Silent Epidemics: A Decade-Long Investigation into Accidental and Suicide Deaths in India

INTRODUCTION WITH OBJECTIVES

Premature deaths, whether due to accidents or suicide, are indeed tragic occurrences that have significant impacts on individuals, families, and society as a whole.^1,2 Accidental deaths, such as those resulting from unintentional injuries, motor vehicle crashes, drownings, or falls, not only devastate the families of the deceased but also place a substantial financial burden on national resources.^1,2 These preventable deaths often occur among younger individuals, leading to a significant loss of potential years of life and productivity.³ Suicide death is another complex and multifaceted form of premature death that has far-reaching consequences. Suicide is influenced by a variety of factors, including mental health conditions, substance abuse, social isolation, and access to lethal means. The emotional toll on families and communities affected by suicide is immense, and the economic impact can also be substantial due to lost productivity and healthcare costs.³ Addressing the underlying causes of both accidental and suicide-related premature deaths is crucial. Effective public health interventions, such as improving road safety, promoting mental health awareness, and restricting access to lethal means, can help reduce the burden of premature mortality. Comprehensive strategies that address the social, economic, and environmental determinants of health are essential to prevent these tragic losses of life.⁴

To address these sensitive issues, promote public health, and guide efforts to prevent premature deaths in the country, in 1967, the then-existing Directorate of Coordination Police Wireless first published a report titled “Accidental deaths and Suicide deaths in India.”⁵ In 1986, the National Crime Records Bureau (NCRB) was established under the Ministry of Home Affairs, taking over the responsibility of publishing the annual report.⁶ The NCRB publishes the “Accidental Deaths and Suicides in India” report annually to provide transparent data on accidental deaths and suicide, inform evidence-based policymaking, identify high-risk groups, raise public awareness, and monitor progress in addressing these critical public health issues in India.^7,8 The report has been published consistently since then, with the latest edition covering data for the year 2022.⁸

Accidental deaths and suicide deaths are critical public health concerns in India, with significant impacts on mortality and societal well-being. India reports one of the highest numbers of suicide deaths globally, accounting for nearly 200,000 suicide deaths annually.⁶ The search results indicate that accidental death and suicide death rates have been changing over time in India, with significant variations across different states and regions.^5-8 For example, Tamil Nadu reported a 53.8% increase in accidental deaths from 2020 to 2021, while Delhi showed a 22.6% decline. Suicide death rates also show diverse trends, with some states such as Tamil Nadu and Andhra Pradesh having higher rates compared to the national average.⁸

Monitoring changes in the number of deaths over time in different states provides insights into evolving trends and patterns of accidental deaths and suicide deaths. This information helps in understanding the dynamics of these causes of death and guides the development of targeted interventions. Studying changes in death rates across states helps identify regions with higher mortality rates and disparities in healthcare access or social determinants of health. This knowledge is essential for implementing region-specific interventions to address the underlying factors contributing to preventable deaths; at the same time, states with declining deaths need to be motivated to continue their interventions, if any. Understanding variations in death numbers across states informs public health planning and resource allocation. It helps prioritize areas with higher mortality rates for targeted interventions, ensuring that resources are directed toward areas most in need of support to prevent premature deaths. Understanding these changes is crucial for policymakers, public health officials, and researchers to address the underlying causes of accidental and suicide deaths and implement evidence-based measures to reduce such incidents.

The present study sought to answer the following research question, What are the trends of accidental death and suicide in different states and union territories of India? By mapping the changes in accidental deaths and suicide deaths over time through secondary data analysis, this study provided insights into the effectiveness of existing prevention strategies in different states, quantifying the changes in these deaths across the states, and identifying states with decreasing trend to guide the states which are lagging so that these states can be focused for targeted interventions to address these critical public health issues.

MATERIAL AND METHODS

RESULTS

The change in the number of accidental deaths across different states and union territories in India between 2012 and 2017 was mapped [Figure 1]. Between 2012 and 2017, Madhya Pradesh recorded the highest increase in accidental deaths, with a rise of 4,594 cases, followed closely by Uttar Pradesh with an increase of 4,552, and Rajasthan with 4,109 additional cases. Uttar Pradesh consistently recorded the highest number of accidental deaths, likely reflecting its large population size. On the other hand, Andhra Pradesh, which experienced a significant drop of 12,614, followed by West Bengal, showed the most considerable decrease with 9,128 cases, and Telangana, with a reduction of 5,144 cases. Among the union territories, the changes were generally less pronounced due to smaller populations. Puducherry registered an increase of 374 accidental deaths, and Dadra and Nagar Haveli reported a modest rise of 19 cases. Conversely, Delhi experienced a notable reduction of 3,447 cases, and Chandigarh reported 1,041 fewer accidental deaths. These figures highlight the varied trends in accidental deaths across the regions, indicating significant increase in some states while others experienced notable declines.

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Figure 1: State-wise accidental death changes between 2012 and 2017.

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Figure 2 shows the difference in accidental deaths in different states of India between the years 2017 and 2022. In the year 2022, Uttar Pradesh witnessed the highest surge in accidental deaths, recording 8,170 more fatalities than in 2017. This alarming increase underscores the pressing need for enhanced safety protocols in the state. Odisha followed closely, with a sharp rise of 6,687 additional accidental deaths over the 5 years, marking the second-highest increase among all states. Karnataka ranked third, with 5,472 more deaths in 2022 compared to 2017. Kerala reported the fourth-largest increase with 3,311 more unintentional deaths. Bihar experienced a significant spike as well, with an additional 4,228 accidental deaths in 2022. Madhya Pradesh reported a rise of 3,115 deaths, while Maharashtra had 2,019 more unintentional fatalities. Jharkhand, with an increase of 1,659 deaths, registered the eighth-highest rise in accidental deaths. In contrast, several states showed a decrease in the number of accidental deaths, including Gujarat (−2,131), Rajasthan (−1,383), and Delhi (−1,263). The Union Territories of Chandigarh, Daman and Diu, and Nagaland also reported decrease in accidental deaths over this period.

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Figure 2: State-wise accidental death changes between 2017 and 2022.

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The difference in suicide deaths between the years 2012 and 2017 across different states and UTs in India is presented in Figure 3. The presented map data highlight a mixed picture, with some states such as Andhra Pradesh, Tamil Nadu, and Telangana having substantial decline in suicide deaths, while others, such as Madhya Pradesh and Maharashtra, experienced a substantial increase in suicide deaths between 2012 and 2017. The state with the largest decrease in suicide deaths was Andhra Pradesh, with 8,884 fewer deaths in 2017 as compared to 2012, followed by Tamil Nadu (−2,468) and Telangana (−2,003). Other states which were reported a considerable decrease in suicide deaths include West Bengal (−2,943), Karnataka (−1,037), Kerala (−620), Rajasthan (−983), and Assam (−988). In contrast, Madhya Pradesh recorded the largest increase, with 1,995 more suicide deaths. This was followed by Maharashtra (+1,534) and Haryana (+560). The UT of Delhi showed an increase of 563 suicide deaths, while Puducherry (+40) and Chandigarh (−1) had smaller changes. The northeastern states generally had smaller variations, both positive and negative. Arunachal Pradesh (−41), Meghalaya (+37), and Nagaland (+3) reported modest changes. Jammu and Kashmir (−127) and Uttarakhand (−93) also reported a decrease in suicide deaths during this period.

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Figure 3: State-wise suicide death changes between 2012 and 2017.

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The difference in the numbers of suicide deaths across the state and union territories of India over a 5-year interval, i.e., 2017 and 2012 year is represented in Figure 4. This mapping of data highlights a substantial increase in suicide deaths across most Indian states, with Tamil Nadu, Maharashtra, Madhya Pradesh, and Andhra Pradesh recording the largest spikes. Tamil Nadu showed the highest increase in suicide deaths, with 5,375 more cases in 2022 compared to 2017. This was followed by Maharashtra (+5,100), Madhya Pradesh (+3,616), and Andhra Pradesh (+3,554). Other states with substantial rise in numbers include Uttar Pradesh (+3,750), Kerala (+2,292), Karnataka (+1,890), Gujarat (+1,584), and Odisha (+1,647). The UT of Delhi recorded 955 additional suicide deaths during this period. In contrast, Puducherry reported a decrease of 100 suicide deaths, and Manipur was the only other state to report a decline, with 17 fewer suicide deaths. The northeastern states generally had smaller increase in number, such as Arunachal Pradesh (+60), Meghalaya (+48), Mizoram (+62), and Nagaland (+16). Jammu and Kashmir (+36) and Uttarakhand (+483) also experienced more moderate rise compared to the national trend.

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Figure 4: State-wise suicide deaths between 2017 and 2022.

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DISCUSSION

In this study, the absolute number of deaths was analyzed rather than state-specific death rates for inter-state comparisons to emphasize that changes in absolute death numbers may be obscured if state-specific death rates are considered, due to variations in population size. While changes in death rates reflect trends, changes in absolute numbers offer a clearer indication of the real public health burden, regardless of fluctuations in state-specific death rates. The trends analysis and mapping of accidental and suicide deaths across Indian states reveal considerable changes in the relative rankings of certain states over time/ between the two 5 years units. For instance, Chhattisgarh and Rajasthan, which were previously in the bottom quartile for accidental deaths for the 5 years between 2012 and 2017, have now moved into the top quartile between the years 2017 and 2022. Conversely, the states of Jammu and Kashmir, Tamil Nadu, Telangana, and West Bengal were shifted from the second quartile to the bottom/fourth quartile in terms of accidental death changes during the two 5-year units. When examining the trend and mapping of suicide deaths, several states have experienced a transition from the top/first quartile to the bottom/fourth quartile. These include Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, and Telangana. In addition, Rajasthan has also seen a similar shift in its ranking for suicide deaths. These findings suggest that the pattern of accidental and suicide deaths has undergone notable changes across different Indian states over the past decade.

Uttar Pradesh has the highest number of accidental deaths in both 5-year intervals. The reason may be that Uttar Pradesh has the largest population as compared to any state in India, with over 200 million people as of 2021. With a large population comes a higher absolute number of accidental deaths, even if the rate is not the highest.⁹ As per the study, the probable causes contributing to high accidental deaths in these states may be due to poor road infrastructure, lack of enforcement of traffic rules, and high rates of speeding and drunk driving.¹⁰ Uttar Pradesh also has a high rate of accidental deaths due to forces of nature like floods and lightning strikes.¹¹ The state is prone to natural disasters which claim many lives each year.⁸ Due to poverty and lack of access to quality healthcare in many parts of Uttar Pradesh, many accident victims may not receive timely and adequate medical treatment, leading to higher mortality rates.¹² Occupational accidents are also a concern, especially in the large informal sector. Construction workers, factory laborers, and farmers face high risks of accidental injuries and deaths.¹⁰

Similarly, suicide deaths in Madhya Pradesh and Maharashtra states have continued to be on the rise since the last decade. Reasons as per studies conducted in these states may be a combination of socioeconomic factors, mental health challenges, and lack of adequate support systems that have led to alarmingly high and rising suicide death tolls in both Madhya Pradesh and Maharashtra over the past decade.^7,13-16 Targeted interventions addressing the root causes are needed to curb this public health crisis in these states.

CONCLUSION

The data on accidental and suicide deaths in India over the last decade reveal significant variations across different states, highlighting the need for targeted interventions and safety measures tailored to the specific challenges faced by each state. A significant change in the burden of accidental and suicide deaths has been observed in different states, and the underlying factors contributing to these changes need to be identified to develop targeted strategies for addressing these public health challenges. Factors such as infrastructure, socioeconomic conditions, mental health support, and disaster preparedness all play a role in shaping accidental and suicide death patterns. Targeted, evidence-based policies and programs are crucial to address these disparities and save lives.