Trends and risk factors for suicide mortality in India from 2001-2019: National mortality study.

One in four of all global suicide deaths occurs in India, yet the epidemiology of suicide mortality in India remains largely undocumented. We analyzed over 20,000 suicides among 829,000 deaths collected from 2001-2019 within a nationally representative random sample of about 1% of Indian homes using lay field reporting with dual central medical adjudication of causes. We applied suicide death proportions to national demographic totals to estimate death rates and used proportional mortality to examine risk factors. While suicide death rates fell by 1.5% annually, the absolute number of suicides remained constant at around 200,000 annually (or 3.8 million from 2001 to 2019) due to rising population. Over this period, 44% and 50% of all suicides occurred at ages 15-29 and 30-69 years, respectively. Suicide death rates declined fastest in women aged 15-29 years, particularly after 2015. Suicide death rates from poisoning, mostly organophosphate pesticides, fell but those from hanging rose. Suicide death risks at ages 15-69 years were about eight times higher in selected southern high-burden states than in selected northern states. Individual suicide risk was highest among sons or daughters' in-law, rural residents, and men who drank alcohol. Suicide is preventable, but requires accelerating prevention policies to address acute social stress, ongoing efforts to reduce lethality of attempts and reliable epidemiological monitoring.