|Year : 2016 | Volume
| Issue : 1 | Page : 38-39
Magnitude of suicide attempt in Pondicherry: An under estimate
P Punitha Kumary1, KC Premarajan2, Swaroop Kumar Sahu2, Shivanand Kattimani3
1 Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
2 Department of Preventive and Social Medicine, JIPMER, Puducherry, India
3 Department of Psychiatry, JIPMER, Puducherry, India
|Date of Web Publication||24-Jun-2016|
Dr. P Punitha Kumary
Department of Community Medicine, PSG Institute of Medical Science and Research, Coimbatore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumary P P, Premarajan K C, Sahu SK, Kattimani S. Magnitude of suicide attempt in Pondicherry: An under estimate. Int J Adv Med Health Res 2016;3:38-9
Suicide is a major public health problem and a leading cause of death worldwide. Every year, approximately one million people commit suicide. Seventy-five percent of global suicide occurred in low- and middle-income countries in 2012. Suicide accounted for 1.4% of all deaths worldwide, making it the 15th leading cause of death and second among the leading causes of death for both genders in the age group of 15–29 years in 2012. This represents a massive loss to societies of young persons in their productive years of life.
Globally, there is an increasing trend of suicide rate from 10 per lakh population in 1950 to 18 per lakh in 1999. In India too there is an increasing trend from 10.4 per lakh in 2003 to 10.9 per lakh in 2009. Puducherry recorded the highest suicide rate of 47.2 per lakh population in 2009; which is four times the national rate. The suicide rate in Tamil Nadu was 21.5 per lakh which is twice the national level., The World Health Report 2001 estimated that suicidal attempts are twenty times higher than the completed suicides. Worldwide, the estimated numbers of yearly suicidal attempts are 9–36 million. One suicide attempt occurs in every 3 s. In India, the prevalence and incidence of suicide attempts were found to be 0.8% and 5.36%., Of all those who engage in nonfatal suicidal behaviors, one-third repeat the behavior within a year, and nearly 10% eventually commit suicide., For every one suicide, there are 7–10 suicide attempts. Hence, attempted suicide is one of the predictors of suicide deaths.
Attempted suicide is a major public health problem requiring mental health interventions, but it continues to be treated as a criminal offence under the section IPC 306 (suicide) and 309 (suicide attempt). Criminalization of suicidal acts causes the problem of suicide to go underground, making it difficult for suicidal persons to receive necessary assistance. Hence, the magnitude of suicide attempts is an underestimate because of the associated social stigma. In India, many deaths, particularly in rural areas, are not registered at all partly because of an inefficient registration system  and partly because of the fear of social and legal consequences associated with suicide.
For the year 2009–2010, the rate of suicide was 50.7 and attempted suicide was 17.95 per lakh population as per CRB Puducherry. However, data on suicide attempt from hospitals (MRD of JIPMER and GH) Puducherry alone showed the rate to be 119.26 per lakh population. Previous studies have found that suicide attempt rate was 5-10 times the suicide rate. Even though the rate of completed suicide was 50.7 according to data from Crime Record Bureau (CRB) of Puducherry, attempted suicide rate was found to be only 17.95 per lakh population.
This revealed that there was gross under-reporting of attempted suicide cases to CRB Puducherry. Not only in Puducherry, but also in the neighboring district of Tamil Nadu (Villupuram) there is gross under-reporting of attempted suicide, as per CRB Villupuram. Possible reason could be due to the social stigma associated with the suicidal attempts and fear of legal implications; people prefer the private health facility than the government. Reported cases of attempted suicide to CRB and hospitals are only the tip of iceberg with huge submerged portion of suicide attempt in the community, which needs to be indentified for better policy prescription.
| Way Forward|| |
From a societal perspective, decriminalization is a more sensitive and humane way of dealing with the problem compared to prosecution. Decriminalization will reduce the trauma and potential prosecution in the aftermath of a suicidal attempt. In addition, it will also help in improving the reporting and generation of better epidemiological data on suicidality. The criminalization of suicidal acts causes the problem of suicide to go underground, making it difficult for suicidal persons to receive necessary assistance. Improved and accurate statistics can help in better planning and resource allocation for efforts toward suicide prevention.
Currently, World Health Organization identified 59 countries across the world that have decriminalized suicide. Attempted suicide has been decriminalized in the whole of Europe, North America, much of South America and few parts of Asia. The Indian judiciary and polity both have recognized the need to repeal the section and several attempts have been made starting from 1970. Supreme Court had recommended to Parliament to consider decriminalizing attempt to suicide, saying the provision had become anachronistic. Eventually, it was included in a few sections of the recently drafted Mental Health Care Bill 2013 which has recently been introduced to Rajya Sabha and is still pending approval before it can take effect as a law.
With a shift in official position from “legal” to a “medical” model of attempted suicide, which is an important challenge from a policy perspective will be to provide access to mental health care for all those with attempted suicide. (e.g., JIPMER suicide attempt clinic-run by Psychiatry Department). There is a need to further increase the emphasis on the public health approach to suicide prevention, for example, increased awareness generation, restrictions on access to commonly used lethal methods of suicides (insecticides, prescription medications) and control over facilitating factors such as alcohol. There is also need to develop an effective framework integrating the mental health with social welfare, education, and other related sectors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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