Abstract

Suicide is a major public health issue in India. We assessed the trends in age-standardised suicide rate at sub-national level and by socio-demographic index (SDI) from 1990 to 2016 for India. We estimated age-standardised suicide mortality per 1 00 000 population as part of the Global Burden of Disease (GBD) Study 2016, utilising all available data from 1990 to 2016. The Indian states were grouped into four epidemiological transition level (ETL) groups, with higher ETL group having higher relative burden of non-communicable diseases and injuries as compared with communicable diseases. We report trends in suicide mortality rates for India and for ETL state groups, and trends over time in male:female suicide rate ratio (MFSR) in relation to SDI for India. For India, suicide rate in males was similar in 1990 (22.3, 95% UI 14.4–27.4) and 2016 (21.3, UI 14.6–23.6), whereas that in females reduced from 20 (UI 16.5–23.5) in 1990 to 14.7 (UI 13.1–16.2) in 2016. Varied suicide rate magnitude and trends were seen at sub-national levels. The suicide rates in males (25.8) and females (17.7) continued to be highest in the high ETL states in 2016. However, there was increase in suicide rates between 1990 and 2016 for men in the lower-middle (22%) and low ETL states (21%), and the decrease in rates for females was more in the high ETL (34%) and higher-middle ETL states (26%). The MFSR for India changed from 0.96 to 1.34 from 1990 to 2016. The magnitude of increase in MFSR had a positive correlation with increasing SDI (R2=0.93, p<000.1). The variations in trends in suicide rates by ETL groups, and the increasing rate in males with increasing SDI can guide the specificity and intensity of suicide prevention programmes in different parts of India.