| Abstract|| |
Objective: The present study had been undertaken to investigate the sociodemographic profile of individuals who had committed suicide in Sikkim which may throw light on the vulnerable groups.
Materials and Methods: Ten-year suicide data (2006–2015) obtained from Police Headquarters, Crime Branch, Gangtok, have been statistically evaluated to study the sociodemographic profile.
Results: The results showed that out of 1604 suicide cases recorded for the past 10 years, 1051 were males (65.5%) and 553 (34.5%) were females. Suicide was found to be common among the age group of 21–30 years (24.4%), Rai community (15.8%), population of rural areas (82.6%), and among the population of eastern districts (50.6%). Hanging (94.8%) was found to be the most common method adopted for suicide.
Conclusion: The study provides preliminary information about the vulnerable groups for suicide in the state which may be vital for taking necessary steps for its prevention shortly.
Keywords: Bhutia, Lepcha, Nepali, Sikkim, suicide
|How to cite this article:|
Chettri R, Gurung J, Singh B. A 10-year retrospective study of suicide in Sikkim, India: Sociodemographic profile and risk assessment. Indian J Psychiatry 2016;58:448-53
| Introduction|| |
Worldwide, about 2% of deaths are attributed to suicide., In comparison to developed and developing nations, the rate of suicide is found to be very high in Estonia, Lithuania, Belarus, and the Russian Federation.
According to the National Crime Report Bureau (NCRB) report, 2014, more than one lakh people die every year due to suicide in India. Moreover, the suicide rates vary widely across the different states of India, ranging from as high as 40.4 in Puducherry to as low as 0.6 in Nagaland. According to the latest report of the NCRB during the past 10 years (2004–2014), the number of suicide has increased to 15.8%. Suicide among the states of India shows the highest incidence from Maharashtra (16,307) (12.4%) followed by Tamil Nadu (16,122) (12.2%), West Bengal (14,310) (10.9%), Karnataka (10,945) (8.3%), and Telangana (9,623 suicides) (7.3%) which together accounts for 51.1% of the total national incidence and the rest 48.9% comes from 24 states and 7 union territories. As far as the rate of suicide is concerned, the national average rate exhibits 10.6 during the year 2014 with Puducherry reporting to be the highest (40.4) followed by Sikkim (38.4), Andaman and Nicobar Islands (28.9), Telangana (26.5), Kerala (23.9), and Tamil Nadu (23.4).
Even though Sikkim has one of the highest suicide rates in the nation, very few studies have been conducted to understand this grave problem of the state. Moreover, previous studies had relied heavily on the NCRB data which do not have enough information about region-specific factors for suicide. In addition, the NCRB data do not give insight into the causes of suicide for specific population. Nonetheless, the regional information may provide a valuable input to understand the factors associated with suicide which, in turn, will help to formulate an effective prevention program. Therefore, the present study was conducted to statistically analyze suicidal data from Sikkim with the focus on throwing light on the vulnerable groups.
| Materials and Methods|| |
Ten-year suicide data (2006–2015) were retrieved from Police Headquarters, Crime Branch, Gangtok, Sikkim, which included name, age, caste, place of suicide, and method of suicide. Special permission was granted by the Superintendent of Crime Branch for retrieving data and its use.
Statistical analysis was carried out using SPSS Software, Version 23, IBM Corp. Mann–Whitney U-test was performed to analyze whether there is a significant difference in the suicidal rate between males and females. ANOVA was performed to: (i) determine the common age group in which suicidal rate is high, (ii) study whether there is a high prevalence of suicide among a particular ethnic group (s), (iii) study the methods commonly used for committing suicide, (iv) and study the rate of suicide in different districts. Student's t-test was performed to study the incidence of suicide among the rural and urban areas.
| Results|| |
Gender and suicide
The present investigation revealed that during the tenure of 10 years, a total number of 1604 suicidal cases were reported, of which 1051 (65.5%) were males and 553 (34.5%) were females [Table 1]. Overall, it was observed that the incidence of male suicide was significantly high compared to female suicide (Mann–Whitney U-test value: P < 0.01). Overall, there was an increase in suicidal incidence from 2006 to 2015.
|Table 1: Suicidal incidence according to age groups and yearly distribution of suicide|
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Age and suicide
Examination of age-specific suicidal rates shows the maximum age range of committing suicide among the young adults to be 21-30. Further, ANOVA showed that the suicide cases were significantly different among different age groups (F8,171 = 48.807, df = 8; P < 0.01) with highest suicide cases in the age group of 21–30 years (24.4%) [Table 1].
Ethnicity and suicide
Among all the ethnic communities who exhibited suicide, Rai (15.8%) was found to be the dominant community followed by Chettri (12.4%) and Subba (9.4%). The least number of suicides was observed among Jogi, Sarki, and Harijan (0.1%) [Table 2]. The results of ANOVA showed a significant difference between all the communities (F22,437 = 38.674; P < 0.01). Overall, among all the communities, male suicidal incidence was found to be high.
Methods adopted for suicide
Hanging (94.8%) was found to be the significantly common (F7,158 = 141.499; P < 0.01) method adopted for suicide by both males and females followed by jumping (2.1%), poisoning (1.4%), self-immolation (0.7%), drowning (0.3%), overconsumption of alcohol (0.3%), stabbing (0.3%), and consumption of kerosene oil (0.1%) [Table 3].
District-wise suicidal rates
The district-wise suicidal incidence shows the occurrence of most of the suicides in eastern districts (50.6%) followed by western (25.3%), southern (21.9%), and northern (2.2%) [Table 4]. The results of ANOVA showed a significant difference in suicidal incidence among all the districts (F3,76 = 48.625; P < 0.01). Male suicide was found to be higher in all the districts.
|Table 4: District-wise distribution of urban versus rural suicidal rates|
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Urban versus rural suicidal rates
In comparison, suicide was found to be fairly high among the rural people (82.6%) than the urban people (17.4%) [Table 4]. The results of t-test showed a significant difference of suicidal incidence among urban and rural population (t = 8.583, df = 38; P < 0.01). In both the rural and urban areas, males outnumbered females in suicidal rates.
| Discussion|| |
The present study is unique in the sense that for the first time primary source of data, i.e., record from Crime Branch, Gangtok, is statistically evaluated for throwing light on the vulnerable groups for suicide in Sikkim. It is worth mentioning here that the data obtained from Crime Branch, Gangtok, contain much more regional information than the NCRB data.
From the present study, it is evident that men accounted for the maximum number (65.5%) of suicidal cases in Sikkim which is in accordance with the study by Momin et al. On the contrary, Saisudheer and Nagaraja  in their study reported that a maximum number of individuals who attempted suicide were females. However, the majority of studies (7/9) in India showed male: female ratio ranging from as low as 1.19:1 in Vellore and Tamil Nadu to as high as 5:1. The reason for higher incidence of suicide among the Indian males may be due patriarchal nature of the Indian society which expects males to have a permanent source of income to sustain his family and shoulder the burden of life.
To study the vulnerable age group for suicide, the range of age groups was divided with 10-year difference, namely, below 10, 11–20, 21–30, 31–40, 41–50, 51–60, 61–70, and 71–80 years. It was observed that the incidence of suicide was high among individuals in the age group of 21–30 years (24.4%), which is in accordance with the study by Khan et al. The association of suicide among the particular age group may be due to marital disharmony, unemployment, greater demands of life which could not be fulfilled, depression, and psychiatric illness such as schizophrenia. In contrast to the present study, Azmak  reported the higher suicidal rate between the age group of 30 and 39 years (20.8%). In a recent study by Soman et al. (2009) in Kerala, it was observed that more than 50% of deaths occurred among females who were aged in between 15 and 24 years, which does not corroborate with the present findings, so as the study in Nepal  where higher rates of suicide were observed among Nepali women in the age group of 15-49 years.
In this study, hanging (94.8%) was found to be the most preferred method for suicide by both males and females. Similar findings were also reported from Puducherry and Kerala. More interestingly, hanging as a means to commit suicide was found to be very high (94.8%) in comparison to other studies. It may be due to the fact that hanging offers a rapid and relatively painless death and there is no cost involved. In contrast, studies conducted by Rastogi and Kochar  in Jaipur and Patel et al. among Gujarati population found poisoning to be the most common method adopted for suicide. On the other hand, according to the NCRB report, there is an over-representation of females for self-immolation.
An effort was also made in the present investigation to study the vulnerability of some of the ethnic groups of Sikkim for the suicidal behavior. It was observed that the maximum number of representation for suicide was from individuals of Rai community (15.8%). This finding is unique and it is too early to suggest the reason for this phenomenon. Moreover, remotely, it can be suggested that sociocultural or some genetic factors may be involved. Similar incidence had also been documented in Maori males (43.7 deaths) and females (18.8 deaths) of New Zealand, among whom significantly higher rates of suicide were documented than their non-Maori peers (males: 18.0; females: 9.1).
The district-wise suicidal rate in Sikkim shows that almost half of the suicidal cases reported in Sikkim are attributed to eastern districts (50.6%) followed by western (25.3%), southern (21.9%), and northern districts (2.2%). According to Census 2011, the total population of eastern districts was highest (281293, i.e., 46.3%) compared to western (136299, i.e., 22.4%), northern (43354, i.e., 7.1%), and southern districts (146742, i.e., 24.2%). Therefore, the over-representation of eastern districts for suicide cases may be due to the larger population size of eastern districts.
The majority of suicidal cases reported in the present study was from rural areas (82.6%). The present findings are not in accordance to the NCRB report  and to the findings of Khan et al. According to Census 2011, most of the population of Sikkim lives in the rural areas. Therefore, the disagreement of the results may be due to higher population size of rural areas (75.03%) compared to urban areas (24.97%).
In the present investigation, sociodemographic parameters such as occupation, psychiatric diagnosis, motives for suicides, physical illness, education, and marital status could not be considered for the study as the data retrieved from Crime Branch, Gangtok, were lacking this information which may be considered as the limitation of the present study. Nonetheless, the study provides preliminary information about suicide in Sikkim which may be vital for taking necessary steps for its prevention in the near future.
| Conclusion|| |
Suicide, especially among youths, may cripple the progress of the nation due to loss of youth energy. Therefore, the need of the hour is to accurately identify those at risk and offer them active monitoring and counseling, especially in rural areas of Sikkim. In addition, there is an urgent need for monitoring the mental health on a regular basis. Future studies involving neurotransmitters such as serotonin which modulates the behavior of the individual will help identify molecular and genetic underpinnings of this major problem of the state.
The authors are grateful to the assistance provided by Dr. Bhoj Kumar Acharya, Assistant Prof., Department of Zoology, for statistical analysis; and Dr. Dhani Raj Chettri, Associate Prof., Department of Botany, for providing valuable information during manuscript preparation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Meier RF, Clinard MB. Sociology of Deviant Behaviour. 14th
ed. Belmont, CA: Wadsworth Cengage Learning; 2008. p. 169.
Suominen K, Isometsä E, Suokas J, Haukka J, Achte K, Lönnqvist J. Completed suicide after a suicide attempt: A 37-year follow-up study. Am J Psychiatry 2004;161:562-3.
Radhakrishnan R, Andrade C. Suicide: An Indian perspective. Indian J Psychiatry 2012;54:304-19.
National Crime Records Bureau. Accidental Deaths and Suicides in India. New Delhi: Ministry of Home Affairs, Government of India; 2014.
Panda S. Suicide in Sikkim: Issues and prevention. Indian J Psychol Sci 2014;5:151-7.
Momin SG, Mangal HM, Kyada HC, Vijapura MT, Bhuva SD. Pattern of ligature mark in cases of compressed neck in Rajkot region: A prospective study. J Indian Acad Forensic Med 2012;34:40-3.
Saisudheer T, Nagaraja TV. A study of ligature mark in cases of hanging deaths. Int J Pharm Biomed Sci 2010;3:80-4.
Bose A, Sandal Sejbaek C, Suganthy P, Raghava V, Alex R, Muliyil J, et al.
Self-harm and self-poisoning in Southern India: Choice of poisoning agents and treatment. Trop Med Int Health 2009;14:761-5.
Sauvaget C, Ramadas K, Fayette JM, Thomas G, Thara S, Sankaranarayanan R. Completed suicide in adults of rural Kerala: Rates and determinants. Natl Med J India 2009;22:228-33.
Khan FA, Anand B, Devi MG, Murthy KK. Psychological autopsy of suicide: A cross-sectional study. Indian J Psychiatry 2005;47:73-8.
Azmak D. Asphyxial deaths: A retrospective study and review of the literature. Am J Forensic Med Pathol 2006;27:134-44.
Soman CR, Safraj S, Kutty VR, Vijayakumar K, Ajayan K. Suicide in South India: A community-based study in Kerala. Indian J Psychiatry 2009;51:261-4.
Rastogi P, Kochar SR. Suicide in youth: Shifting paradigm. J Indian Acad Forensic Med 2009;32:45-8.
Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, Gururaj G, et al.
Suicide mortality in India: A nationally representative survey. Lancet 2012;379:2343-51.
Beautrais AL, Collings SC, Ehrhardt P. Suicide Prevention: A Review of Evidence of Risk and Protective Factors, and Points of Effective Intervention. Wellington, New Zealand: Ministry of Health; 2005.
Department of Zoology, School of Life Sciences, Sikkim University, Samdur, Tadong, Gangtok, Sikkim
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]