Suicide in South India: A community-based study in Kerala

BACKGROUND: Studies from Tamil Nadu, South India, have reported the world's highest suicide rates. As per official reports, Kerala, another South Indian state has the highest suicide rate among the major states in India. OBJECTIVE: The purpose of this analysis is to estimate the rates and age-specific incidence of suicide in a rural community in Kerala, under continuous observation for the last five years. SETTINGS AND DESIGN: The study setting comprised of seven contiguous panchayats constituting a development block in Kerala. A prospective cohort study design was used. MATERIALS AND METHODS: Through regular home visits, every death that occurred in the community was captured by local resident health workers and the cause of death assigned. STATISTICAL ANALYSIS: Suicide rates by age and sex and relative share of suicide deaths to all-cause deaths in men and women were calculated. RESULTS: During the five-year period from 2002 to 2007, 284 cases of suicide were reported. The suicide rates were 44.7/100,000 for males and 26.8/100,000 for females. Male to female suicide ratio was 1.7. Among females aged between 15 and 24, suicides constituted more than 50% of all deaths. Male to female ratio of suicide varied from 0.4 in children aged 14 years or less to 4.5 in the 45-54 year age group. CONCLUSION: Our analysis shows that the level of under-reporting of suicides in rural Kerala is much less than that reported in Tamil Nadu.