India’s suicide deaths rose from 27.3% of the global female total in 1990 to 36.5% in 2019, and from 16.7% to 20.9% among males, yet the country lacks standardised data on why people die by suicide or attempt it. Police reports, the official source, capture limited risk factors, leaving India unable to design targeted prevention or meet the UN’s 2030 goal of reducing suicide mortality. This project adapts the UK’s National Confidential Inquiry into Suicide and Safety in Mental Health for India, creating the India Inquiry. Researchers will analyse 6,000 retrospective and 1,000 prospective suicide deaths from police stations, plus 2,000 suicide attempts and 2,000 ideation cases from hospitals, and interview families in 500 prospective deaths to understand how risk factors are documented and missed. If successful, the work will produce a minimum dataset and shared definitions for risk factors, enabling police and health systems to collect comparable data and trigger appropriate interventions. Because India leads the world in suicide numbers—with a large share among young adults—better surveillance could directly save lives by informing where and how to act.
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Background: India’s contribution to global suicide deaths increased from 27.3% in 1990 to 36.5% in 2019 among females, and from 16.7% to 20.9% among males, in the background of India having 18% of the global population. At an estimated 195,000 suicide deaths in 2019, India had the highest number of suicide deaths globally. The official source for suicide deaths in India are the National Crimes Record Bureau reports, based on information collected by the police at the time of reporting of the death. These reports allow limited understanding of suicide deaths and related risk factors for meaningful action. India is unlikely to reach the SDG 2030 suicide death rate reduction target if the current trends continue. Standardised and comparable data on risk factors associated with suicide deaths, suicide ideation, and suicide attempts remains a major limitation in India’s ability to respond to the SDG target of reducing suicide mortality. Aims and objectives: The aim is to set up the National Confidential Inquiry into Suicide Deaths, Suicide Ideation and Suicide Attempts (India Inquiry) by adapting the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) of the United Kingdom. The adaptation will be done within the context of improving data capture of risk factors associated with suicide deaths, suicide ideation, and suicide attempts in India. The objectives include understanding the risk factors for suicide deaths in the police data and for suicide ideation and suicide attempt in the mental health services, identify gaps in this documentation and understanding, and build a consensus on a minimum dataset and shared operational definitions for risk factors to inform suicide prevention in India. Methods: The research will be undertaken in two geographic areas in India, the National Capital Region (north) and Tamil Nadu state (South). The NCISH will be adapted as India Inquiry following consultations with representatives from police and health systems, and through community engagement and involvement. The India Inquiry will be tested in 6,000 retrospective and 1,000 prospective suicide deaths from sampled police stations; and in 2,000 suicide attempt and 2,000 suicide ideation retrospective cases and 1,000 suicide attempt and 1,000 suicide ideation prospective cases from two major tertiary care public sector hospitals. Qualitative research will be undertaken in 500 prospective suicide deaths to understand risk factors documentation by the police, and variations in the reporting of risk factors since the time of death will be assessed through interviews with the family of the deceased. Barriers and facilitators to take the India Inquiry to scale will be explored. This research will be undertaken with guidance and involvement of people with lived experience in India and UK, and community organisation directly engaged with support of survivors and families, and in suicide prevention. Timelines for delivery: 4-years. Anticipated impact and dissemination: Because India leads the global suicide death numbers with a large proportion of these in young adults, the anticipated impact of this research is likely to be substantial. Impact on facilitation of appropriate suicide prevention interventions, improved data systems and surveillance, and capacity-building of the police and health systems for more responsive data collection and action is anticipated. Dissemination will be undertaken for a variety of stakeholders.
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