Suicide is a self directed act of fatal outcome. A related phenomenon is DSH or attempted suicide and it is a self inflicted injury with varying degree of lethal intent. 0.4 to 0.9 % of all deaths are due to suicide and 0.3 to 1%of all casualty admissions are due to attempted suicide. Suicide rate increases in most countries all over the world. In Kerala also the rate of suicide increases. But the rate of increase is disproportionately high in our state. Among other states of India Kerala has highest suicidal rate. This is in spite of the fact that Kerala is having the highest rate of literacy and Kerala is having an accepted model for Health Care Delivery System. In this context it is also important to note that Kerala is the largest market of psychiatric drugs in South India and our state is having the highest rate of unemployment and the highest per capita alcoholic consumption.

Statistics

There is no sufficient clinical data to give a clear picture of suicide in our state. Available information is based on the data of National Crime Record Bureau (NCRB) and State Crime Record Bureau (SCRB). In these police records all cases of suicide are not reported and it is an under representation of the real picture. The possible causes for this under reporting of suicides are.

• Social Stigma
• Legal Actions
• Scandals

In addition DSH cases are not usually reported here.

As per the censes of 2001, India has a population of 102.53 cores and Kerala has a population of 3.18 crores (i.e., 3.1 % of National Population) But 10.1 % of all the suicides in India is reported from Kerala. During the period from 1991-2002 population growth reported in Kerala is 2.2 % but the increase in suicide rate reported is 4.6%.

As per the available statistics of 2002 Kerala has the highest suicidal rate (30.8/Lakh.) among other states. The National rate is only 11.2/Lakh and the Global rate is14.5/Lakh. The total number of Suicides reported in Kerala during 2002 is 9810 i.e., 27/day or one suicide per hour (1/hr). The corresponding ratio of suicide in India is 1/5mts and the Global rate is 1/40sec Kerala is first in the suicide rate for the 7the time. 

DSH is 8-20 times more than completed suicide and approximately Nearly 14 persons attempt suicide per hour in our state. Suicide rate in young people is also increasing in Kerala. Family Suicide is also increasing in Kerala (SCRB) and is maximum in Kerala. This has increased from 38 families to 53 families during 1998 to 2000.

District wise data in Kerala shows that suicide rate in Idukki District is consistently high for the last 10 years. The rate of suicide in four districts during 2003 is as follows.

Some of the causes for this increased suicide rate are fall of price of agricultural products, crisis in the traditional industrial sectors, increasing incidence of alcoholism, increasing rate of mental illness and effect of migration to Middle East countries.

During the period from1995 to 2002 there is a slight fall in the suicide rate in Trissur and Wynad districts (Trissur 37.5/L to 34.5/L) (Wynad 44.4/L to 40.6/L). In Thiruvananthapuram district the rate has gone up from 17.2/L to 38.5/L during this period. In Kollam district the rate has increased to 43.6/L from32/L and in Pathanamthittah from 23.5/L to 38.2/L. In all other districts the rate is more or less steady.

Another interesting observation is that in Malappuram district suicide rate is consistently low. This may be due to the effect of religion as Muslims views are against suicide and they encourage submission to God’s will in sufferings and sickness.

Maximum number of suicide in our state occurs in the age group of 30 to 45 years. suicide rate is more in the age groups 30 – 45 and 60 and above. Young suicide is also increasing here. In young females maximum suicide occurs in the age group 15– 25 years. Now a days more and more cases of suicide are reported among school children also especially in relation to the stress associated with examinations.

The western literature shows a prominent male predominance in suicide (M: F=4:1). In our state the male dominance is not that prominent. In Kerala, M: F ratio is 7:3

All over the years SR is maximum among the unemployed. Though Kerala constitutes 3.1 % of the National population, 16 % of the unemployment is here. According to 2002 data, 19.8% of suicide cases were unemployed, 15.6% were farmers and14.8% were those employed in the private sector.

Marriage is not having a protective effect on suicide in our culture. As per the western literature suicide is more among the unmarried and separated. But 75.2% of the suicides in Kerala were married, 18% were unmarried and 6.8% were widows or widowers. The possible reason is in our culture prior to the marriage the fitness for married life is not looked in to. Moreover, marriage is considered to be a treatment for mental illness. So, marital problems are likely to be more among them.

In Kerala there is an increasing trend of suicide among the married housewives. This may be due to the increased marital stress. Factors like submissive nature of Indian females, hostile family atmosphere, dowry related problems and their inability to deal their negative feelings contribute to the risk of suicide.

Hanging is the most common method adopted in our culture followed by poisoning, drowning, self immolation, jumping off or in front of moving vehicles, self inflicted injury, and medicine overdose. Among females self immolation and drowning are the commonest methods. Factors that decide the choice of the method are suicidal intent, accessibility, feasibility, credibility and rapidity of the method. If the suicidal intent is more the method adopted will be lethal. Accessibility is more important in impulsive types of suicidal attempts.

This is 8-20 times more than completed suicide the rate being 244-610/Lakh.It is more in 2^nd & 3^rd decades of age. Some important causes are Adjustment Disorders, Depressive disorder, and Alcohol &other substances related problems

Compared to other states Kerala is first in the list of family suicides. 
Important causes are

• Financial crisis
• Despair related to family life
• Concern for children--to complete the act of suicide children are also included by the parents
• Effect of consumerism – borrowing from money lenders leading to ‘debt traps’ Mental illness in the dominant member in the family
• Alcoholism and drug abuse in the family members.
• Role of Media is also important here. The Sensational style of reporting suicides promote ‘copycat’ suicidal attempts.