2014-2019: Suicide rates in adolescents aged 14-17 years higher in females

While suicide rates are generally similar among males and females in the 15-29 years age group in India, the suicide rates during 2014 and 2019 among female adolescents aged 14-17 years were two-six times higher than other Southeast Asian countries, while suicide rates among male adolescents were in line with the global average

A recently published study has found that among adolescents aged 14-17 years, suicide rates during 2014 and 2019 among females in India were two-six times higher than other Southeast Asian countries and high-income countries. In contrast, suicide rates among male adolescents were in line with the global average. In all, 49,341 adolescents aged 14-17 years died by suicide in India between 2014 and 2019. Of these, 23,075 were male and 26,266 were female, and the national suicide rate among adolescents (14-17 years) between 2014 and 2019 ranged between 7.12 and 8.74 per 1,00,000 population.

The latest study found that female adolescent suicide rates in India ranged between 8.10 and 9.04 per 1,00,000 population, while suicide rates ranged between 6.24 and 8.47 per 1,00,000 population for male adolescents. The results of the study were published recently in the journal Cambridge Prisms: Global Mental Health analysed suicide rates among adolescents for the period 2014 to 2019.

“The study does not cover the entire adolescent age group, which is 10-19 years (and moving to 10-24 years),” Dr. Rakhi Dandona, Director of PHFI Injury Prevention Research Centre, Public Health Foundation of India (PHFI), New Delhi and a coauthor of the papers says in an email. She cautions that the results of the study should not be interpreted as reflection of the entire adolescent age group but limited to adolescents aged 14-17 years.

Suicide rate trends

Overall, the number of suicides among men are more than women in India. However, this gets reversed among adolescents. “Globally, suicide rates are higher among males, while attempted suicides are more common among females. India follows this global pattern overall, with male suicide rates exceeding female rates,” Dr. Vikas Arya, Research Fellow in mental health from the Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne and the corresponding author of the study says in an email. “However, when it comes to the younger age group (15-29 years), suicide death rates are generally similar among males and females in India. Indeed, our study showed that they are in fact higher among females compared to males for those aged 14-17 years.”

Referring to the 2023 Global Burden of Disease study data that provides suicide death rate and numbers of suicides for adolescent boys and girls aged 10-19 years and 15-19 years, Dr. Dandona says: “The suicide death rate is similar for males and females (boys/girls) in the adolescent age group 10-19 years. The rate is slightly higher in 15-19 years for girls as compared with boys but not statistically significant. In other words, [the rates are] similar.”

As per the Global Burden of Disease data 2023, for the age group 10-19 years, the number of suicide deaths in males is 9,975 and 12,455 for females. This translates to 7.3 suicide death rate per 1,00,000 for males and 9.8 per 1,00,000 for females.

Among adolescents aged 15-19 years, the number of suicide deaths in males is 8,393 and 10,803 for females. The suicide death rate is 12.1 per 1,00,000 for males and 16.8 per 1,00,000 for females.

Unique opportunity

Up until 2013, the suicide data provided by the National Crimes Records Bureau (NCRB) were grouped into five categories based on age groups — up to 14 years, 15-29 years, 30-44 years, 45-59 years, and over 60 years. But in 2014, for the first time, NCRB split the 15-29 years category into 14-17 years and 18-29 years categories. This provided a “unique opportunity” to explore suicide rates among adolescents in India aged 14-17 years at the national and State levels. However, two years after it revised age category classification, NCRB abandoned it in 2016. Despite NCRB not officially publishing the data for the 14-17 years category, the authors NCRB’s unpublished, age-stratified suicide data by State for the period 2016 to 2019 under the Right to Information Act (RTI).

Comparing the two time periods — 2014-2016 and 2017-2019 — the study found that adolescent suicide rates increased during the second part of the study period 2017-2019. What makes the increase in adolescent suicide rates even more strikingly is the fact that the suicide deaths were reducing during the first time period of 2014-2016 and suddenly witnessed an uptick during the second study period (2017-2019). 

“Our previous studies have reported that suicide rates in India generally showed a decreasing trend from 2010 until 2017, with the trend reversing after this period, particularly for males. In general, between 1990 to 2016, suicide rates among females have seen a decline while male rates have remained somewhat steady in India,” Dr. Arya says.

However, Dr. Dandona says the increase in suicide rates should be interpreted with caution. “Interpretation of increase or decrease within such a short span is difficult. This is because we do not fully understand the extent of underreporting over time to make a reasonable comment on increase or decrease,” she says.

According to the study, between 2014 and 2016, adolescent suicide rates decreased from 8.74 to 7.12 per 1,00,000. The reduction in the rates was seen in males and females. While it reduced from 9.04 to 8.10 per 1,00,000 in females, the decrease was sharper in males — from 8.47 to 6.24 per 1,00,000. After witnessing a decrease during the period 2014 and 2016, suicide rates increased from 7.51 to 7.82 per 1,00,000 population overall during the second part of the study period 2017-2019. During this period, female rates increased from 8.45 to 8.98 per 1,00,000, while male rates increased from 6.64 to 6.76 per 1,00,000. “These national trends were also evident among less developed States, but not among more developed States,” the authors write.

Rising suicide rates in less developed States

Significant increase in suicide rates, both overall and among females, during the period 2017-2019 were in less developed States. However, Dr. Arya clarifies that adolescent suicide rates are actually higher in more developed States than in less developed ones, for both males and females. “For adolescent females, the rates are more than double in more developed States,” he says. “However, between 2017-2019, suicide rates increased in less developed States, while remaining relatively stable in more developed ones.” According to the paper, “pronounced increases” in suicide rates among females during 2017-2019 were in States including Uttarakhand, Punjab, Jharkhand and, Himachal Pradesh.

Dr. Arya says the increased suicide rates in less developed States between 2017 and 2019 is particularly concerning as less developed States face significant resource constraints and have more limited access to mental health services, making it harder to respond to such increases.

Suicides underreported

In general, suicides among women are less reported in India and especially in less developed States. If that holds true even for adolescents, will it mean that the suicide rates are far higher among females and more in number in less developed States? “Our research found that NCRB data underreports suicides by roughly 27% for males and 50% for females each year compared with Global Burden of Disease (GBD) estimates. Underreporting is especially severe among younger people and in less developed states. This means that the true burden of female adolescent suicides is almost certainly higher than official figures suggest, particularly in less developed regions,” says Dr. Arya.

Dr. Dandona says the understanding of the extent of underreporting is between NCRB data and modelled estimates.  “Both men and women suicide deaths are underreported, perhaps, women suicide deaths more than men suicides, but we do not fully know how it is by age groups, States and over time,” she points out. Referring to a recent work, Dr. Dandona says that underreporting of suicides is not peculiar to less developed States and that the study found “significant underreporting even in developed States”.

Decriminalisation of suicides

According to the Section 309 of Indian Penal Code (IPC), suicide attempt was considered as an offence. The intent of criminalising suicides was probably to act as a deterrent to prevent suicidal attempts. But the fact is that many suicide attempts occur in the background of severe mental stress. A 2013 study found that 93% of suicide attempters were by people who were psychiatrically ill. In 2017, India decriminalised attempted suicide as such individuals were presumed to have severe stress.

Explaining the increased trend in suicide deaths since 2017, Arya says the decriminalisation of attempted suicide might be one possibility for improved reporting of such deaths particularly in some States. “Since underreporting is more common in less developed states and among women, better reporting could inflate observed rates in these groups,” he says. “That said, I am cautious about attributing the rise solely to reporting improvements. Despite legal reforms, evidence suggests that suicide attempt survivors continue to face stigma and harassment in India, which limits how much reporting could really have improved.”

Higher suicide rates among female adolescents than male adolescents could possibly be linked to gender-based discrimination, rigid patriarchal norms, early marriage, and higher risks of depression among younger females. But exact reasons are not known. “Unfortunately, current data systems in India don’t capture these complexities. For instance, NCRB classifies reasons for suicides under broad categories such as “family problems” or “love affairs”, which obscure the underlying social, cultural, and psychological drivers,” Dr. Arya says.

Dr. Dandona explains the hazy understanding of suicide risk factors. “Understanding of risk factors is still in an early stage in India. Our understanding predominately comes from police data, which is not designed to capture risk factors. Broadly, love affairs, family problems, personal and social problems, and examinations are cited.”

Preventive strategies

Dr. Dandona points out a fundamental flaw in the approach of the India Adolescent Health Strategy in addressing suicides. “The India Adolescent Health Strategy aims to address suicide as well, but within mental health framework.  It would be important to go beyond that framework to address suicides,” she says. “In simple words, economic issues, bullying, family issues cannot be addressed through mental health.  A larger public health and safety net approach is needed to effectively address suicides.”

Dr. Dandona also highlights other important issues that need to be considered while addressing suicide preventive strategies that target adolescents. She says: “Adolescents are a wide age group. Risk factors and solutions for [adolescents aged] 10-14 years will not be the same for [those in the age group] 15-19 years.  Also, issues with boys and girls are not necessarily the same. Both age and gender will need to be taken into consideration for suicide prevention as against generic suicide prevention.”

Explaining the measures that may be necessary to reduce suicide deaths among adolescents, Dr. Arya says a multipronged prevention strategy is required as the reasons for suicide are complex. “We need the National Suicide Prevention Strategy and the India Adolescent Health Strategy to work together to address the issue of adolescent suicide in India. Pilot programs conducted in Indian schools such as Gender Equity Movement in Schools (GEMS) which aim to sensitise adolescent boys on the issues of gender-inequity and violence could be implemented at a wider scale.”

He further adds that school-based interventions are especially important as they, along with digital interventions, are the platforms known to attract highest adolescent engagement. However, this does not imply ignoring the more disadvantaged adolescents who are neither in school nor active on digital platforms. “We also need to prioritise the surveillance of adolescent suicidal behaviour,” Dr. Arya says. “For example, India can adopt the Global Action for Measurement of Adolescent Health (GAMA) indicators for measuring mental health among adolescents. Given that approximately one fifth of India’s population is accounted for by adolescents, this issue cannot, and should not, be ignored anymore.”

(Assistance for overcoming suicidal thoughts is available on the Tamil Nadu’s health helpline 104, TeleMANAS 14416 and Sneha’s suicide prevention helpline 044-24640050)