1.1) years and 39.9 (SD 1.4) years respectively using life expectancy.
Poisoning (X68) (41.1%) was the most common mode of suicide followed by hanging (X70) (36.8%) and burns (X76) (14.7%). Poisoning and hanging were among most common modes of suicide in males and females respectively. There was no seasonal pattern observed in suicides in this duration of 8 years (data not shown).
Informal discussion revealed that suicidal deaths were increasing in the community and was a major problem amongst youngsters, supported by also health workers. Poisoning was the major mode of suicide as it was easily available and accessible in the form of pesticides. Marital conflicts were come out as major cause of suicide in adults followed by financial constraint. Parental conflict and educational failure were identified as other causes of suicide particularly amongst youngsters.
Health workers also suggested that targeted services through Primary Health Center to the vulnerable people in the community such as young males, newly married couples; person with known mental illness can lead to improvement in the current situation.
The average suicide rate (24.4/100,000 population) in this study was more than double the estimated rate in Haryana (10.2/100,000 Population). 
The strength of the study was it covered large population under regular demographic surveillance of 8 years using verbal autopsy tool and it therefore, unlikely to be biased. Community based survey can be used for mortality data; however, major limitation with it is missing deaths. This problem could be overcome by studying population under demographic surveillance, which provide better estimate of mortality data.
Suicide rates reported in this study are comparable to suicide rates reported in Jhansi city (29)  and in Warrangal (22.8).  Higher suicide rates and high YPLL were reported in economically productive age group (20-49),
which corresponds to the previous study in Vellore.  Higher values of YPLL reported in males, is also proxy indicator of increase economic burden due to suicide in the community.  Suicide rates were high in males as that in females that correspond to previous studies in southern India. Soman et al reported hanging as common mode of suicide in rural south India in contrast to this study, which showed poisoning as the most common mode of suicide. 
The finding which were observed in informal discussion in this study were also reported by, Shukla et al.  Analysis of surveillance data showed poisoning as the most common mode of suicide, which was corroborated by the community, which attributed it to the easy availability of pesticides like Sulphas. Community members identified important role for health system as well as for them as a community in addressing this issue. This is an important finding of the study as perception of any community regarding magnitude of problem and their role in addressing it is required to implement any intervention in that community.
This study showed that the problem of suicide was endemic and it was spread across the year, not related to agricultural worries, occurred almost equally in both sexes and affected the young population it was also resulting in productivity loss. This indicates that suicides are emerging as an important public-health problem in rural north India. Community also perceived suicide as major public-health problem. Currently, health system is not to addressing this issue at all. The public-health approach is required to address this complex issue of suicide in the rural community. This would include creating awareness amongst community members, creating village level mechanism to identify people with potential suicidal behavior and assuring availability and accessibility of counselling and mental health services at primary care level.
| References|| |
|1.||Government of India. National crime records bureau. Accidental deaths and suicides in India: ADSI 2008. Available from: http://www.ncrb.nic.in/accdeaths.htm. [Accessed on 2010 Jun 10]. |
|2.||Murthy RS. Approaches to suicide prevention in Asia and the Far East. In: Hawton K, Van Heeringen K, editors. The International Handbook of Suicide and Attempted Suicide. Chichester: Wiley; 2000. p. 631-41. |
|3.||Sharma PG, Anand B. Suicide in Warrangal district: Season and suicide. Indian J Psychol Med 2000;23:33-6. |
|4.||Soman CR, Safraj S, Kutty VR, Vijayakumar K, Ajayan K. Suicide in South India: A community-based study in Kerala. Indian J Psychiatry 2009;51:261-4. |
|5.||Banerjee G, Nandi DN, Nandi S, Sarkar S, Boral GC, Ghosh A.The vulnerability of Indian women to suicide a field-study. Indian J Psychiatry 1990;32:305-8. |
|6.||Krishnan A, Kumar R, Nongkynrih B, Misra P, Srivastava R, Kapoor SK. Adult mortality surveillance by routine health workers using a short verbal autopsy tool in rural north India. J Epidemiol Community Health 2012;66: 501-6 |
|7.||Report on Population projection constituted by the planning commission. Population 1996 projections for India and states. India: Registrar General; 1996-2016. Available from: http://www.cbhidghs.nic.in/hia2005/2.13.htm. [Accessed on 2010 Jun 10]. |
|8.||Shukla GD, Verma BL, Mishra DN. Suicide in Jhansi city. Indian J Psychiatry 1990;32:44-51. |
|9.||Chavan BS, Singh GP, Kaur J, Kochar R. Psychological autopsy of 101 suicide cases from northwest region of India. Indian J Psychiatry 2008;50:34-8. |
|10.||Aaron R, Joseph A, Abraham S, Muliyil J, George K, Prasad J,et al. Suicides in young people in rural southern India. Lancet 2004;363:1117-8. |