OBJECTIVE

To study the relationship between suicide rate and marital status.

Introduction

Data about suicides in India are collected by the local police department when they
file a first information report. This is then subsequently sent to the National Crime
Records Bureau, which releases it as part of its yearly Accidental Deaths & Suicides
in India (ADSI) reports. The NCRB report suggests that more than one hundred
thousand people (1 34 799) in the country lost their lives by committing suicide
during the year 2013 making the suicide rate (number of suicides per hundred
thousand population) 11%.1 This makes for an increase in suicide rate of 5.7% over
the period of 2004–13 for a simultaneous increase of 15% in the population during
the same period. An analysis of ADSI reports from 2000 to 2021 shows that the
number of suicide deaths in India has increased marginally in some years while
there has been a decline in other years. This is the reason of why the suicide rate in
the country has ranged between 10 and 11.5 since 2000. Suicide rate of India has
been increasing at a high rate. This evident in the reports by National Crime Records
Bureau. The NCRB recorded 1.5 lakh suicide deaths in 2020, against 1.39 lakh in
2019. Between 2020 and 2021, there was a 7.1 per cent increase. Moreover, it was
reported that 1.64 lakh people committed suicide in 2021. The suicide rate jumped
to 11.3 in 2020 and was at a record high at 12 in 2021. According to the WHO
estimates, India has the 41st highest suicide rate globally, as of 2019. According to
the NCRB data, in 2021, 57 per cent of the total suicides occurred by hanging, while
25.1 per cent happened by poison consumption. However, at the beginning of the
millennium, a majority of suicide deaths, according to the NCRB, occurred by
poisoning.

There are a number of causes that lead to suicide in India and worldwide , namely
low socioeconomic status, mental illness, psychological stressors and domestic
violence.

There are fairly consistent reports of higher suicide rates in persons of low SES.
Low SES was reported in 50 to 66% of suicide victims.[34,38,42,44] A case control
study[28] reported that 35% of suicides occurred in households with monthly
incomes of less than 3000 rupees (about 50 $US) and another 35% occurred in
households with incomes of 3001 to 6000 rupees(rane & nadkarni, 2014).

In addition to this, psychological autopsy studies reported a 34% prevalence of

mental disorders in suicide decedents, case series studies reported a prevalence of
24% and studies based on police records reported a prevalence ranging from 5 to
25%.[11,14,22,37,38,40] Several studies found that the presence of a current mental
disorder increased the risk of suicide(aggarwal,2015).

Moreover, it has been found that psychological stressors are a major

contributpors to suicides. The common stressors associated with suicides included
interpersonal difficulties (especially conflicts with spouse or other family
members ), psychosocial stress, financial problems, chronic illnesses, domestic
violence, work-related problems, extramarital relationships, legal problems,
academic difficulties, living alone, and other types of stressful life events. One
multivariate analysis of the independent role of various psychosocial stressors as
risk factors for suicide reported that longstanding alcohol abuse, absence of social
support networks and limited resources were independent risk factors for
suicide(rane & nadkarni, 2014).

Besides, it has been found that the other cause includes lack of social justice, social
inequities and domestic violence(. Gururaj , Isaac , Subbakrishna , et al, 2004).
The victim usually finds himself/herself helpless, consequently having suicidal
thoughts and willingness to end one’s life. For married girls aged 15-19 years,
personal experiences of marital violence were associated with suicidality and
moderate-severe depressive symptoms whereas among unmarried boys 13-19
years, witnessing parental marital violence was associated with suicidality (Bhan,
Jose,Silverman& Raj, 2019).

The cumulative and repetitive interaction of several factors result in suicides. Some
factors include the following.

The interplay of Age and gender is very prominent. The time trends using NCRB
data over the period of 10 years from 2004 to 2013 showed that the maximum
suicide deaths have consistently occurred in 15–29 years age group for women and
30–44 years age group for men. The median age of suicide In men has remained
higher when compared with women over the 10-year period i.e women of 25 years
whereas men of 34 years. The overall (both genders together) total rates of suicide
is highest in 15– 29 years old. A lower median age of suicide in women shows higher
prevalence of suicide in younger females. The overall male:female (M:F) ratio of
suicide victims over the 10-year period has shown an increase from 1.8 to 2. The
higher rates of female suicide in Asian countries may be linked to the position of
women in the traditionally patriarchal societies of Asia as noted in Strategies to
Prevent Suicide (STOPS) project in Asia of Suicide Prevention International (SPI).
The self-esteem, self-image and the worth and identity of women are dependent
upon the male members in many of these patriarchal societies. Additionally, the
family, social and work pressures result in a significant impact on women’s mental
health(aggarwal,2015).

Geographical variation plays a significant role. On analysis of the data from NCRB,
it is evident that around 80% of suicides occur in 9 states out of 29 states in India,
and this figure has remained almost static over the period of 2004–13. , cumulative
rates in Tamil Nadu, West Bengal, Andhra Pradesh, Maharashtra and Karnataka
make for over 50% of suicides . the most common contributors to suicide in
Southern states are a combination of social problems, such as interpersonal and
family problems, financial difficulties and pre-existing mental illness( Swain,
Tripathy, Priyadarshini, & Acharya, 2021).

Occupation has a major contribution in suicide rate. The NCRB data shows that
housewives consistently form the largest group of suicide victims (around 18%) of
total persons committing suicides and for over 50% of the total female victims. One
reason being employment can offer various benefits like bringing interest and
fulfilment, structure and sense of control as well as income, social status and social
contacts,10 that could improve mental health and psychological wellbeing in
women(aggarwal,2015). Those involved in farming and agriculture form the next
largest group, comprising around 11% of the total victims followed by those
working in the public and private sectors, and unemployed. Farmers’ suicide in
India has been a sensitive issue for the policy makers and public health researchers
alike. There have been a significant number of media and government reports,
ethnographies and case studies suggesting that the liberalization of the Indian
economy in the early 1990s resulted in an ‘agrarian crisis’ and an increase in
farmers’ suicides(Patel, Ramasundarahettige , Vijayakumar , et al.,2012).

Law is a significant factor of increasing suicide rates. A comparison of suicide rates

in Canada in the 10-year period before and after decriminalization of suicide found
no increase in the rate of suicide following decriminalization, while the suicide rates
in seven countries (Canada, England and Wales, Finland, Hong Kong, Ireland, New
Zealand and Sweden) 5 years prior and 5 years following decriminalization noted an
increase in the suicide rates after decriminalization of suicide.29,30 This increase in
suicide rates could be due to better reporting of such attempts as earlier they could
have been reported as accidents to prevent legal hassles(lester, 2002).

People who are considering suicide may show signs that they are thinking about or
planning to attempt suicide. These are known as warning signs of suicide. Thse signs
include:

According to Suicide Prevention Resource Center(2023), warning signs of suicide

encompass talking about: attempting suicide, feeling unbearable pain, death or a
recent fascination with death ,feeling hopeless, worthless, or “trapped” , feeling guilt,
shame, or anger , feeling like they are a burden to others. Also, depression is a major
indicator for suicide. Moreover, it includes changes in behavior or mood for
instance, recent suicide attempt, planning a suicide attempt, increased alcohol or
drug use, losing interest in personal appearance or hygiene, withdrawing from
family, friends, or community , lose interest in pleasurable activities, saying goodbye
to friends and family, giving away prized possessions, a recent episode of
depression, emotional distress, and/or anxiety, changes in eating patterns ,changes
in sleep patterns , becoming violent or being a victim of violence, expressing rage or
recklessness. The way to respond if these signs are observed is by letting the person
know you are concerned and ask if they are ok, asking the person if they are having
thoughts of suicide, listening attentively and without judgment, letting the person
know you care about them and support them and by offering to help connect them
with professionals.

Besides, recent studies have found an increased risk of suicide in people on sickness
absence. In a study conducted on non-retired adults living in Sweden were followed-
up for 6 years regarding suicide attempt and suicide to examine sickness absence
and sick-leave duration as risk indicators for suicide attempt and suicide. Results
showed that suicide attempt and current antidepressants prescription and sickness
absence predicted suicide attempt and suicide, particularly mental sickness absence.
The risks were also increased for somatic sickness absence, for example,
musculoskeletal and digestive diseases and injury/poisoning. Moreover, the risks
increased with sick-leave duration (Wang, Alexanderson, Runeson , Head, Melchior,
Perski,et al., 2014).

Relationship between suicide and marital status

Marital status represents a risk factor for suicidal behavior. Innumerable studies have been
conducted to establish a relationship between suicide and marital status.

In a regression analysis conducted on the data obtained from the Italian Data Base on Mortality
of men and women and for three different age groups (25–44 years, 45–64 years and 65 years
and over) for 2000–2002 to study the relationship between Suicide and Marital Status in Italy. It
was found that both among men and women, being unmarried, widowed or divorced/separated
is associated with a higher suicide rate. Being married appears to be a protective factor for
suicide, but the impact of being never-married, divorced/separated or widowed varies with age
and gender. Also, the differences between married and non-married women were less
consistent than those among men, especially for elderly women(Masocco, Pompili, Vichi,
Vanacore, Lester,& Tatarelli, 2008).

A study examined whether marital status is associated with suicide rates among various age,
sex, and racial groups among young adults of both sexes using US national suicide mortality
data. It was found that suicide rates indicated an approximately 17-fold increase among young
widowed White men (aged 20–34 years), a 9-fold increase among young widowed African
American men, and lesser increases among young widowed White women compared with their
married counterparts(Luoma & Pearson,2002).

Similarly, a study conducted to calculate marital-status-specific suicidal rates using national

vital statistics and census data showed that for each marital status group, by age and sex,
married persons have the lowest suicide rates and young widowed males have
exceptionally high rates(Smith, Mercy, & Conn, 1988).

From the aforementioned studies, it can be inferred that widowed, unmarried and divorced
individuals are more prone to commit suicide than married people.
References
Luoma, J. B., & Pearson, J. L. (2002). Suicide and marital status in the United States, 1991–1996: is
widowhood a risk factor?. American journal of public health, 92(9), 1518-1522.

Smith, J. C., Mercy, J. A., & Conn, J. M. (1988). Marital status and the risk of suicide. American journal of
public health, 78(1), 78-80.