On suicide rates, there is a clear divide between north and south India
A recent Lancet study, in which I am one of the collaborators, shows a clear geographical divide between the northern and southern states of India on suicide rates, regardless of gender.
But this is not a new phenomenon.
The southern states have higher suicide rates, the central and west have a moderate rate and the northern states have a low rate. We have seen this pattern being repeated in the last 20 years.
When we first came across this geographic divide in suicide rates, we thought it was a reporting error. So, five years ago, we conducted the Million Deaths Study and correlated it with data from the National Crime Records Bureau (NCRB). My colleagues and I focused on suicides and found that the geographical divide was not an error but a reality.
Do education & history matter?
We then focused on why this divide existed. After having examined various variables, the only one that stood out was education. Higher education rates were linked to higher suicide rates.
Higher education leads to higher expectations. And, if these expectations are not met, then there is a chance of suicide. In the southern states, education levels are higher.
Another explanation that is more historical than scientific is that northern states have always been invaded by outsiders. So, people in this region are prone to externalising their aggression.
The peninsular region of India, in contrast, has witnessed fewer invasions. Therefore, people here are used to internalising the aggression. And suicide, we have said, is aggression directed at oneself.
A third plausible reason is that the south of India has a rich history of mythological narratives and culture where the act of suicide is accepted and, to some extent, glorified.
For the northeast, the study shows relatively low rates, except for Tripura.
Among Indian metropolises, Bengaluru and Chennai continue to have the highest suicide rates.
Married women & suicides
In India, the gender difference in suicide rates is also stark. The Lancet study shows that nearly four out of every 10 women who commit suicide globally are from India. And, most of them are married.
If you look at the global trends, Asian women have the highest suicide rates, and of them, southeast Asian women have a higher suicide rate. In countries like Afghanistan and Bangladesh too, more women commit suicides than men.
The reason for the high suicide rate among women is both patriarchal structures and social institutions like marriage and family. In India, suicides among women drastically decrease after the age of 30, almost by half. This is because by the age of 30, most women have a child. Children are seen as a responsibility and become a strong protection against suicides.
Before that, women experience various marital pressures – arranged marriage, child marriages, the trauma of dowry, and physical and mental torture. Economic independence and education are also concerning factors. And, this is seen across all states.
We do not have enough data right now to conclude if the employment status of women makes a difference to the suicide rate like marriage does.
In the southern states, though the suicide rates are high, the decrease in suicide rates among women has been the sharpest since 1990s.
Blanket policies won’t work
The only way India can reduce suicides is through a geography and gender-specific approach. A blanket policy can’t be adopted everywhere. It must be an evidence-based approach.
For instance, we know that Andhra Pradesh and Telangana have high suicide rates among farmers due to pesticide consumption. So, banning them or moderating their sale helps.
If you look at suicides in the northeast, then controlling alcohol and substance abuse is the first step towards addressing the problem.
Therefore, we need to provide a bouquet of interventions so that each region or state can choose what’s best for them.
To reduce the suicide rates, among women especially, the stigma around mental health must be addressed. A health-seeking behaviour should be inculcated among Indian women. Women have to be taught to read the signs and ask for help.
When it comes to suicide, people think it is an individual choice and they have nothing to do with it. But, there is always another option.
It is too soon to tell if the decriminalisation of suicide through the Mental Health Bill has made any positive changes. Section 309 of the Indian Penal Code, which criminalises suicide, still exists and despite our protestations, it has not been removed. So, people are still hesitant to come out and talk about it.
The effect of the new law is yet to be realised.
The author is an award-winning psychiatrist and specialises in suicide prevention strategies.