14:30 02 April 04

NewScientist.com news service

The highest suicide rate in the world has been reported among young women in South India by a new study. The research is of major importance, according to the World Health Organization, as it brings to light Asia's suicide problem.

The average suicide rate for young women aged between 15 to 19 living around Vellore in Tamil Nadu was 148 per 100,000. This compares to just 2.1 suicides per 100,000 in the same group in the UK.

The global suicide rate stands at 14.5 deaths per 100,000, with suicide the fourth leading cause of death in the 15 to 19 age group. However, in the Tamil Nadu study, suicide was the number one cause of death among these adolescents.

Notably, young women were much more likely to kill themselves than young men - the reverse of the rest of the world. In Western countries, men are three times more likely to commit suicide than women.

"I was surprised to find the rates were so staggeringly high," says paediatrician Anuradha Bose, who led the study at the Christian Medical College in Vellore.

Major problem

Jose Bertolote, co-ordinator for the management of mental and brain disorders at the World Health Organization in Switzerland says: "I very much praise the authors for having done this. It highlights a major problem."

Bertolote says work in countries like Vietnam have indicated disturbing levels of suicide but until now there had been no studies published in major, English-language journals.

Bose's work, published in The Lancet, follows is the second study to reveal more women killing themselves than men. The first was in China. But it also tallies with unpublished work the WHO is currently carrying out in India, China, Sri Lanka and Vietnam. "This is something striking, unfortunately for women," says Bertolote.

"I wonder if it's just another manifestation of the gender bias," says Bose. She believes stress factors such as family conflicts, domestic violence, academic failures, unfulfilled romantic ideals and mental illness all contribute to the high levels of teen suicide. She also suspects that poor countries that are developing rapidly may suffer higher suicide rates.

Bertolote points out stress factors that affect Indian women in particular, such as issues of marriage and dowry. Even one common suicide method is almost unique to Indian women, that of self-immolation. Sacrificing oneself on a fire was the third most frequent method of suicide recorded in the study and was carried out exclusively by girls.

Verbal autopsy

To collect their data, the team in Vellore followed a population of 108,000 people from 1992 to 2000, including about 20,000 children between 10 to 19.

They suspected that other Indian investigations, using police reports of suicide, seriously underestimated suicide rates. So they used a surveillance technique called "verbal autopsy".

After a death, the community health worker in each village visited the family to finds out what happened. This information was relayed to a health nurse, who visits once a week, and then to hospital doctors.

Suicides accounted for between 50 and 75 per cent of all deaths in adolescent girls and about a quarter of all deaths in boys aged 10 to 19. Hanging was the most common method used, followed by poisoning using insecticide.

Bertolote cautions that the study group of 20,000 is too small to be extrapolated to India's population of one billion and notes that there is an established "suicide gradient" in India which rises to the south. But he stresses that these limitations do not diminish the study's importance.

Journal reference: The Lancet (vol 363, p 1117)

 Shaoni Bhattacharya

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