Youth suicide is a significant public health problem in Low-and middle-income countries (LMIC), including India. It is a distinct phenomenon with various bio-psycho-social determinants. Despite this, comprehensive literature on this topic is lacking from India. Thus, the current paper aimed to review the available literature on youth-suicide from India and other LMIC, discusses the contentious issues, including potential solutions for the possible roadblocks, and provides recommendations for the national suicide-prevention policy and strategy (NSPPS) in the Indian context. We found that the magnitude of youth suicide in India is substantial with the distinct bio-psycho-social determinants. Although, youth-specific suicide prevention and therapeutic intervention do exist; its feasibility and effectivity in the Indian context are yet to be established. The is an urgent need for the NSPPS; experiences from other LMIC should be incorporated while framing such policies. More research is required from India in this area.
AaronR.JosephA.AbrahamS.MuliyilJ.GeorgeK.PrasadJ.MinzS.AbrahamV. J.BoseA. (2004).
Suicides in young people in rural Southern India. Lancet (London, England),
363(9415), 1117–1118. https://doi.org/10.1016/S0140-6736(04)15896-0
AguilarE. J.SirisS. G. (2007).
Do antipsychotic drugs influence suicidal behavior in schizophrenia?Psychopharmacology Bulletin,
40(3), 128–142.
5.
ArieM.ApterA.OrbachI.YefetY.ZalsmanG.ZalzmanG. (2008).
Autobiographical memory, interpersonal problem solving, and suicidal behavior in adolescent inpatients. Comprehensive Psychiatry,
49(1), 22–29. https://doi.org/10.1016/j.comppsych.2007.07.004
6.
ArunP.ChavanB. S. (2009).
Stress and suicidal ideas in adolescent students in Chandigarh. Indian Journal of Medical Sciences,
63(7), 281–287. https://doi.org/10.4103/0019-5359.55112
7.
AsarnowJ. R.BaraffL. J.BerkM.GrobC. S.Devich-NavarroM.SuddathR.PiacentiniJ. C.Rotheram-BorusM. J.CohenD.TangL. (2011).
An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment. Psychiatric Services (Washington, D.C.),
62(11), 1303–1309. https://doi.org/10.1176/ps.62.11.pss6211_1303
8.
AsarnowJ. R.HughesJ. L.BabevaK. N.SugarC. A. (2017).
Cognitive-behavioral family treatment for suicide attempt prevention: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry,
56(6), 506–514. https://doi.org/10.1016/j.jaac.2017.03.015
9.
AseltineR. H.JamesA.SchillingE. A.GlanovskyJ. (2007).
Evaluating the SOSsuicide prevention program: A replication and extension. BMC Public Health,
7(1), 161. https://doi.org/10.1186/1471-2458-7-161
10.
BalazsJ.KeresztenyA. (2017).
Attention-deficit/hyperactivity disorder and suicide: A systematic review. World Journal of Psychiatry,
7(1), 44–59. https://doi.org/10.5498/wjp.v7.i1.44
11.
BolzW. (2002).
Psychological analysis of the Sri Lankan conflict culture with special reference to the high suicide rate. Crisis,
23(4), 167–170. https://doi.org/10.1027/0227-5910.23.4.167
12.
BonannoG. A.BurtonC. L. (2013).
Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological Science,
8(6), 591–612. https://doi.org/10.1177/1745691613504116
13.
BrentD. A.KolkoD. J.WartellaM. E.BoylanM. B.MoritzG.BaugherM.ZelenakJ. P. (1993).
Adolescent psychiatric inpatients’ risk of suicide attempt at 6-Month follow-up. Journal of the American Academy of Child and Adolescent Psychiatry,
32(1), 95–105. https://doi.org/10.1097/00004583-199301000-00015
14.
BrentD. A.MannJ. J. (2005).
Family genetic studies, suicide, and suicidal behavior. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics,
133C(1), 13–24. https://doi.org/10.1002/ajmg.c.30042
15.
BrentD. A.OquendoM.BirmaherB.GreenhillL.KolkoD.StanleyB.ZelaznyJ.BrodskyB.BridgeJ.EllisS.SalazarJ. O.MannJ. J. (2002).
Familial pathways to early-onset suicide attempt: Risk for suicidal behavior in offspring of mood-disordered suicide attempters. Archives of General Psychiatry,
59(9), 801–807. https://doi.org/10.1001/archpsyc.59.9.801
16.
BrentD.OquendoM.BirmaherB.GreenhillL.KolkoD.StanleyB.ZelaznyJ.BrodskyB.FirinciogullariS.EllisS.MannJ. (2003).
Peripubertal suicide attempts in offspring of suicide attempters with siblings concordant for suicidal behavior. The American Journal of Psychiatry,
160(8), 1486–1493. https://doi.org/10.1176/APPI.AJP.160.8.1486
17.
BridgeJ. A.GoldsteinT. R.BrentD. A. (2006).
Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry,
47(3–4), 372–394. https://doi.org/10.1111/j.1469-7610.2006.01615.x
18.
Brodzinsky, D. M., &LynskeyM. T. (1995).
Suicide attempts and suicidal ideation in a birth cohort of 16-year-old New Zealanders. Journal of the American Academy of Child & Adolescent Psychiatry,
34(10), 1308–1317. https://doi.org/10.1097/00004583-199510000-00016
19.
BucknerR. L.Andrews-HannaJ. R.SchacterD. L. (2008).
The brain’s default network: Anatomy, function, and relevance to disease. Annals of the New York Academy of Sciences,
1124, 1–38. https://doi.org/10.1196/annals.1440.011
20.
CatoV.HolländareF.NordenskjöldA.SellinT. (2019).
Association between benzodiazepines and suicide risk: A matched case-control study. BMC Psychiatry,
19(1), 317. https://doi.org/10.1186/s12888-019-2312-3
21.
ChaC. B.FranzP. J.M GuzmánE.GlennC. R.KleimanE. M.NockM. K. (2018).
Annual research review: Suicide among youth – Epidemiology, (potential) etiology, and treatment. Journal of Child Psychology and Psychiatry, and Allied Disciplines,
59(4), 460–482. https://doi.org/10.1111/jcpp.12831
22.
CherianA.LukoseA.RappaiR.Vijaya SagarK.ArmstrongG. (2020).
Adolescent suicide in India: Significance of public health prevention plan. Asian Journal of Psychiatry, Mar;49:101993. doi: 10.1016/j.ajp.2020.101993.
23.
ConnellA. M.McKillopH. N.DishionT. J. (2016).
Long-term effects of the family check-up in early adolescence on risk of suicide in early adulthood. Suicide & Life-Threatening Behavior,
46(Suppl 1), S15–S22. https://doi.org/10.1111/sltb.12254
24.
CzyzE. K.BeronaJ.KingC. A. (2015).
A prospective examination of the interpersonal-psychological theory of suicidal behavior among psychiatric adolescent inpatients. Suicide & Life-Threatening Behavior,
45(2), 243–259. https://doi.org/10.1111/sltb.12125
25.
DadiomovD.LeeK. (2019).
The effects of ketamine on suicidality across various formulations and study settings. The Mental Health Clinician,
9(1), 48–60. https://doi.org/10.9740/mhc.2019.01.048
26.
DanielS. S.GoldstonD. B.ErkanliA.FranklinJ. C.MayfieldA. M. (2009).
Trait anger, anger expression, and suicide attempts among adolescents and young adults: A prospective study. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53,
38(5), 661–671. https://doi.org/10.1080/15374410903103494
27.
DiamondG. S.WintersteenM. B.BrownG. K.DiamondG. M.GallopR.ShelefK.LevyS. (2010).
Attachment-based family therapy for adolescents with suicidal ideation: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry,
49(2), 122–131. https://doi.org/10.1097/00004583-201002000-00006
28.
DsouzaD. D.QuadrosS.HyderabadwalaZ. J.MamunM. A. (2020).
Aggregated COVID-19 suicide incidences in India: Fear of COVID-19 infection is the prominent causative factor. Psychiatry Research,
290, 113145. https://doi.org/10.1016/j.psychres.2020.113145
FergussonD. M.WoodwardL. J.HorwoodL. J. (2000).
Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychological Medicine,
30(1), 23–39. https://doi.org/10.1017/s003329179900135x
31.
FranklinJ. C.PuziaM. E.LeeK. M.PrinsteinM. J. (2014).
Low implicit and explicit aversion toward self-cutting stimuli longitudinally predict nonsuicidal self-injury. Journal of Abnormal Psychology,
123(2), 463–469. https://doi.org/10.1037/a0036436
32.
GewirtzA. H.DeGarmoD. S.ZamirO. (2016).
Effects of a military parenting program on parental distress and suicidal ideation: After deployment adaptive parenting tools. Suicide & Life-Threatening Behavior,
46(Suppl 1), S23–S31. https://doi.org/10.1111/sltb.12255
33.
GhaziuddinN.KutcherS. P.KnappP.BernetW.ArnoldV.BeitchmanJ.BensonR. S.BuksteinO.KinlanJ.McClellanJ.RueD.ShawJ. A.StockS.Kroeger PtakowskiK., & AACAP. (2004).
Practice parameter for use of electroconvulsive therapy with adolescents. Journal of the American Academy of Child and Adolescent Psychiatry,
43(12), 1521–1539. https://doi.org/10.1097/01.chi.0000142280.87429.68
34.
GibbB. E.AlloyL. B.AbramsonL. Y.RoseD. T.WhitehouseW. G.HoganM. E. (2001).
Childhood maltreatment and college students’ current suicidal ideation: A test of the hopelessness theory. Suicide & Life-Threatening Behavior,
31(4), 405–415. https://doi.org/10.1521/suli.31.4.405.22042
35.
GosnellS. N.VelasquezK. M.MolfeseD. L.MolfeseP. J.MadanA.FowlerJ. C.Christopher FruehB.BaldwinP. R.SalasR. (2016).
Prefrontal cortex, temporal cortex, and hippocampus volume are affected in suicidal psychiatric patients. Psychiatry Research. Neuroimaging,
256, 50–56. https://doi.org/10.1016/j.pscychresns.2016.09.005
36.
GouldM.PetrieK.KleinmanM. H.WallensteinS. (1994).
Clustering of attempted suicide: New Zealand national data. International Journal of Epidemiology,
23(6), 1185–1189. https://doi.org/10.1093/ije/23.6.1185
37.
GouldM. S.CrossW.PisaniA. R.MunfakhJ. L.KleinmanM. (2013).
Impact of applied suicide intervention skills training (ASIST) on national suicide prevention lifeline counselor. Suicide & Life-Threatening Behavior,
43(6), 676-91. https://doi.org/10.1111/sltb.12049
38.
GouldM. S.MunfakhJ. L. H.KleinmanM.LakeA. M. (2012).
National suicide prevention lifeline: Enhancing mental health care for suicidal individuals and other people in crisis. Suicide & Life-Threatening Behavior,
42(1), 22–35. https://doi.org/10.1111/j.1943-278X.2011.00068.x
39.
GunnellD.AshbyD. (2004).
Antidepressants and suicide: What is the balance of benefit and harm. BMJ: British Medical Journal,
329(7456), 34–38.
40.
GuptaS.SagarR. (2020).
Juvenile justice system, juvenile mental health, and the role of MHPs: Challenges and opportunities. Indian Journal of Psychological Medicine,
42(3), 304–310. https://doi.org/10.4103/IJPSYM.IJPSYM_82_20
41.
HindujaS.PatchinJ. W. (2010).
Bullying, cyberbullying, and suicide. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research,
14(3), 206–221. https://doi.org/10.1080/13811118.2010.494133
42.
JacobK. S. (2008).
The prevention of suicide in India and the developing world: The need for population-based strategies. Crisis,
29(2), 102–106. https://doi.org/10.1027/0227-5910.29.2.102
43.
JiJ.KleinmanA.BeckerA. E. (2001).
Suicide in contemporary China: A review of China’s distinctive suicide demographics in their sociocultural context. Harvard Review of Psychiatry,
9(1), 1–12.
44.
KennardB. D.BiernesserC.WolfeK. L.FoxwellA. A.Craddock LeeS. J.RialK. V.PatelS.ChengC.GoldsteinT.McMakinD.BlastosB.DouaihyA.ZelaznyJ.BrentD. A. (2015).
Developing a brief suicide prevention intervention and mobile phone application: A qualitative report. Journal of Technology in Human Services,
33(4), 345–357. https://doi.org/10.1080/15228835.2015.1106384
45.
KeugoungB.KongnyuE. T.MeliJ.CrielB. (2013).
Profile of suicide in rural Cameroon: Are health systems doing enough?Tropical Medicine & International Health: TM & IH,
18(8), 985–992. https://doi.org/10.1111/tmi.12140
KimW. J.SinghT. (2004).
Trends and dynamics of youth suicides in developing countries. Lancet (London, England),
363(9415), 1090–1091. https://doi.org/10.1016/S0140-6736(04)15931-X
48.
LathaK. S.BhatS. M.D’SouzaP. (1996).
Suicide attempters in a general hospital unit in India: Their socio-demographic and clinical profile–emphasis on cross-cultural aspects. Acta Psychiatrica Scandinavica,
94(1), 26–30. https://doi.org/10.1111/j.1600-0447.1996.tb09820.x
49.
LinkerJ.GillespieN. A.MaesH.EavesL.SilbergJ. L. (2012).
Suicidal ideation, depression, and conduct disorder in a sample of adolescent and young adult twins. Suicide & Life-Threatening Behavior,
42(4), 426–436. https://doi.org/10.1111/j.1943-278X.2012.00101.x
50.
LoganA. C. (2004).
Omega-3 fatty acids and major depression: A primer for the mental health professional. Lipids in Health and Disease,
3, 25. https://doi.org/10.1186/1476-511X-3-25
MarchJ.SilvaS.PetryckiS.CurryJ.WellsK.FairbankJ.BurnsB.DominoM.McNultyS.VitielloB.SevereJ., & Treatment for Adolescents With Depression Study (TADS) Team. (2004).
Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for adolescents with depression study (TADS) randomized controlled trial. JAMA,
292(7), 807–820. https://doi.org/10.1001/jama.292.7.807
53.
MashrekyS. R.RahmanF.RahmanA. (2013).
Suicide kills more than 10,000 people every year in Bangladesh. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research,
17(4), 387–396. https://doi.org/10.1080/13811118.2013.801809
McGowanP. O.SasakiA.D’AlessioA. C.DymovS.LabontéB.SzyfM.TureckiG.MeaneyM. J. (2009).
Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nature Neuroscience,
12(3), 342–348. https://doi.org/10.1038/nn.2270
56.
MckeownR. E.GarrisonC. Z.CuffeS. P.WallerJ. L.JacksonK. L.AddyC. L. (1998).
Incidence and predictors of suicidal behaviors in a longitudinal sample of young adolescents. Journal of the American Academy of Child and Adolescent Psychiatry,
37(6), 612–619. https://doi.org/10.1097/00004583-199806000-00011
57.
McKinnonB.GariépyG.SentenacM.ElgarF. J. (2016).
Adolescent suicidal behaviours in 32 low- and middle-income countries. Bulletin of the World Health Organization,
94(5), 340F–350F. https://doi.org/10.2471/BLT.15.163295
58.
MelhemN. M.KeilpJ. G.PortaG.OquendoM. A.BurkeA.StanleyB.CooperT. B.MannJ. J.BrentD. A. (2016).
Blunted HPA axis activity in suicide attempters compared to those at high risk for suicidal behavior. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology,
41(6), 1447–1456. https://doi.org/10.1038/npp.2015.309
59.
MillerA.JennessJ. L.OppenheimerC. W.Barrocas GottleibA. L.YoungJ. F.HankinB. L. (2017).
Childhood emotional maltreatment as a robust predictor of suicidal ideation: A multi-wave, prospective investigation. Journal of Abnormal Child Psychology,
45(1), 105–116. https://doi.org/10.1007/s10802-016-0150-z
60.
MillerA. L.RathusJ. H.LinehanM. M.WetzlerS.LeighE. (1997).
Dialectical behavior therapy adapted for suicidal adolescents. Journal of Psychiatric Practice®,
3(2), 78.
61.
NanselT. R.OverpeckM.PillaR. S.RuanW. J.Simons-MortonB.ScheidtP. (2001).
Bullying behaviors among US youth: Prevalence and association with psychosocial adjustment. JAMA,
285(16), 2094–2100.
62.
NathY.ParisJ.ThombsB.KirmayerL. (2012).
Prevalence and social determinants of suicidal behaviours among college youth in India. The International Journal of Social Psychiatry,
58(4), 393–399. https://doi.org/10.1177/0020764011401164
63.
NockM. K.BanajiM. R. (2007).
Prediction of suicide ideation and attempts among adolescents using a brief performance-based test. Journal of Consulting and Clinical Psychology,
75(5), 707–715. https://doi.org/10.1037/0022-006X.75.5.707
64.
PalaniappanV.RamachandranV.SomasundaramO. (1983).
Suicidal ideation and biogenic amines in depression. Indian Journal of Psychiatry,
25(4), 286–292.
65.
PandeyG. N.DwivediY.RizaviH. S.RenX.PandeyS. C.PesoldC.RobertsR. C.ConleyR. R.TammingaC. A. (2002).
Higher expression of serotonin 5-HT2A receptors in the postmortem brains of teenage suicide victims. The American Journal of Psychiatry,
159(3), 419–429. https://doi.org/10.1176/appi.ajp.159.3.419
66.
PandeyG. N.RenX.RizaviH. S.ConleyR. R.RobertsR. C.DwivediY. (2008).
Brain-derived neurotrophic factor and tyrosine kinase B receptor signalling in post-mortem brain of teenage suicide victims. The International Journal of Neuropsychopharmacology,
11(8), 1047–1061. https://doi.org/10.1017/S1461145708009000
67.
PandeyG. N.RizaviH. S.RenX.FareedJ.HoppensteadtD. A.RobertsR. C.ConleyR. R.DwivediY. (2012).
Proinflammatory cytokines in the prefrontal cortex of teenage suicide victims. Journal of Psychiatric Research,
46(1), 57–63. https://doi.org/10.1016/j.jpsychires.2011.08.006
68.
PatelV.RamasundarahettigeC.VijayakumarL.ThakurJ. S.GajalakshmiV.GururajG.SuraweeraW.JhaP.MillionD. S. C., & Million Death Study Collaborators. (2012).
Suicide mortality in India: A nationally representative survey. Lancet (London, England),
379(9834), 2343–2351. https://doi.org/10.1016/S0140-6736(12)60606-0
69.
PhillipsM. R.LiuH.ZhangY. (1999).
Suicide and social change in China. Culture, Medicine and Psychiatry,
23(1), 25–50. https://doi.org/10.1023/a:1005462530658
70.
PillaiA.AndrewsT.PatelV. (2009).
Violence, psychological distress and the risk of suicidal behaviour in young people in India. International Journal of Epidemiology,
38(2), 459–469. https://doi.org/10.1093/ije/dyn166
71.
PisaniA. R.WymanP. A.PetrovaM.Schmeelk-ConeK.GoldstonD. B.XiaY.GouldM. S. (2013).
Emotion regulation difficulties, youth-adult relationships, and suicide attempts among high school students in underserved communities. Journal of Youth and Adolescence,
42(6), 807–820. https://doi.org/10.1007/s10964-012-9884-2
72.
PritchardC. (1996).
Suicide in the People’s Republic of China categorized by age and gender: Evidence of the influence of culture on suicide. Acta Psychiatrica Scandinavica,
93(5), 362–367. https://doi.org/10.1111/j.1600-0447.1996.tb10661.x
73.
RajaramanD.TravassoS.ChatterjeeA.BhatB.AndrewG.ParabS.PatelV. (2012).
The acceptability, feasibility and impact of a lay health counsellor delivered health promoting schools programme in India: A case study evaluation. BMC Health Services Research,
12(1): 127. https://doi.org/10.1186/1472-6963-12-127
74.
SamuelD.SherL. (2013).
Suicidal behavior in Indian adolescents. International Journal of Adolescent Medicine and Health,
25(3), 207–212. https://doi.org/10.1515/ijamh-2013-0054
75.
SchererS.PestianJ.MorencyL.-P. (2013). Investigating the speech characteristics of suicidal adolescents [Paper presentation]. 2013 IEEE International Conference on Acoustics, Speech and Signal Processing, Vancouver, BC, Canada, May, 2013. https://doi.org/10.1109/ICASSP.2013.6637740
76.
ShafferD.FisherP.HicksR. H.ParidesM.GouldM. (1995).
Sexual orientation in adolescents who commit suicide. Suicide and Life-Threatening Behavior,
25(Suppl), 64–71.
77.
ShafferD.PfefferC. R. (2001).
Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. Journal of the American Academy of Child & Adolescent Psychiatry,
40(7), 24S–51S. https://doi.org/10.1097/00004583-200107001-00003
78.
ShaikhM. A.LloydJ.AcquahE.CeledoniaK. L.WilsonM. L. (2016).
Suicide attempts and behavioral correlates among a nationally representative sample of school-attending adolescents in the republic of Malawi. BMC Public Health,
16(1), 843. https://doi.org/10.1186/s12889-016-3509-8
79.
SharmaR.GroverV. L.ChaturvediS. (2008).
Suicidal behavior amongst adolescent students in South Delhi. Indian Journal of Psychiatry,
50(1), 30–33. https://doi.org/10.4103/0019-5545.39756
StanleyB.BrownG. K. (2012).
Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice,
19(2), 256–264. https://doi.org/10.1016/j.cbpra.2011.01.001
82.
TangT.-C.JouS.-H.KoC.-H.HuangS.-Y.YenC.-F. (2009).
Randomized study of school-based intensive interpersonal psychotherapy for depressed adolescents with suicidal risk and parasuicide behaviors. Psychiatry and Clinical Neurosciences,
63(4), 463–470. https://doi.org/10.1111/j.1440-1819.2009.01991.x
VitielloB.OrdóñezA. E. (2016).
Pharmacological treatment of children and adolescents with depression. Expert Opinion on Pharmacotherapy,
17(17), 2273–2279. https://doi.org/10.1080/14656566.2016.1244530
89.
VizcarraB.HassanF.HunterW. M.MuñozS. R.RamiroL.De PaulaC. S. (2004).
Partner violence as a risk factor for mental health among women from communities in the Philippines, Egypt, Chile, and India. Injury Control and Safety Promotion,
11(2), 125–129. https://doi.org/10.1080/15660970412331292351
WelchS. S. (2001).
A review of the literature on the epidemiology of parasuicide in the general population. Psychiatric Services (Washington, D.C.).),
52(3), 368–375. https://doi.org/10.1176/appi.ps.52.3.368
92.
WymanP. A.BrownC. H.InmanJ.CrossW.Schmeelk-ConeK.GuoJ.PenaJ. B. (2008).
Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. Journal of Consulting and Clinical Psychology,
76(1), 104–115. https://doi.org/10.1037/0022-006X.76.1.104
ZalsmanG.FrischA.BrombergM.GelernterJ.MichaelovskyE.CampinoA.ErlichZ.TyanoS.ApterA.WeizmanA. (2001).
Family-based association study of serotonin transporter promoter in suicidal adolescents: No association with suicidality but possible role in violence traits. American Journal of Medical Genetics,
105(3), 239–245. https://doi.org/10.1002/ajmg.1261
96.
ZhangS.ChenJ.KuangL.CaoJ.ZhangH.AiM.WangW.ZhangS.WangS.LiuS.FangW. (2016).
Association between abnormal default mode network activity and suicidality in depressed adolescents. BMC Psychiatry,
16(1), 337. https://doi.org/10.1186/s12888-016-1047-7
