Changing trends in suicide in India, 2013-2023: Rising suicide rates among men

Changing trends in suicide in India, 2013-2023: Rising suicide rates among men | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Changing trends in suicide in India, 2013-2023: Rising suicide rates among men Vikas Arya, Soumitra Pathare, Sadhvi Krishnamoorthy, Simone Scotti Requena, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9583059/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Suicide is a major public health concern in India, which accounts for a substantial share of global suicides. Long-term declines in suicide rates appear to have reversed after 2017, but it is unclear whether this increase has persisted and how it varies by sex, age, and development level. Methods Annual suicide counts (2013–2023) from the National Crime Records Bureau (NCRB) were combined with population estimates to calculate crude suicide rates per 100,000 by sex and state. Age-specific rates were estimated nationally for five age groups (0–17, 18–29, 30–44, 45–59, ≥ 60 years) for 2019–2023. States were grouped into low, middle, and high Sociodemographic Index (SDI) categories. Rate ratios (RRs) and rate differences (RDs) for 2018–2023 were calculated using 2017 as the reference year, with 95% uncertainty and confidence intervals. Results Between 2013 and 2023, the national suicide rate increased by ~ 14% (10.84 to 12.36 per 100,000), driven by a ~ 24% rise in male suicide rates (14.16 to 17.53 per 100,000) and a ~ 6% decline in female rates (7.33 to 6.91 per 100,000). Rates declined to 2017, then increased, with the highest male rate in 2023, while female rates were more variable and peaked in 2022. Relative post-2017 increases were largest among males in low SDI states, but absolute increases were often greater in high SDI states. The steepest rises (2019–2023) occurred among middle-aged men and adults aged ≥ 60 years. Limitations: NCRB data likely underestimate the true suicide burden and are available only as aggregate state-level counts, precluding individual-level analyses and limiting age-specific analyses to the national level. Conclusion Police-recorded suicide rates in India have increased since 2017, largely due to rising male suicides. Findings highlight the need for India’s suicide prevention efforts to more explicitly address suicide among men, particularly middle-aged and older men. Epidemiology Suicide India National Crime Records Bureau (NCRB) Figures Figure 1 Figure 2 Introduction Suicide is a major public health concern in India, which accounts for approximately one-quarter of all suicides globally (India State-Level Disease Burden Initiative Suicide Collaborators, 2018 ; Vijayakumar et al., 2021; Arya, 2024 ). Suicide rates in India are substantially higher than global averages, particularly among women, with female and male rates estimated to be around twice and 1.4 times higher, respectively (India State-Level Disease Burden Initiative Suicide Collaborators, 2018 ). Suicide is also the leading cause of death among individuals aged 15–39 years in India, with approximately 70% of female and 60% of male suicides occurring in this age group (India State-Level Disease Burden Initiative Suicide Collaborators, 2018 ). Like many countries worldwide, suicide rates in India declined from the 1990s onwards (Arya et al., 2018 ; India State-Level Disease Burden Initiative Suicide Collaborators, 2018 ). These reductions were largely driven by decreases in female suicide rates, while male suicide rates remained relatively stable over time (Arya et al., 2018 ; India State-Level Disease Burden Initiative Suicide Collaborators, 2018 ). More recent evidence indicates a concerning reversal of this trend, with suicide rates increasing since 2017, primarily driven by rising male suicide rates (Arya et al., 2022 ). Male suicide rates increased steadily between 2017 and 2020, with the sharpest rise observed in 2020, the first year of the COVID-19 pandemic (Arya et al., 2022 ). While estimates suggest that suicide rates among females in India are exceptionally high compared with many other countries, particularly in younger age groups, emerging national data indicate that recent increases are now being driven predominantly by men, underscoring the importance of understanding how these global gender patterns manifest in the Indian context. In this study, we aimed to examine national and state-level trends in suicide rates in India between 2013 and 2023, with particular attention to changes occurring after 2017, when prior evidence suggested a reversal in long-term declining trends. Specifically, we sought to (1) assess whether the post-2017 increase in suicide rates has persisted through 2023; (2) examine sex-specific patterns in these trends; (3) explore variation across states grouped by Sociodemographic Index (SDI); and (4) describe recent age-specific patterns at the national level. Building on previous work that documented rising suicide rates in India up to 2020, including during the first year of the COVID-19 pandemic (Arya et al., 2022 ), this study extends surveillance through 2023 to determine whether the observed post-2017 increase has persisted. By incorporating sex-specific, SDI-grouped, and age-specific analyses, and by examining both relative (RRs) and absolute (RDs) changes in suicide rates, we clarify which populations and regions are driving the growing burden. Methods Data The National Crime Records Bureau (NCRB) compiles and publishes annual suicide statistics for each state and union territory in India based on police-recorded data (NCRB, 2013–2023). Suicide data for 2013–2023, disaggregated by sex, were obtained from the NCRB website. Age-specific suicide counts were available only at the national level, with age-group classifications differing between 2013–2017 and 2019–2023, and no age-disaggregated data reported for 2018. To ensure consistency in age-group definitions, age-specific suicide rates were therefore reported at the national level for 2019–2023 only. Administrative boundary changes were accounted for to maintain geographic comparability over time. The state of Andhra Pradesh was split in 2014 into Andhra Pradesh and Telangana, while the former state of Jammu and Kashmir was reorganised in 2019 into the union territories of Jammu and Kashmir and Ladakh. For analytical consistency, suicide counts for Andhra Pradesh and Telangana were combined for 2013–2023, and those for Jammu and Kashmir and Ladakh were combined for 2020–2023. Corresponding population denominators for each state and union territory were obtained from Ministry of Health and Family Welfare estimates (National Health Profile, 2020) for the period 2013–2023. Analysis Crude suicide rates stratified by sex and state were calculated for the period 2013–2023. In addition, crude suicide rates stratified by sex and five age groups (0–17 years, 18–29 years, 30–44 years, 45–59 years, and ≥ 60 years) were estimated at the national level for 2019–2023. Crude suicide rates were also calculated for three groups of Indian states classified according to their SDI: low SDI, middle SDI, and high SDI (Web Appendix 1). States in the low SDI category represent those with comparatively lower levels of development, characterised by lower per capita income and literacy and higher fertility rates (GBD 2017 DALYs and HALE Collaborators, 2018 ; India State-Level Disease Burden Initiative Air Pollution Collaborators, 2019). Consistent with previous work (Arya et al., 2022 ), rate ratios (RRs) of crude suicide rates, stratified by sex and state, were calculated for 2018, 2019, 2020, 2021, 2022, and 2023 using 2017 as the reference point, the year prior to the identified shift in suicide trends (Arya et al., 2022 ). These RRs were used to assess whether subsequent changes in suicide rates were greater or smaller relative to earlier increases. Additional RRs were estimated for the three SDI-based state groupings. All RRs were presented with 95% uncertainty intervals (UIs) derived from Monte Carlo simulations conducted in Ersatz software (Barendregt, 2009 ). The ErRelativeRisk function was applied, assuming a normal distribution for ln(RR) with a standard deviation equal to SE[ln(RR)], and 1000 iterations were performed to ensure stability of estimates. To complement relative comparisons based on RRs, absolute changes in suicide rates were also examined by calculating rate differences (RDs) for 2018–2023 using 2017 as the reference year. RDs were defined as the difference between the crude suicide rate in each subsequent year and the corresponding crude suicide rate in 2017. Additional RDs were calculated for the three SDI-based state groupings. 95% confidence intervals (CIs) for the RDs were calculated assuming independent Poisson-distributed suicide counts. Analyses were undertaken using MS Excel, STATA 19, and Ersatz 1.35 (Mitchell, 2008 ; Barendregt, 2009 ). Results Overall, suicide rates in India increased by approximately 14%, rising from 10.84 to 12.36 per 100,000 population between 2013 and 2023. This increase was driven by a ~ 24% rise in male suicide rates over the same period (from 14.16 to 17.53 per 100,000 population) (Fig. 1; Web Appendix 2–4). In contrast, female suicide rates decreased by ~ 6%, declining from 7.33 to 6.91 per 100,000 population between 2013 and 2023. Patterns were broadly similar across low, middle, and high SDI state groups, except among females in low SDI states, where suicide rates increased by ~ 8% (from 4.54 to 4.92 per 100,000 population) during this period (Fig. 1; Web Appendix 5). Suicide rates were consistently higher in high SDI states and lower in low SDI states (Fig. 1; Web Appendix 5). States with the largest increases in suicide rates between 2013 and 2023 included the high SDI states of Uttarakhand (from 3.52 to 8.07 per 100,000 population) and Punjab (from 3.43 to 7.47 per 100,000 population), and the low SDI state of Uttar Pradesh (from 2.56 to 3.88 per 100,000 population) (Web Appendix 2). Male suicide rates increased steadily following 2017, with the highest increase observed in 2023 (RR = 1.32, 95% UI 1.30–1.33) (Table 1; Web Appendix 6–7). Female suicide rates showed a more variable pattern after 2017, with the highest increase observed in 2022 (RR = 1.11, 95% UI 1.10–1.13) (Table 1; Web Appendix 6–7). Among males, increases were evident across all SDI state groups, with the largest relative rise in 2023 occurring in low SDI states (RR = 1.43, 95% UI 1.41–1.45). Among females, suicide rates generally increased in low and high SDI state groups, while remaining relatively stable in middle SDI states. The largest increase among females was observed in 2022 in low SDI states (RR = 1.28, 95% UI 1.25–1.31) (Table 1; Web Appendix 6–7). When examined on the absolute scale, increases in suicide rates following 2017 were often greater in high SDI states than in low SDI states (Table 2). Among males, the largest absolute increase in suicide rates was observed in high SDI states in 2023 (RD = 7.47, 95% CI 7.12–7.82), compared with 2.96 (95% CI 2.82–3.10) in low SDI states and 4.14 (95% CI 3.86–4.42) in middle SDI states. Among females, the largest absolute increase was observed in low SDI states in 2022 (RD = 1.20, 95% CI 1.10–1.31), whereas female suicide rates in middle SDI states remained relatively stable or declined slightly over time. At the national level, absolute increases in suicide rates were also substantially greater among males than females, with the largest increase observed in 2023 among males (RD = 4.26, 95% CI 4.13–4.39) compared with 2022 among females (RD = 0.76, 95% CI 0.67–0.85). Between 2019 and 2023, suicide rates were consistently higher among males than females across all age groups, except among those aged 0–17 years (Fig. 2; Web Appendix 8). Among males, rates were highest in middle-aged groups, whereas among females, the highest rates were observed among those aged 18–29 years (Fig. 2; Web Appendix 8). Male suicide rates increased across all age groups between 2019 and 2023, with the largest increases observed among individuals aged 30–44 years (from 22.56 to 27.90 per 100,000 population; ~24% increase), those aged 45–59 years (from 20.01 to 24.93 per 100,000 population; ~25% increase) and those aged 60 years and above (from 12.63 to 17.73 per 100,000 population; ~40% increase). Female suicide rates also increased across most age groups, except among those aged 18–29 years, where rates remained relatively stable (12.57 to 12.21 per 100,000 population; ~3% decrease). As with males, the largest increases among females were observed in the 45–59 year age group (from 4.86 to 6.07 per 100,000 population; ~25% increase) and among those aged 60 years and above (from 3.91 to 5.10 per 100,000 population; ~30% increase) (Fig. 2; Web Appendix 8). Discussion We found that suicide rates in India increased between 2013 and 2023, reversing earlier declines and signalling a sustained shift in the epidemiology of suicide. Over this period, rising male suicide rates, particularly after 2017, were the primary driver of the overall increase, whereas female suicide rates remained comparatively stable. These patterns were broadly consistent across low, middle, and high SDI state groups, and age-specific analyses indicated that the steepest recent increases occurred among middle-aged and older adults of both sexes. Previous studies have reported increases in suicide rates in India between 2017 and 2020 (Arya et al., 2022 ; Ganguli et al., 2025 ). The present study extends this evidence, demonstrating that suicide rates have continued to rise through to 2023. This sustained increase, driven primarily by rising male suicide rates, suggests a concerning shift in the epidemiology of suicide in India. Prior to this recent upturn, male suicide rates had remained relatively stable for more than two decades (Arya et al., 2018 ; India State-Level Disease Burden Initiative Suicide Collaborators, 2018 ). The rise in suicide rates may partly reflect improvements in suicide reporting in India following the decriminalisation of suicide attempts. The Mental Healthcare Act (2017) effectively restricted the application of Section 309 of the Indian Penal Code, which previously criminalised suicide attempts, and may have reduced apprehension among families and authorities about reporting suicides (Behere et al., 2015 ). Such changes could plausibly have improved reporting of suicides to police authorities, particularly in higher SDI states where administrative systems may be more responsive to legal changes. However, decriminalisation does not necessarily remove other legal and social complexities surrounding suicide reporting, particularly among women. For example, any suspected unnatural death of a married woman within the first seven years of marriage requires a mandatory magistrate inquest (Kethineni et al., 2009). Investigations into female suicides may also carry additional cultural and social repercussions, including the potential disclosure of physical or sexual abuse or romantic relationships considered socially unacceptable, which remain highly stigmatised in many parts of India (Grover, 2017 ). These socio-legal and reporting factors may, at least in part, explain the observed post-2017 increase in reported male suicide rates alongside relatively stable female rates. However, irrespective of potential improvements in suicide reporting, the observed increases may also reflect a genuine rise in suicides in India. This is because despite the decriminalisation of attempted suicide, evidence indicates that individuals who attempt suicide may continue to experience police harassment and stigma, implying limited change “on the ground” in how cases are handled and reported (Pathare et al., 2023 ). Furthermore, there is also evidence that underreporting of suicides in India may have been exacerbated during the first year of the COVID-19 pandemic (Kallakuri and Maulik, 2020 ). However, suicide rates increased in 2020 despite these concerns, suggesting that reporting artefacts alone are unlikely to account for the observed rise. Evidence from alternative data sources provides a more complex picture of recent suicide trends in India. The Global Burden of Disease (GBD) Study integrates multiple data sources, including Sample Registration System (SRS) verbal autopsy data and individual-level community surveillance studies, and applies ensemble modelling approaches to estimate underlying suicide counts (India State-Level Disease Burden Initiative Suicide Collaborators, 2018 ). Recent GBD estimates suggest that suicide rates among both sexes in India declined in 2019 and 2021 compared with 2016 estimates (India State-Level Disease Burden Initiative Suicide Collaborators, 2018 ; GBD 2021 Suicide Collaborators, 2025 ), in contrast to the post-2017 increase in police-recorded suicides observed in the NCRB data. Nonetheless, the consistent upward trend in NCRB-recorded suicides remains an important signal for policy, regardless of whether it reflects changes in true incidence, reporting practices, or (quite possibly) both. Beyond differences between data sources, the patterns observed in this study point to substantive changes in who is most affected by suicide in India. Low SDI states experienced the largest relative increases in suicide rates after 2017 among both males and females. Among males, however, these increases were closely followed by rising rates in high and middle SDI states. On the absolute scale, increases were often greater in high SDI states, particularly among males, reflecting their higher baseline suicide rates. Together, these findings suggest that although suicide rates have risen fastest in relative terms in low SDI states, the absolute increase in suicide burden has been greatest in high SDI states, which continue to carry the highest burden of suicide in India. This underscores the importance of considering both relative and absolute measures when interpreting changes in suicide patterns across regions. Among females, post-2017 increases were less pronounced and more variable across SDI state groups, mirroring the overall national pattern of relatively stable suicide rates. Beyond geographic variation, important demographic patterns were also evident. Higher suicide rates among middle-aged males and younger females have been previously documented in India (Arya et al., 2018 ; India State-Level Disease Burden Initiative Suicide Collaborators, 2018 ; Arya et al., 2025 ). Potential explanations for these age- and sex-specific patterns include increasing familial and financial responsibilities among middle-aged men, as well as the influence of rigid patriarchal norms that may disproportionately affect younger women in India (Mayer, 2011 ; Petroni et al., 2015 ). Although suicide rates increased across most age groups in both sexes between 2019 and 2023, the largest rises were observed among middle-aged adults and, in particular, among those aged 60 years and above. The increase in suicide rates among older adults is especially concerning given projections that individuals aged 60 years and above will account for approximately 15% of India’s population by 2036 (Census of India 2011 , 2020). The underlying drivers of these increases, particularly among older adults, remain unclear and warrant further investigation. Future research could consider the potential role of changing social and family structures in influencing suicide and suicidal behaviour among older adults, including shifts from traditional decision-making roles to more dependent or supportive roles in later life, increased social isolation and economic insecurity associated with the rise of nuclear families, and migration-related separation from family members (Bloom et al., 2010 ; Gray et al., 2019 ; Mehra et al., 2024 ). The sustained increase in male suicide rates has important implications for suicide prevention policy and practice in India. The National Suicide Prevention Strategy identifies several high-risk groups, including young and middle-aged adults, economically vulnerable populations (e.g., farmers), and individuals experiencing family, social, and financial stressors (National Suicide Prevention Strategy, 2022). These risk factors affect both men and women; however, their distribution and impact may differ by gender. In the Indian context, men are more likely to be exposed to certain stressors, particularly those related to financial responsibility, employment, and socially prescribed provider roles (Mayer, 2011 ). At the same time, although India’s patriarchal social structure disproportionately disadvantages women through lower autonomy, reduced control over resources, early marriage, and gender-based violence (Gopalakrishnan et al., 2024 ), it may also adversely affect men by reinforcing norms around emotional suppression, self-reliance, and reluctance to seek help, which can contribute to psychological distress, substance use, and other maladaptive coping responses (Dochania and Dochania, 2025 ). Taken together, this highlights the need for more gender-responsive suicide prevention strategies in India that address the distinct pathways to suicide among both men and women. In particular, the sustained increase in male suicide rates suggests that men, especially middle-aged and older men, may benefit from greater recognition as a priority population within prevention efforts. This could involve strengthening interventions that address gendered norms and employment instability, as well as improving access to acceptable and non-stigmatising mental health support in settings more frequently accessed by men, such as primary care and workplaces. This study has some limitations. First, suicide counts reported by the NCRB are likely to underestimate the true burden of suicide, potentially due to stigma, misclassification, and resource constraints within reporting systems (Arya et al., 2021 ). Second, NCRB data are available only as aggregate counts at the state level, limiting the ability to draw individual-level inferences; for example, it is not possible to determine whether higher suicide rates in high SDI states are driven by socioeconomically advantaged or disadvantaged populations. Third, age-specific data were not available at the state level, which restricted the examination of regional variations in age-specific suicide rates. In conclusion, suicide rates in India increased between 2013 and 2023, largely driven by rising male suicide rates. Following 2017, male suicide rates increased consistently, with the largest rise observed in 2023 compared with preceding years. Part of this increase may reflect improved reporting following the decriminalisation of suicide in 2017, particularly among males, whereas persistent cultural and legal complexities surrounding female deaths may have limited comparable improvements in female reporting. However, decriminalisation alone is unlikely to fully explain the recent rise in male suicide rates. The effects of such policy changes are likely to occur gradually, and emerging evidence suggests limited “on the ground” changes in stigma and police practices affecting individuals with suicidal behaviour. Continued monitoring of suicide trends will be important to better understand the drivers of the sustained post-2017 increase in male suicide rates in India and to inform effective suicide prevention strategies. In particular, the findings highlight the need for suicide prevention efforts in India to more explicitly recognise and address the growing burden of suicide among men. References Arya V, Armstrong G, Tapp C, Onie S, Bandara P, Kumar GA, Spittal M, Page A, Vijayakumar L, Pirkis J, Dandona R (2025) Trends in suicide among adolescents aged 14–17 years in India: 2014–2019. Cambridge Prisms: Global Mental Health. ;12:e90 Arya V, Page A, Armstrong G, Kumar GA, Dandona R (2021) Estimating patterns in the under-reporting of suicide deaths in India: comparison of administrative data and Global Burden of Disease Study estimates, 2005–2015. J Epidemiol Community Health 75(6):550–555 Arya V, Page A, River J, Armstrong G, Mayer P (2018) Trends and socio-economic determinants of suicide in India: 2001–2013. Soc Psychiatry Psychiatr Epidemiol 53(3):269–278 Arya V, Page A, Spittal MJ, Dandona R, Vijayakumar L, Munasinghe S, John A, Gunnell D, Pirkis J, Armstrong G (2022) Suicide in India during the first year of the COVID-19 pandemic. J Affect Disord 307:215–220 Arya V (2024) Suicide prevention in India. Mental Health Prev 33:200316 Barendregt JJ (2009) Ersatz user guide. EpiGear, Brisbane Behere PB, Sathyanarayana Rao TS, Mulmule AN (2015) Decriminalization of attempted suicide law: journey of fifteen decades. Indian J Psychiatry 57:122 Bloom DE, Mahal A, Rosenberg L, Sevilla J (2010) Economic security arrangements in the context of population ageing in India. Int Social Secur Rev 63(3–4):59–89 Census of India (2011) Population Projections for India and States 2011–2036. Report of the technical group on population projections. 2020. National Commission on Population Ministry of Health & Family Welfare Nirman Bhawan, New Delhi. Available: https://nhm.gov.in/New_Updates_2018/Report_Population_Projection_2019.pdf Dochania R, Dochania A (2025) Burdened by masculinity: Exploring men’s discrimination in India through the lens of hegemonic masculinity. J Psychosexual Health 7(4):392–397 Ganguli D, Singh P, Das A (2025) Decriminalizing suicide: the 2017 Mental Healthcare Act and suicide mortality in India, 2001–2020. Cambridge Prisms: Global Mental Health. ;12:e74 GBD 2017 DALYs and, Collaborators HALE (2018) Global, regional, and national disability- adjusted life- years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet 392:1859–1922 GBD 2021 Suicide Collaborators (2025) Global, regional, and national burden of suicide, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Public Health 10(3):e189–202 Gopalakrishnan L, El Ayadi A, Diamond-Smith N (2024) The role of community-level men’s and women’s inequitable gender norms on women’s empowerment in India: A multilevel analysis using India’s National Family Health Survey–5. PLoS ONE 19(12):e0312465 Gray PB, Longkumer W, Panda S, Rangaswamy M (2019) Grandparenting in urban Bangalore, India: Support and involvement from the standpoint of young adult university students. Sage open 9(3):2158244019871070 Grover S (2017) Marriage, love, caste and kinship support: lived experiences of the urban poor in India. Routledge India State- Level Disease Burden Initiative Air Pollution Collaborators (2019) The impact of air pollution on deaths, disease burden, and life expectancy across the states of India:the global burden of disease study 2017. Lancet Planet Health 3:e26–39 India State-Level Disease Burden Initiative Suicide Collaborators (2018) Gender differentials and state variations in suicide deaths in India: the Global Burden of Disease Study 1990–2016. Lancet Public Health 3(10):e478–e489 Kallakuri S, Maulik PK (2020) Challenges facing individuals and researchers: suicide in India in the COVID-19 pandemic. Lancet Psychiatry 7(8):e49 Kethineni S, Srinivasan M (2009) Police handling of domestic violence cases in Tamil Nadu, India. J Contemp Crim Justice 25:202–213 Mayer P (2011) Suicide and society in India. Routledge, New York Mehra A, Agarwal A, Bashar M, Avasthi A, Chakravarty R, Grover S (2024) Prevalence of loneliness in older adults in rural population and its association with depression and caregiver abuse. Indian J Psychol Med 46(6):564–569 Mitchell MN (2008) A Visual Guide to Stata graphics. Stata National Crime Records Bureau. Accidental deaths and suicides in India. Government of India, New Delhi, 2013–2023. Available: https://ncrb.gov.in/en/adsi-reports-of-previous-years [Accessed 15 January 2026] National Health Profile, Government of India (2020) Central Bureau of Health Intelligence. Ministry of Health and Family Welfare,. 2020. Available: http://www.indiaenvironmentportal.org.in/content/470474/national-health-profile-2020/ [Accessed 18 January 2026] National Suicide Prevention Strategy. Ministry of Health & Family Welfare (2022) Available: https://www.mhinnovation.net/resources/Indias-national-suicide-prevention-strategy [Accessed 17 March 2026] Pathare S, Fernandes TN, Hamid S, Lyons S (2023) How India Continues to Punish Those Who Attempt Suicide. https://doi.org/10.54377/e466-de60 Petroni S, Patel V, Patton G (2015) Why is suicide the leading killer of older adolescent girls? Lancet 386(10008):2031–2032 Vijayakumar L, Chandra PS, Kumar MS, Pathare S, Banerjee D, Goswami T, Dandona R (2022) The national suicide prevention strategy in India: context and considerations for urgent action. Lancet Psychiatry 9(2):160–168 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9583059","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":632812101,"identity":"7e1c855b-41b6-4a9a-8fee-fc31a8e5d887","order_by":0,"name":"Vikas Arya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIie3PP2sCMRjH8d9xoAVPXSOivoUcB0VBfC15EJw6i1sF4d5D0RdxcuCfTbihy1NdAy66d7jSRXAxrUO3VLdC84UkBPLhIYDL9XfrAr45jmOzbW4jgyuhO0h2PW4i1SmHuRfvaFks0YFWaFa08j4DCxHbp0h48Z7Wk3IqiRHVtPLrNgIOpADvKcnKC0ExKNEKVtLiIDqBt19keTLk2RD/bCOSg0eB0eZ7CgxRUquCdUrIhWFbjfqRIakgFuELH+POzEKa7Kc6l71Gsnub5x+rbqvy2s/0u+37eJBQPzdhlje2AqB4+OWBy+Vy/fsuNLxPudMDA0MAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-0594-1526","institution":"University of Melbourne","correspondingAuthor":true,"prefix":"","firstName":"Vikas","middleName":"","lastName":"Arya","suffix":""},{"id":636551509,"identity":"f22bb70c-85bc-4e9b-839e-cde2004f5312","order_by":1,"name":"Soumitra Pathare","email":"","orcid":"","institution":"Centre for Mental Health Law and Policy","correspondingAuthor":false,"prefix":"","firstName":"Soumitra","middleName":"","lastName":"Pathare","suffix":""},{"id":636551510,"identity":"6b4b59c2-764d-455c-92a6-641275c5bbf9","order_by":2,"name":"Sadhvi Krishnamoorthy","email":"","orcid":"","institution":"University of Melbourne","correspondingAuthor":false,"prefix":"","firstName":"Sadhvi","middleName":"","lastName":"Krishnamoorthy","suffix":""},{"id":636551511,"identity":"ecdf86c8-b354-40df-9345-86b617677702","order_by":3,"name":"Simone Scotti Requena","email":"","orcid":"","institution":"University of Melbourne","correspondingAuthor":false,"prefix":"","firstName":"Simone","middleName":"Scotti","lastName":"Requena","suffix":""},{"id":636551512,"identity":"16e131d5-adb1-4219-afc8-402c8ed88b2c","order_by":4,"name":"Lakshmi Vijayakumar","email":"","orcid":"","institution":"Sneha - Suicide Prevention Centre, Voluntary Health Services","correspondingAuthor":false,"prefix":"","firstName":"Lakshmi","middleName":"","lastName":"Vijayakumar","suffix":""},{"id":636551513,"identity":"4da7a0a1-3bc6-4ee0-b344-81dd647e8918","order_by":5,"name":"Christine Linhart","email":"","orcid":"","institution":"UNSW","correspondingAuthor":false,"prefix":"","firstName":"Christine","middleName":"","lastName":"Linhart","suffix":""},{"id":636551514,"identity":"00acda48-27b8-493e-9348-b1b92ce872d2","order_by":6,"name":"Andrew Page","email":"","orcid":"","institution":"Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Page","suffix":""},{"id":636551515,"identity":"5c1ad04a-3af8-4fe9-9be8-f27b4b7ff4aa","order_by":7,"name":"Jane Pirkis","email":"","orcid":"","institution":"University of Melbourne","correspondingAuthor":false,"prefix":"","firstName":"Jane","middleName":"","lastName":"Pirkis","suffix":""},{"id":636551516,"identity":"3dada62a-a750-4646-b91a-47139e486f5c","order_by":8,"name":"Gregory Armstrong","email":"","orcid":"","institution":"University of Melbourne","correspondingAuthor":false,"prefix":"","firstName":"Gregory","middleName":"","lastName":"Armstrong","suffix":""}],"badges":[],"createdAt":"2026-05-01 05:48:14","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9583059/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9583059/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108968620,"identity":"cff4034b-1a8e-4edd-866a-946461a99cbe","added_by":"auto","created_at":"2026-05-11 10:03:55","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111067,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSuicide rates (crude): India and by Socio-Demographic Index (SDI) state categories (2013–2023)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9583059/v1/18974f407a25dcf4e86d7871.jpg"},{"id":108968618,"identity":"796984d3-d09a-48d8-af6a-eb6b360c5218","added_by":"auto","created_at":"2026-05-11 10:03:55","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":83532,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSuicide rates (crude) by sex and age group: India (2019–2023)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9583059/v1/824a3df15a18482810794f4a.jpg"},{"id":108968640,"identity":"e50f4088-f2cf-4086-afbb-bfc9282d9bdb","added_by":"auto","created_at":"2026-05-11 10:03:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":365465,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9583059/v1/49c0ad50-ebd2-4b04-b02f-d287c64b0d18.pdf"},{"id":108968619,"identity":"288d2711-2295-4f26-94e8-e323f497dc27","added_by":"auto","created_at":"2026-05-11 10:03:55","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":78888,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-9583059/v1/73f439888406b41e2dcbc346.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e Changing trends in suicide in India, 2013-2023: Rising suicide rates among men\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSuicide is a major public health concern in India, which accounts for approximately one-quarter of all suicides globally (India State-Level Disease Burden Initiative Suicide Collaborators, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Vijayakumar et al., 2021; Arya, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Suicide rates in India are substantially higher than global averages, particularly among women, with female and male rates estimated to be around twice and 1.4 times higher, respectively (India State-Level Disease Burden Initiative Suicide Collaborators, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Suicide is also the leading cause of death among individuals aged 15\u0026ndash;39 years in India, with approximately 70% of female and 60% of male suicides occurring in this age group (India State-Level Disease Burden Initiative Suicide Collaborators, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLike many countries worldwide, suicide rates in India declined from the 1990s onwards (Arya et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; India State-Level Disease Burden Initiative Suicide Collaborators, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). These reductions were largely driven by decreases in female suicide rates, while male suicide rates remained relatively stable over time (Arya et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; India State-Level Disease Burden Initiative Suicide Collaborators, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). More recent evidence indicates a concerning reversal of this trend, with suicide rates increasing since 2017, primarily driven by rising male suicide rates (Arya et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Male suicide rates increased steadily between 2017 and 2020, with the sharpest rise observed in 2020, the first year of the COVID-19 pandemic (Arya et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). While estimates suggest that suicide rates among females in India are exceptionally high compared with many other countries, particularly in younger age groups, emerging national data indicate that recent increases are now being driven predominantly by men, underscoring the importance of understanding how these global gender patterns manifest in the Indian context.\u003c/p\u003e \u003cp\u003eIn this study, we aimed to examine national and state-level trends in suicide rates in India between 2013 and 2023, with particular attention to changes occurring after 2017, when prior evidence suggested a reversal in long-term declining trends. Specifically, we sought to (1) assess whether the post-2017 increase in suicide rates has persisted through 2023; (2) examine sex-specific patterns in these trends; (3) explore variation across states grouped by Sociodemographic Index (SDI); and (4) describe recent age-specific patterns at the national level. Building on previous work that documented rising suicide rates in India up to 2020, including during the first year of the COVID-19 pandemic (Arya et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), this study extends surveillance through 2023 to determine whether the observed post-2017 increase has persisted. By incorporating sex-specific, SDI-grouped, and age-specific analyses, and by examining both relative (RRs) and absolute (RDs) changes in suicide rates, we clarify which populations and regions are driving the growing burden.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData\u003c/h2\u003e \u003cp\u003eThe National Crime Records Bureau (NCRB) compiles and publishes annual suicide statistics for each state and union territory in India based on police-recorded data (NCRB, 2013\u0026ndash;2023). Suicide data for 2013\u0026ndash;2023, disaggregated by sex, were obtained from the NCRB website. Age-specific suicide counts were available only at the national level, with age-group classifications differing between 2013\u0026ndash;2017 and 2019\u0026ndash;2023, and no age-disaggregated data reported for 2018. To ensure consistency in age-group definitions, age-specific suicide rates were therefore reported at the national level for 2019\u0026ndash;2023 only.\u003c/p\u003e \u003cp\u003eAdministrative boundary changes were accounted for to maintain geographic comparability over time. The state of Andhra Pradesh was split in 2014 into Andhra Pradesh and Telangana, while the former state of Jammu and Kashmir was reorganised in 2019 into the union territories of Jammu and Kashmir and Ladakh. For analytical consistency, suicide counts for Andhra Pradesh and Telangana were combined for 2013\u0026ndash;2023, and those for Jammu and Kashmir and Ladakh were combined for 2020\u0026ndash;2023. Corresponding population denominators for each state and union territory were obtained from Ministry of Health and Family Welfare estimates (National Health Profile, 2020) for the period 2013\u0026ndash;2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eCrude suicide rates stratified by sex and state were calculated for the period 2013\u0026ndash;2023. In addition, crude suicide rates stratified by sex and five age groups (0\u0026ndash;17 years, 18\u0026ndash;29 years, 30\u0026ndash;44 years, 45\u0026ndash;59 years, and \u0026ge;\u0026thinsp;60 years) were estimated at the national level for 2019\u0026ndash;2023. Crude suicide rates were also calculated for three groups of Indian states classified according to their SDI: low SDI, middle SDI, and high SDI (Web Appendix 1). States in the low SDI category represent those with comparatively lower levels of development, characterised by lower per capita income and literacy and higher fertility rates (GBD 2017 DALYs and HALE Collaborators, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; India State-Level Disease Burden Initiative Air Pollution Collaborators, 2019).\u003c/p\u003e \u003cp\u003eConsistent with previous work (Arya et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), rate ratios (RRs) of crude suicide rates, stratified by sex and state, were calculated for 2018, 2019, 2020, 2021, 2022, and 2023 using 2017 as the reference point, the year prior to the identified shift in suicide trends (Arya et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These RRs were used to assess whether subsequent changes in suicide rates were greater or smaller relative to earlier increases. Additional RRs were estimated for the three SDI-based state groupings. All RRs were presented with 95% uncertainty intervals (UIs) derived from Monte Carlo simulations conducted in Ersatz software (Barendregt, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). The ErRelativeRisk function was applied, assuming a normal distribution for ln(RR) with a standard deviation equal to SE[ln(RR)], and 1000 iterations were performed to ensure stability of estimates.\u003c/p\u003e \u003cp\u003eTo complement relative comparisons based on RRs, absolute changes in suicide rates were also examined by calculating rate differences (RDs) for 2018\u0026ndash;2023 using 2017 as the reference year. RDs were defined as the difference between the crude suicide rate in each subsequent year and the corresponding crude suicide rate in 2017. Additional RDs were calculated for the three SDI-based state groupings. 95% confidence intervals (CIs) for the RDs were calculated assuming independent Poisson-distributed suicide counts. Analyses were undertaken using MS Excel, STATA 19, and Ersatz 1.35 (Mitchell, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Barendregt, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOverall, suicide rates in India increased by approximately 14%, rising from 10.84 to 12.36 per 100,000 population between 2013 and 2023. This increase was driven by a\u0026thinsp;~\u0026thinsp;24% rise in male suicide rates over the same period (from 14.16 to 17.53 per 100,000 population) (Fig.\u0026nbsp;1; Web Appendix 2\u0026ndash;4). In contrast, female suicide rates decreased by ~\u0026thinsp;6%, declining from 7.33 to 6.91 per 100,000 population between 2013 and 2023. Patterns were broadly similar across low, middle, and high SDI state groups, except among females in low SDI states, where suicide rates increased by ~\u0026thinsp;8% (from 4.54 to 4.92 per 100,000 population) during this period (Fig.\u0026nbsp;1; Web Appendix 5). Suicide rates were consistently higher in high SDI states and lower in low SDI states (Fig.\u0026nbsp;1; Web Appendix 5). States with the largest increases in suicide rates between 2013 and 2023 included the high SDI states of Uttarakhand (from 3.52 to 8.07 per 100,000 population) and Punjab (from 3.43 to 7.47 per 100,000 population), and the low SDI state of Uttar Pradesh (from 2.56 to 3.88 per 100,000 population) (Web Appendix 2).\u003c/p\u003e \u003cp\u003eMale suicide rates increased steadily following 2017, with the highest increase observed in 2023 (RR\u0026thinsp;=\u0026thinsp;1.32, 95% UI 1.30\u0026ndash;1.33) (Table\u0026nbsp;1; Web Appendix 6\u0026ndash;7). Female suicide rates showed a more variable pattern after 2017, with the highest increase observed in 2022 (RR\u0026thinsp;=\u0026thinsp;1.11, 95% UI 1.10\u0026ndash;1.13) (Table\u0026nbsp;1; Web Appendix 6\u0026ndash;7). Among males, increases were evident across all SDI state groups, with the largest relative rise in 2023 occurring in low SDI states (RR\u0026thinsp;=\u0026thinsp;1.43, 95% UI 1.41\u0026ndash;1.45). Among females, suicide rates generally increased in low and high SDI state groups, while remaining relatively stable in middle SDI states. The largest increase among females was observed in 2022 in low SDI states (RR\u0026thinsp;=\u0026thinsp;1.28, 95% UI 1.25\u0026ndash;1.31) (Table\u0026nbsp;1; Web Appendix 6\u0026ndash;7).\u003c/p\u003e \u003cp\u003eWhen examined on the absolute scale, increases in suicide rates following 2017 were often greater in high SDI states than in low SDI states (Table\u0026nbsp;2). Among males, the largest absolute increase in suicide rates was observed in high SDI states in 2023 (RD\u0026thinsp;=\u0026thinsp;7.47, 95% CI 7.12\u0026ndash;7.82), compared with 2.96 (95% CI 2.82\u0026ndash;3.10) in low SDI states and 4.14 (95% CI 3.86\u0026ndash;4.42) in middle SDI states. Among females, the largest absolute increase was observed in low SDI states in 2022 (RD\u0026thinsp;=\u0026thinsp;1.20, 95% CI 1.10\u0026ndash;1.31), whereas female suicide rates in middle SDI states remained relatively stable or declined slightly over time. At the national level, absolute increases in suicide rates were also substantially greater among males than females, with the largest increase observed in 2023 among males (RD\u0026thinsp;=\u0026thinsp;4.26, 95% CI 4.13\u0026ndash;4.39) compared with 2022 among females (RD\u0026thinsp;=\u0026thinsp;0.76, 95% CI 0.67\u0026ndash;0.85).\u003c/p\u003e \u003cp\u003eBetween 2019 and 2023, suicide rates were consistently higher among males than females across all age groups, except among those aged 0\u0026ndash;17 years (Fig.\u0026nbsp;2; Web Appendix 8). Among males, rates were highest in middle-aged groups, whereas among females, the highest rates were observed among those aged 18\u0026ndash;29 years (Fig.\u0026nbsp;2; Web Appendix 8). Male suicide rates increased across all age groups between 2019 and 2023, with the largest increases observed among individuals aged 30\u0026ndash;44 years (from 22.56 to 27.90 per 100,000 population; ~24% increase), those aged 45\u0026ndash;59 years (from 20.01 to 24.93 per 100,000 population; ~25% increase) and those aged 60 years and above (from 12.63 to 17.73 per 100,000 population; ~40% increase). Female suicide rates also increased across most age groups, except among those aged 18\u0026ndash;29 years, where rates remained relatively stable (12.57 to 12.21 per 100,000 population; ~3% decrease). As with males, the largest increases among females were observed in the 45\u0026ndash;59 year age group (from 4.86 to 6.07 per 100,000 population; ~25% increase) and among those aged 60 years and above (from 3.91 to 5.10 per 100,000 population; ~30% increase) (Fig.\u0026nbsp;2; Web Appendix 8).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe found that suicide rates in India increased between 2013 and 2023, reversing earlier declines and signalling a sustained shift in the epidemiology of suicide. Over this period, rising male suicide rates, particularly after 2017, were the primary driver of the overall increase, whereas female suicide rates remained comparatively stable. These patterns were broadly consistent across low, middle, and high SDI state groups, and age-specific analyses indicated that the steepest recent increases occurred among middle-aged and older adults of both sexes.\u003c/p\u003e \u003cp\u003ePrevious studies have reported increases in suicide rates in India between 2017 and 2020 (Arya et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ganguli et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The present study extends this evidence, demonstrating that suicide rates have continued to rise through to 2023. This sustained increase, driven primarily by rising male suicide rates, suggests a concerning shift in the epidemiology of suicide in India. Prior to this recent upturn, male suicide rates had remained relatively stable for more than two decades (Arya et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; India State-Level Disease Burden Initiative Suicide Collaborators, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe rise in suicide rates may partly reflect improvements in suicide reporting in India following the decriminalisation of suicide attempts. The Mental Healthcare Act (2017) effectively restricted the application of Section 309 of the Indian Penal Code, which previously criminalised suicide attempts, and may have reduced apprehension among families and authorities about reporting suicides (Behere et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Such changes could plausibly have improved reporting of suicides to police authorities, particularly in higher SDI states where administrative systems may be more responsive to legal changes. However, decriminalisation does not necessarily remove other legal and social complexities surrounding suicide reporting, particularly among women. For example, any suspected unnatural death of a married woman within the first seven years of marriage requires a mandatory magistrate inquest (Kethineni et al., 2009). Investigations into female suicides may also carry additional cultural and social repercussions, including the potential disclosure of physical or sexual abuse or romantic relationships considered socially unacceptable, which remain highly stigmatised in many parts of India (Grover, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). These socio-legal and reporting factors may, at least in part, explain the observed post-2017 increase in reported male suicide rates alongside relatively stable female rates.\u003c/p\u003e \u003cp\u003eHowever, irrespective of potential improvements in suicide reporting, the observed increases may also reflect a genuine rise in suicides in India. This is because despite the decriminalisation of attempted suicide, evidence indicates that individuals who attempt suicide may continue to experience police harassment and stigma, implying limited change \u0026ldquo;on the ground\u0026rdquo; in how cases are handled and reported (Pathare et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Furthermore, there is also evidence that underreporting of suicides in India may have been exacerbated during the first year of the COVID-19 pandemic (Kallakuri and Maulik, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). However, suicide rates increased in 2020 despite these concerns, suggesting that reporting artefacts alone are unlikely to account for the observed rise.\u003c/p\u003e \u003cp\u003eEvidence from alternative data sources provides a more complex picture of recent suicide trends in India. The Global Burden of Disease (GBD) Study integrates multiple data sources, including Sample Registration System (SRS) verbal autopsy data and individual-level community surveillance studies, and applies ensemble modelling approaches to estimate underlying suicide counts (India State-Level Disease Burden Initiative Suicide Collaborators, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Recent GBD estimates suggest that suicide rates among both sexes in India declined in 2019 and 2021 compared with 2016 estimates (India State-Level Disease Burden Initiative Suicide Collaborators, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; GBD 2021 Suicide Collaborators, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), in contrast to the post-2017 increase in police-recorded suicides observed in the NCRB data. Nonetheless, the consistent upward trend in NCRB-recorded suicides remains an important signal for policy, regardless of whether it reflects changes in true incidence, reporting practices, or (quite possibly) both.\u003c/p\u003e \u003cp\u003eBeyond differences between data sources, the patterns observed in this study point to substantive changes in who is most affected by suicide in India. Low SDI states experienced the largest relative increases in suicide rates after 2017 among both males and females. Among males, however, these increases were closely followed by rising rates in high and middle SDI states. On the absolute scale, increases were often greater in high SDI states, particularly among males, reflecting their higher baseline suicide rates. Together, these findings suggest that although suicide rates have risen fastest in relative terms in low SDI states, the absolute increase in suicide burden has been greatest in high SDI states, which continue to carry the highest burden of suicide in India. This underscores the importance of considering both relative and absolute measures when interpreting changes in suicide patterns across regions. Among females, post-2017 increases were less pronounced and more variable across SDI state groups, mirroring the overall national pattern of relatively stable suicide rates.\u003c/p\u003e \u003cp\u003eBeyond geographic variation, important demographic patterns were also evident. Higher suicide rates among middle-aged males and younger females have been previously documented in India (Arya et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; India State-Level Disease Burden Initiative Suicide Collaborators, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Arya et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Potential explanations for these age- and sex-specific patterns include increasing familial and financial responsibilities among middle-aged men, as well as the influence of rigid patriarchal norms that may disproportionately affect younger women in India (Mayer, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Petroni et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Although suicide rates increased across most age groups in both sexes between 2019 and 2023, the largest rises were observed among middle-aged adults and, in particular, among those aged 60 years and above. The increase in suicide rates among older adults is especially concerning given projections that individuals aged 60 years and above will account for approximately 15% of India\u0026rsquo;s population by 2036 (Census of India \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2011\u003c/span\u003e, 2020). The underlying drivers of these increases, particularly among older adults, remain unclear and warrant further investigation. Future research could consider the potential role of changing social and family structures in influencing suicide and suicidal behaviour among older adults, including shifts from traditional decision-making roles to more dependent or supportive roles in later life, increased social isolation and economic insecurity associated with the rise of nuclear families, and migration-related separation from family members (Bloom et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Gray et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Mehra et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe sustained increase in male suicide rates has important implications for suicide prevention policy and practice in India. The National Suicide Prevention Strategy identifies several high-risk groups, including young and middle-aged adults, economically vulnerable populations (e.g., farmers), and individuals experiencing family, social, and financial stressors (National Suicide Prevention Strategy, 2022). These risk factors affect both men and women; however, their distribution and impact may differ by gender. In the Indian context, men are more likely to be exposed to certain stressors, particularly those related to financial responsibility, employment, and socially prescribed provider roles (Mayer, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). At the same time, although India\u0026rsquo;s patriarchal social structure disproportionately disadvantages women through lower autonomy, reduced control over resources, early marriage, and gender-based violence (Gopalakrishnan et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), it may also adversely affect men by reinforcing norms around emotional suppression, self-reliance, and reluctance to seek help, which can contribute to psychological distress, substance use, and other maladaptive coping responses (Dochania and Dochania, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Taken together, this highlights the need for more gender-responsive suicide prevention strategies in India that address the distinct pathways to suicide among both men and women. In particular, the sustained increase in male suicide rates suggests that men, especially middle-aged and older men, may benefit from greater recognition as a priority population within prevention efforts. This could involve strengthening interventions that address gendered norms and employment instability, as well as improving access to acceptable and non-stigmatising mental health support in settings more frequently accessed by men, such as primary care and workplaces.\u003c/p\u003e \u003cp\u003eThis study has some limitations. First, suicide counts reported by the NCRB are likely to underestimate the true burden of suicide, potentially due to stigma, misclassification, and resource constraints within reporting systems (Arya et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Second, NCRB data are available only as aggregate counts at the state level, limiting the ability to draw individual-level inferences; for example, it is not possible to determine whether higher suicide rates in high SDI states are driven by socioeconomically advantaged or disadvantaged populations. Third, age-specific data were not available at the state level, which restricted the examination of regional variations in age-specific suicide rates.\u003c/p\u003e \u003cp\u003eIn conclusion, suicide rates in India increased between 2013 and 2023, largely driven by rising male suicide rates. Following 2017, male suicide rates increased consistently, with the largest rise observed in 2023 compared with preceding years. Part of this increase may reflect improved reporting following the decriminalisation of suicide in 2017, particularly among males, whereas persistent cultural and legal complexities surrounding female deaths may have limited comparable improvements in female reporting. However, decriminalisation alone is unlikely to fully explain the recent rise in male suicide rates. The effects of such policy changes are likely to occur gradually, and emerging evidence suggests limited \u0026ldquo;on the ground\u0026rdquo; changes in stigma and police practices affecting individuals with suicidal behaviour. Continued monitoring of suicide trends will be important to better understand the drivers of the sustained post-2017 increase in male suicide rates in India and to inform effective suicide prevention strategies. In particular, the findings highlight the need for suicide prevention efforts in India to more explicitly recognise and address the growing burden of suicide among men.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eArya V, Armstrong G, Tapp C, Onie S, Bandara P, Kumar GA, Spittal M, Page A, Vijayakumar L, Pirkis J, Dandona R (2025) Trends in suicide among adolescents aged 14\u0026ndash;17 years in India: 2014\u0026ndash;2019. Cambridge Prisms: Global Mental Health. ;12:e90\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArya V, Page A, Armstrong G, Kumar GA, Dandona R (2021) Estimating patterns in the under-reporting of suicide deaths in India: comparison of administrative data and Global Burden of Disease Study estimates, 2005\u0026ndash;2015. J Epidemiol Community Health 75(6):550\u0026ndash;555\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArya V, Page A, River J, Armstrong G, Mayer P (2018) Trends and socio-economic determinants of suicide in India: 2001\u0026ndash;2013. Soc Psychiatry Psychiatr Epidemiol 53(3):269\u0026ndash;278\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArya V, Page A, Spittal MJ, Dandona R, Vijayakumar L, Munasinghe S, John A, Gunnell D, Pirkis J, Armstrong G (2022) Suicide in India during the first year of the COVID-19 pandemic. J Affect Disord 307:215\u0026ndash;220\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArya V (2024) Suicide prevention in India. Mental Health Prev 33:200316\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarendregt JJ (2009) Ersatz user guide. EpiGear, Brisbane\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehere PB, Sathyanarayana Rao TS, Mulmule AN (2015) Decriminalization of attempted suicide law: journey of fifteen decades. Indian J Psychiatry 57:122\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBloom DE, Mahal A, Rosenberg L, Sevilla J (2010) Economic security arrangements in the context of population ageing in India. Int Social Secur Rev 63(3\u0026ndash;4):59\u0026ndash;89\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCensus of India (2011) Population Projections for India and States 2011\u0026ndash;2036. Report of the technical group on population projections. 2020. National Commission on Population Ministry of Health \u0026amp; Family Welfare Nirman Bhawan, New Delhi. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nhm.gov.in/New_Updates_2018/Report_Population_Projection_2019.pdf\u003c/span\u003e\u003cspan address=\"https://nhm.gov.in/New_Updates_2018/Report_Population_Projection_2019.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDochania R, Dochania A (2025) Burdened by masculinity: Exploring men\u0026rsquo;s discrimination in India through the lens of hegemonic masculinity. J Psychosexual Health 7(4):392\u0026ndash;397\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGanguli D, Singh P, Das A (2025) Decriminalizing suicide: the 2017 Mental Healthcare Act and suicide mortality in India, 2001\u0026ndash;2020. Cambridge Prisms: Global Mental Health. ;12:e74\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGBD 2017 DALYs and, Collaborators HALE (2018) Global, regional, and national disability- adjusted life- years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990\u0026ndash;2017: a systematic analysis for the global burden of disease study 2017. Lancet 392:1859\u0026ndash;1922\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGBD 2021 Suicide Collaborators (2025) Global, regional, and national burden of suicide, 1990\u0026ndash;2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Public Health 10(3):e189\u0026ndash;202\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGopalakrishnan L, El Ayadi A, Diamond-Smith N (2024) The role of community-level men\u0026rsquo;s and women\u0026rsquo;s inequitable gender norms on women\u0026rsquo;s empowerment in India: A multilevel analysis using India\u0026rsquo;s National Family Health Survey\u0026ndash;5. PLoS ONE 19(12):e0312465\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGray PB, Longkumer W, Panda S, Rangaswamy M (2019) Grandparenting in urban Bangalore, India: Support and involvement from the standpoint of young adult university students. Sage open 9(3):2158244019871070\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrover S (2017) Marriage, love, caste and kinship support: lived experiences of the urban poor in India. Routledge\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIndia State- Level Disease Burden Initiative Air Pollution Collaborators (2019) The impact of air pollution on deaths, disease burden, and life expectancy across the states of India:the global burden of disease study 2017. Lancet Planet Health 3:e26\u0026ndash;39\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIndia State-Level Disease Burden Initiative Suicide Collaborators (2018) Gender differentials and state variations in suicide deaths in India: the Global Burden of Disease Study 1990\u0026ndash;2016. Lancet Public Health 3(10):e478\u0026ndash;e489\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKallakuri S, Maulik PK (2020) Challenges facing individuals and researchers: suicide in India in the COVID-19 pandemic. Lancet Psychiatry 7(8):e49\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKethineni S, Srinivasan M (2009) Police handling of domestic violence cases in Tamil Nadu, India. J Contemp Crim Justice 25:202\u0026ndash;213\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMayer P (2011) Suicide and society in India. Routledge, New York\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehra A, Agarwal A, Bashar M, Avasthi A, Chakravarty R, Grover S (2024) Prevalence of loneliness in older adults in rural population and its association with depression and caregiver abuse. Indian J Psychol Med 46(6):564\u0026ndash;569\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitchell MN (2008) A Visual Guide to Stata graphics. Stata\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Crime Records Bureau. Accidental deaths and suicides in India. Government of India, New Delhi, 2013\u0026ndash;2023. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ncrb.gov.in/en/adsi-reports-of-previous-years\u003c/span\u003e\u003cspan address=\"https://ncrb.gov.in/en/adsi-reports-of-previous-years\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [Accessed 15 January 2026]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Health Profile, Government of India (2020) Central Bureau of Health Intelligence. Ministry of Health and Family Welfare,. 2020. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.indiaenvironmentportal.org.in/content/470474/national-health-profile-2020/\u003c/span\u003e\u003cspan address=\"http://www.indiaenvironmentportal.org.in/content/470474/national-health-profile-2020/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [Accessed 18 January 2026]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Suicide Prevention Strategy. Ministry of Health \u0026amp; Family Welfare (2022) Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mhinnovation.net/resources/Indias-national-suicide-prevention-strategy\u003c/span\u003e\u003cspan address=\"https://www.mhinnovation.net/resources/Indias-national-suicide-prevention-strategy\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [Accessed 17 March 2026]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePathare S, Fernandes TN, Hamid S, Lyons S (2023) How India Continues to Punish Those Who Attempt Suicide. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.54377/e466-de60\u003c/span\u003e\u003cspan address=\"10.54377/e466-de60\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetroni S, Patel V, Patton G (2015) Why is suicide the leading killer of older adolescent girls? Lancet 386(10008):2031\u0026ndash;2032\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVijayakumar L, Chandra PS, Kumar MS, Pathare S, Banerjee D, Goswami T, Dandona R (2022) The national suicide prevention strategy in India: context and considerations for urgent action. Lancet Psychiatry 9(2):160\u0026ndash;168\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Melbourne","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Suicide, India, National Crime Records Bureau (NCRB)","lastPublishedDoi":"10.21203/rs.3.rs-9583059/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9583059/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSuicide is a major public health concern in India, which accounts for a substantial share of global suicides. Long-term declines in suicide rates appear to have reversed after 2017, but it is unclear whether this increase has persisted and how it varies by sex, age, and development level.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAnnual suicide counts (2013\u0026ndash;2023) from the National Crime Records Bureau (NCRB) were combined with population estimates to calculate crude suicide rates per 100,000 by sex and state. Age-specific rates were estimated nationally for five age groups (0\u0026ndash;17, 18\u0026ndash;29, 30\u0026ndash;44, 45\u0026ndash;59, \u0026ge;\u0026thinsp;60 years) for 2019\u0026ndash;2023. States were grouped into low, middle, and high Sociodemographic Index (SDI) categories. Rate ratios (RRs) and rate differences (RDs) for 2018\u0026ndash;2023 were calculated using 2017 as the reference year, with 95% uncertainty and confidence intervals.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBetween 2013 and 2023, the national suicide rate increased by ~\u0026thinsp;14% (10.84 to 12.36 per 100,000), driven by a\u0026thinsp;~\u0026thinsp;24% rise in male suicide rates (14.16 to 17.53 per 100,000) and a\u0026thinsp;~\u0026thinsp;6% decline in female rates (7.33 to 6.91 per 100,000). Rates declined to 2017, then increased, with the highest male rate in 2023, while female rates were more variable and peaked in 2022. Relative post-2017 increases were largest among males in low SDI states, but absolute increases were often greater in high SDI states. The steepest rises (2019\u0026ndash;2023) occurred among middle-aged men and adults aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years.\u003c/p\u003e\u003ch2\u003eLimitations:\u003c/h2\u003e \u003cp\u003eNCRB data likely underestimate the true suicide burden and are available only as aggregate state-level counts, precluding individual-level analyses and limiting age-specific analyses to the national level.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePolice-recorded suicide rates in India have increased since 2017, largely due to rising male suicides. Findings highlight the need for India\u0026rsquo;s suicide prevention efforts to more explicitly address suicide among men, particularly middle-aged and older men.\u003c/p\u003e","manuscriptTitle":"Changing trends in suicide in India, 2013-2023: Rising suicide rates among men","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 10:03:40","doi":"10.21203/rs.3.rs-9583059/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"13d2075c-1155-4854-9dbd-f8bed3f40605","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":67358290,"name":"Epidemiology"}],"tags":[],"updatedAt":"2026-05-11T10:03:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 10:03:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9583059","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9583059","identity":"rs-9583059","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}