This was first published as an opinion article in Science Chronicle.
In India, one child dies by suicide every hour. Since 2020, over 10,000 children under 18 have died by suicide each year. This dire situation spotlights a significant systemic failure, calling for deeper scrutiny.
Considering the scale of the crisis, it becomes crucial to question: what is driving it? Suicide is a multifaceted public health challenge. To tackle this crisis efficiently, it is necessary to unpack the numerous intersecting and overlapping causal factors.
As per the National Crime Records Bureau (NCRB) data on suicides in India in 2022, ‘family problems’, ‘love affairs’, and ‘failure in examination’ were the leading causes of suicide in this population, accounting for 25%, 15%, 11% of suicides, respectively. However, the NCRB reduces each suicide to a single cause, and fails to capture the multicausal reality of suicides.
A strange statistic emerges in the data on child suicides in India – contrary to what is seen in other age groups, a higher number of girls die by suicide when compared to boys. 55% of all under-18 suicides are among girls. This has been attributed to higher incidence of sexual assault, love failure, unwanted marriage and pregnancies, and limited emotional support from family members among girls. A study on family violence and suicidality in India found married adolescent girls at highest risk of suicidal ideation, with unmarried adolescent girls being at roughly the same level of risk as boys of a similar age.
Interpersonal challenges and suicide risk
It is not just the NCRB data that points a finger at interpersonal and family factors; studies in India show a similar pattern. Feeling neglected by parents, persistent criticism, and family history of substance abuse increase the risk of suicide. In a qualitative study of adolescents admitted to an inpatient ward after a suicide attempt, family factors were seen as a prominent cause. Parental conflicts and separation, a hostile home environment, negative relationships with parents, and living in a single-parent household were all noted as significant causes. The study also noted socioeconomic factors such as financial issues, violence in the neighbourhoods, and the stigma of having a mental illness in the family.
In another qualitative study in urban India, abuse, violence, lack of family connectedness, a communication gap with parents, and loneliness raised the risk of attempting suicide. Physical and sexual abuse are also recurrent themes. Sexual assault and rape, parental marital violence, and physical or sexual abuse were major risk factors for suicidal ideation and suicide attempts.
Interpersonal factors influencing suicide include another pressing issue – peer relationships and bullying. Studies have found bullying poses a serious risk to mental health. A large study across 6 countries, one of which was India, found that cyberbullying and traditional bullying in schools increased the odds of suicide attempts. Cyberbullying, with the added concern of being public, permanent, and permeable through online messaging, exacerbates the effect of bullying on adolescents’ mental health.
Individual challenges
As often recognised, mental health challenges also contribute to suicides. Several studies have shown that mental health conditions such as depression, substance use disorders, and anxiety disorders are linked to suicides in India in this population. Childhood and adolescence are periods which mark the onset of mental health conditions for many, and it is therefore crucial to ensure sufficient mental health support during this time.
Academic failure, one of the major causes as per the NCRB data, is also noted in the news and research in the form of suicides from excessive academic pressure for what are seen as lucrative fields of study, such as medicine and engineering.
Marginalisation and society
Marginalisation makes people further vulnerable to social discrimination and exclusion, economic insecurity, unemployment, and violence, thus exacerbating suicide risk. People from adivasi communities, scheduled castes, and the LGBTQI+ community are particularly susceptible.
For instance, Jawahar Navodaya Vidyalayas, residential schools for gifted students from rural backgrounds, are infamous for student suicides. Between 2013-2017 and 2019-2023, a total of 74 suicides occurred in these schools. Students from Other Backward Classes (OBC), Scheduled Caste (SC), and Scheduled Tribe (ST) backgrounds accounted for 57% of these suicides. In 2023, a 14-year-old boy from the Dalit community died by suicide in a Navodaya school, with caste discrimination by an upper-caste teacher being cited as a major reason.
Globally, young people belonging to the LGBTQ+ community are recognised as being particularly vulnerable to suicidal behaviour. In 2022, NCRB recorded only one death by suicide of a transgender person in this age-group. This is incongruent with the global studies that suggest that suicidality and suicidal behaviour is a major concern in this population.
The NCRB data, and wider suicide discourse, often largely ignore such stratifications and fail to adequately account for the role of marginalisation in suicides among children.
The digital world and suicide
In current times, social media platforms and artificial intelligence have also played a significant role in suicide by young people. Social media influences suicides through exposure to self-injurious behavior by others, messaging that encourages suicidal behavior, and exacerbates other risk factors of suicide such as stress, mental health conditions, and the experience of negative emotions.
In the last few years, the use of chat-based generative artificial intelligence tools like ChatGPT and Claude has become increasingly popular among young people. Worryingly, such tools have been found to have inadequate guardrails to avoid encouraging suicidal behavior. This is reflected in the slew of recent reports on suicides by adolescents linked to such tools.
What is the current response?
A look at government initiatives to prevent suicides among children and young people reveals a predominant focus on academic settings. Two of the most prominent initiatives to address children's mental health and suicides are the Manodarpan initiative (2020) to provide psychosocial support to students, parents, and teachers and the draft UMMEED guidelines (2023) for suicide prevention in schools by the Ministry of Education. Earlier this year, the Supreme Court constituted a National Task Force to address student suicides in higher educational institutes. More recently, it released fifteen binding interim guidelines for all educational institutions to reduce student suicides.
The National Suicide Prevention Strategy, 2022 while not adequately addressing the many factors that influence suicides in this population, does call for an intersectoral approach to tackling the suicide crisis, providing an opportunity to involve various other stakeholders and to integrate suicide prevention for this population in other efforts.
How do we address this challenge?
An effective approach to suicide prevention in under-18s must be holistic and multi-sectoral. It calls for the involvement of a range of stakeholders – government bodies, policymakers, funders, civil society organisations, and the public. This is the goal of the 10k to ZERO initiative – to reduce suicides among children from 10,000 to 0 and to ensure that no child ever feels like suicide is their only option.
The initiative, a collaborative effort between the Centre for Mental Health Law & Policy, Indian Law Society, and Quicksand, aims to address the suicide crisis in children through focusing public attention on suicide prevention, generating high-quality research to understand suicide and suicide prevention, and advocating for policy change with policymakers.
