Trajectory of suicide among Indian children and adolescents: a pooled analysis of national data from 1995 to 2021

Abstract

Background

Suicide is a major public health concern in India especially among children and adolescents. The yearly national statistics show a concerning trend of rising suicide deaths in these age groups.

Methods

The present study, taking 26 years of national data from the National Crime Record Bureau during 1995–2021, examined the trend, patterns, means, and modes of children/adolescent suicides in India. We also undertook a time series analysis by using ARIMA (0,2,1) model to forecast the expected suicide rate for the next one decade.

Results

A rising trend of suicide rate among children and adolescents was observed in India over the last 26 years. The forecast indicates a continuance of rising suicide cases for the upcoming decade in India. A substantially different trend of suicide rate was observed among early and late adolescents indicating significantly high vulnerability of late adolescents. Among children /adolescents, the most common causes of suicide were family problems, academic failure, illness, and unemployment. Illness has emerged as one of the leading causes of suicide, with a significant rise over time. Poverty and unemployment were also found as the important contributors with a steadily increasing trend of suicide among children and adolescents facing these problems in recent years.

Conclusion

The study provides important analysis and information on suicide among children/adolescents in India, by providing useful insights for parents, teachers, policymakers, healthcare practitioners, and stakeholders aiming to prevent and control children and adolescent suicide and boost mental health. The study also provides important leads on risk factors with a forecast of suicide trends for the next 10 years.

Introduction

Suicide among children and adolescents is a significant public health concern globally, with wide-ranging social, political, and emotional implications [1] A pooled analysis of the Global School-Based Survey (GSHS) across 90 countries revealed a significant prevalence of suicidal ideation among 397,299 adolescents [2]. The majority of suicides occur in low- and middle-income countries (LMICs) in the world [3]; India witnessed a constantly rising suicide rate over the past three decades with the highest number of incidences in the world [4].

The suicide scenario among Indian children, adolescents and youth (< 30 years old) is highly alarming as it is their top leading cause of death [5,6,7] (Fig. 1C). It is here noteworthy that India with 253 million children and adolescent age constitutes one-fifth and the largest proportion of the adolescent population in the world [5]. It has been observed that 40% of suicide deaths in men and 56% of suicide deaths in women occurred between 15 and 29 years of age [8]. A systematic review and meta-analysis revealed a high burden of psychiatric disorders among Indian adolescents in the community (6.5%) and school settings (23.3%) as well as urban (0.8–29.4%) and rural areas (1.60–5.84%) [9]. Recent reviews of risk factors of adolescent suicide scenarios in India revealed that the most frequently reported risk factors included; mental health problems, negative life issues, academic stressors, violence, economic distress, relationship factors, etc [10, 11].

Fig. 1

A, B and C): Top 10 Countries with Highest Adolescent Population (A), Top 15 adolescent suicide reporting countries in the world (B), and T 26 years (1995–2021) suicide trend among children, adolescents, and Youth in India (C).

At the same time, mental health in India is also neglected and inadequately understood across all age groups [12, 13]. Youths in India generally view suicide as morally unacceptable and heavily stigmatized [14]. Adolescents and their issues in Indian culture are not taken seriously as they are considered naive and exaggerated, for which they must be put to face life’s challenges, most importantly with the least support, to learn from adversities [15]. Furthermore, misconceptions surrounding mental health coupled with poor reporting, poor treatment-seeking practices, and non-adherence to treatment in case of psychiatric need/diseases are deep-rooted and widespread concerns [8].

As per our recent scoping review, there is a substantial gap in adolescent mental health research in India with a major vacuum of evidence around the status, major risk factors, and future risks of suicide at the national population level [10]. In this context, this study examines the detailed historical and recent trends and causes of children and adolescent suicide rates stratified by age and sex in India over the last 26-year period (from 1995 to 2021). Additionally, the paper also tries to understand the future trend of children and adolescent suicide by forecasting the suicide rate for the next 10 years by using time series data. The study based on previous reported findings and our primary experience aims to identify and contribute valuable insights to healthcare planning and suicide prevention programs.

Methodology

Study design and study settings

The study employed a retrospective cross-sectional analysis design utilizing data on reported adolescent suicides across India for a period of 26 years from 1995 to 2021. The data indicates that there are nearly 0.2 million reported suicides during this timeframe.

Study participants

National Crime Record Bureau (NCRB) in its report “Accidental Deaths and Suicides in India (ADSI)” stratified and reported the suicide data on children up to 14 years of both male and females till the year 2023; from the year 2014 onwards, the age group for children and adolescent was extended up to 18 years. So, our analysis included the data accordingly.

Data source and data extraction

We collected the data from the NCRB, India, the primary body for gathering information on suicide incidences across India. National Crime Record Bureau (NCRB) is part of the Ministry of Home Affairs, Government of India and it releases yearly time series data on accidental deaths and suicides from the year 1969 onwards. All the states and union territories were covered during the study. For this study, we gathered data on children’s suicide for a period of 26 years (1995–2021) from NCRB annual reports on Accidental Deaths and Suicides in India (ADSI), freely available at https://ncrb.gov.in/en/adsi-reports-of-previous-years [16]. The data of the period 1995–2013 reported the year-wise suicide among children below 14 years of age with information on both causes and means of suicide. Year 2014 onwards, the NCRB reported suicide among children/adolescents up to 18 years old. However, they dropped the reporting of means and only reported the causes of suicide. So, we have analysed the data in two sets as 1995–2013 and 2014–2021 where required. We have also added a population figure at the time when the data was extracted for the analysis (Additional File 2).

Data have been extracted from NCRB reports, available as PDF documents, by two researchers (1st and 3rd authors). The year-wise suicide data was entered into a Microsoft Excel 2019 spreadsheet. The data extraction, validation, and entry were alternatively checked by two researchers (1st and 3rd authors) and were finally cross-checked by the corresponding author for consistency and correctness.

Ethical approval statement

This research paper does not require ethical approval; it involves a systematic analysis and presentation of available secondary data resources.

Statistical methods

The present study aimed to understand the patterns and trends of suicide among adolescents in India. We also intended to study the major risk factors in this process. In this context, we used descriptive analysis of the data to reach conclusions. We used various graphs to explain the patterns and trends of suicide in India; we used the adolescent population data available from UNICEF for calculating the country-wise adolescent population while the number of suicide was calculated by using the adolescent suicide rate and adolescent population of each country available from the same source [17, 18]. By using the data available at NCRB, Government of India, we prepared the 26 years (1995–2021) suicide trend among adolescents and youth in India. The heatmap method was used to highlight the trends and patterns for various modes and means of children/adolescent suicide (Figs. 4 and 5). The primary purpose of a heat map is to quickly and intuitively highlight areas of high or low concentration within the dataset to indicate the risks. Based on our analysis of the 26 years of data, we identified the top leading factors causing suicide which we illustrated with line graphs.

We calculated yearly crude suicide rates per 100,000 populations with 95% confidence intervals using projected mid-year population estimates. Also, the crude suicide rate per 100,000 population and trends were described using joint point regression analysis to determine the major deviation in trend during the 26 years (1995–20221), utilizing the Joint Point Regression Program, Version 4.5.0.1 (Surveillance Research Program, National Cancer Institute, USA) [19].

Moreover, we undertook a time series analysis and forecasting of suicide trends (for the next 10 years) based on available data. Time series forecasting is a process of evaluating previous observations of a time series, which is a series of data points collected over time, in order to construct a model that accurately describes its underlying structure. The aim is to use this model to forecast expected future trends of suicide risks among Indian adolescents. One of the most popular and frequently used stochastic time series models is the Auto-Regressive Integrated Moving Average (ARIMA) model [20] which we used for the present analysis and forecasting purpose. The ARIMA model has been successfully applied in the field of health as well as in different fields in the past due to its simple structure, fast applicability, and ability to explain the data set. The ARIMA model combines these three components to create a powerful forecasting tool. It considers past suicide rates (AR), adjusts for potential trends (I), and accounts for random fluctuations (MA) to provide a more accurate forecast of future suicide risk.

The statistical analysis and forecasting were carried out using various software tools, including Microsoft Excel 2019, and R software version 3.6.2.

Results

The proportion of India’s adolescent population to that of the world, as per the recent data, stands highest at 253 million among all the countries followed by China at 168 million (Fig. 1A). The number of suicides among Indian adolescents stands the highest (10,730) than the second highest reporting country, Pakistan (2421) followed by China (Fig. 1B). As per the last 26 years of NCRB reports, 1,34,735 reported children and adolescents died by committing suicide in the country. By adjusting the data discrepancy, it can be observed that 1.3 million deaths among children and youth combined took place due to suicide during the same period. This number is about 40% of the approximately 3.3 million total suicides (including all age groups) in the country that happened in India during these 26 years (Fig. 1C).

• 1. Trends of children and adolescent suicide in India (1995–2021)

Figure 2 illustrates the trends in children and adolescent suicide rates in India from 1995 to 2021. Where Fig. 2A describes the Trend in children and early adolescent suicide in India from 1995 to 2013, and Fig. 2B describes trends in Children and adolescents suicide in India from 2014 to 2021. The Bar graphs highlight a significant increase in the suicide rate among these vulnerable populations over 26 years. In Fig. 2A, the data on children and early adolescents from 1995 to 2013 shows a fluctuating suicide rate between males and females each year. However, Fig. 2B reveals a shift in the trend after 2014, indicating higher suicide rates among female children and adolescents compared to males. The latest data in 2021 shows that approximately 5075 males and 5655 females in India in this age group died by suicide.

Fig. 2

Historical and recent trends in children and adolescent suicide rate in India

Table 1 represents the data on yearly crude suicide rates per 100,000 population from 1995 to 2021 revealing significant fluctuation over the period. In the late 1990s, the rates were relatively similar, with a slight peak in 1999 at 7.53 [95% CI: 7.29, 7.78] and a dip in 1997 at 6.52 [95% CI: 6.28, 6.75]. A notable decline was observed from 2001 to 2008, with the lowest rate recorded in 2008 at 4.72 [95% CI: 4.53,4.91]. However, starting from 2009, there is a clear upward trend, culminating in a dramatic increase from 2014 onwards. The most substantial rise occurred in 2015, with a rate of 18.67 [95% CI: 18.29, 19.04], which continued to escalate, peaking in 2020 at 23.8 [95% CI: 22.6, 23.50]. A slight decrease was seen in 2021 with a rate of 21.9 [95% CI: 21.49, 22.31]. this trend indicates a worrying increase in suicide rates over the last decade.

Table 1 Year wise crude suicide rates per 100,000 populations with 95% confidence intervals [95% CI]

We calculated annual percentage changes (APC) and average annual percentage changes (AAPC) in suicide rates by gender and years using the Joint Point Regression Analysis model (Fig. 3). Here, the positive value of APC suggests an increasing trend, and the negative value of APC suggests a decreasing trend. The analysis of suicide rates over different periods reveals significant insights into trends among males, females, and the total population (Fig. 3).

Fig. 3

Annual percentage changes (APC) and average annual percentage changes (AAPC) in suicide rates by gender and years using joint point regression analysis

For males, the APC from 1995 to 2012 was − 1.0% [95% CI: -2.2, 0.2], indicating a decreasing trend, though not statistically significant (t = -1.8, p = 0.090). This trend reversed sharply from 2012 to 2015, with an APC of 53.3% [95% CI: 8.1, 117.4], showing a significant increase (t = 2.6, p = 0.019). From 2015 to 2021, the trend stabilized with an APC of 0.1% [95% CI: -5.7, 6.2] (t = 0, p = 0.981). The average annual percentage change (AAPC) for the entire period was significant at 4.4% [95% CI: 0.2, 8.7].

Among females, the APC from 1995 to 2012 was − 1.6% [95% CI: -2.5, -0.7], reflecting a significant decreasing trend (t = -3.8, p = 0.001). However, from 2012 to 2015, there was a significant increase with an APC of 57.8% [95% CI: 22, 104.1] (t = 3.7, p = 0.001). The period from 2015 to 2021 showed a non-significant increase with an APC of 2.1% [95% CI: -2.3, 6.6] (t = 1, p = 0.337). The AAPC for females over the entire period was significant at 4.8% [95% CI: 1.7, 8].

For both genders combined, the APC from 1995 to 2012 was − 1.5% [95% CI: -2.5, -0.5], indicating a significant decreasing trend (t = -3.2, p = 0.004). This was followed by a significant increase from 2012 to 2015 with an APC of 49.3% [95% CI: 11.9, 99.1] (t = 2.9, p = 0.009). From 2015 to 2021, the trend showed a non-significant increase with an APC of 4.6% [95% CI: -0.3, 9.8] (t = 1.9, p = 0.067). The AAPC for the combined population was significant at 4.8% [95% CI: 1.3, 8.3].

• 2. Patterns of modes of suicide among the children and adolescents

NCRB reported the various modes of suicide among children below 14 years of age from the year 1995 to 2013 (Fig. 4). However, data on the modes of suicide was discontinued from 2014 onwards. We analyzed the major modes of suicide among children under 14 years from the available data in the NCRB record. It was observed that hanging was the most common method of suicide among children (< 14 years) in India, accounting for 27.87% of all methods in the year 2013 among both males and females. This trend remained consistent from 1995 to 2013 (Fig. 4). The other prevalent mode of suicide among Indian children was suicide by consuming poison, which accounted for 17.15% of all suicides among children (< 14 years) only in India in 2013 in both genders. These modes of suicide involve ingesting a toxic substance, such as pesticides or drugs. Suicide by drowning was notable in number accounting for 16.41% of all reported cases in 1995, which later decreased to around 3% by 2013. Suicide by fire/self-immolation during 1995 was comparatively high in number, but afterward, it steadily decreased and by 2013, it accounted for 7% of all reported modes. Jumping from a height is another mode of suicide that is prevalent among Indian children, which according to NCRB data, accounted for 2.13% of all reported suicides in 2013. Firearms, touching electric wires, and coming under running vehicles/trains are relatively less prevalent methods (overall accounting for 4.24%) along with jumping from a height (accounting for 2.13%) among Indian children in this age group in 2013.

Fig. 4

Year-wise reported suicide among children and adolescents (below 14 years) from 1995 to 2013 according to the mode of suicide

There was also observed a gender perspective in the rising suicide scenario particularly in terms of adopted modes. With the rise of suicide among both males and females, hanging was the most common mode of suicide among both male and female children. However, poisoning was more prevalent among female children, accounting for 21% of all suicides among them (< 14 years) only in the year 2013, compared to 13.6% among male children. Overall retrospective data from 1995 to 2013 shows that suicide by consuming poison was decreasing in both genders.

• 3. Cause-wise reported suicide among children and adolescents in India

Figure 5 depicts the heat map describing the distribution of reported suicides among children and adolescents over the years based on various causes. This figure is represented in two parts, the first part covers the period from 1995 to 2013 focusing on children and early adolescents (below 14 years old), while the second part covers the period from 2014 to 2021, focusing on the cause of suicide among children and adolescents (below 18 years old). It can be observed that academic failure, family problems and related issues, love affairs, and illness were the major reasons for suicide among both male and female adolescents in India. Unknown causes and other undefined causes were observed to present a significant section of suicide. As per the trend observed in this analysis, academic failure as a risk of suicide among male adolescents has reduced from 13% during 1995–1999 to 11.1% during 2000–2005 and 9.4% during 2006–2010, while a significant rise was reported with 20.8% during 2011–2015 and 45.5% during 2016–2021. Family problems and related issues have decreased from 7.7% during 1995–1999 to 7.4% during 2000–2005 and 6.8% during 2006–2010 but it has increased to 16.4% during 2011–2015 and 61.4% during 2016–2021. From the year 1995–1999, illness as a causative factor decreased from 13.8 to 11.6% during 2000–2005 and 10.5% during 2006–2010; however, during 2011–2015, the suicide rate due to illness among males rose to 18.7% and this trend during 2016–2021 has significantly increased by 45.1%.

Fig. 5

Year-wise reported suicide among children and adolescents according to the causes of suicide from 1995-2021

Considering female suicide, academic failure caused cases have decreased from 14.3% during 1995–1999 to 13.5% during 2000–2005 and 10.8% during 2006–2010; however, during 2011–2015 female suicide due to academic failure again increased by 12.9% and this trend during 2016–2021 further raised by 48.2%. Suicides among female adolescents due to family problems and related issues fell from 7.8% during 1995–1999 to 6.9% during 2000–2005 and (6.93%) in 2006–2010. A substantial rise was observed from 2011 to 2015 by 14.5% followed by a 63.7% rise during 2016–2021. The trend of suicide due to illness has experienced a rise of 11.3% from 1995 to 1999 and 11.0% from 2000 to 2005 whereas from 2006 to 2010 the rate has risen to 12.2%, 14.8% from 2011 to 2015, and a significant rise of 50.4% was observed in 2016–2021. In terms of gender, it was shown that from the period 2014 to 2021, suicide due to family problem and academic failure is high among males, while suicide due to love affairs and illness is high among females.

We undertook the cumulative gender-wise difference analysis for the cause of suicide among children and adolescents to understand the differences. We have presented the findings in Table 2. It was observed that there is a significant difference among males and females with respect to various causes of suicide.

Table 2 Cumulative gender-wise differences in causes of suicide among children and adolescents (1995–2021)

Illness–as a major addressable cause of suicide among children and adolescents

In most cases of illnesses leading to suicide, children, and adolescents have been observed taking extreme steps due to unbearable worries without a visible solution and a lack of understanding of the very health conditions. Figure 6 shows that illness is a major cause of suicide among both male and female adolescents. The major illnesses causing suicide, as reported by NCRB, are AIDS/STD, cancer, paralysis, mental illness, and other chronic conditions. Among all the suicides reported due to illness, mental health, and other prolonged illnesses have been consistently high among both males and females as observed from 1995 to 2021 (Fig. 6). Out of the total death due to illness among children and adolescents, death due to mental illness was 7.74% in 1995–1999, but significantly increased after 2011, reaching 47.14% in 2016–2021 (male-59.34%; female-61.33%).

Fig. 6

Year-wise reported suicide among children and adolescents based on Illness

Apart from illness, suicidal deaths due to poverty and unemployment were observable issues among adolescents. Over the period, adolescent suicidal deaths due to poverty (Additional File 1, Figure (A1 & A2) and unemployment (Additional File 1, Figure (B1 and B2)) have consistently evolved as major concerns.

• 4. Forecasting the future trends of children and adolescent suicide in india for the next 10 years.

We analyzed the time series data from 2014 to the last report available i.e. 2021 to see the future 10-year trend of suicide among children (< 18 years) through forecasting. We adopted the data from 2014 onwards because NCRB started reporting up to 18 years during 2014 and the later period (Fig. 2). We adopted the AREMA model for this time series analysis purpose. As per the finding from the ACF and PACF plots (Fig. 7), the following ARIMA models have been proposed to estimate additional model parameters: ARIMA (0,2,0), ARIMA (0,0,0), ARIMA (0,2,1), ARIMA (1,2,1), ARIMA (2,2,1), ARIMA (1,2,2), ARIMA (0,2,2). The ARIMA (0,2,1) model was found as the best appropriate ARIMA model for Indian children/adolescent suicide rate data because its LL (Log-Likelihood), AIC (Akaike Information Criterion), and BIC (Bayesian Information Criterion) values are the lowest among all suggested models Additional file 3). Additional File 4 shows estimated suicide rates for the next ten years (2022–2031). The graph presenting the forecasted trend of suicide rate for Indian children/adolescents is shown in Fig. 7.

Fig. 7

10 year forecasted trend of children and adolescent suicide in India.

Discussion

This study explores the pattern, trends, and major risk factors of child and adolescent suicide in India along with forecasting for the next decade. Our study reveals a concerning rise in suicide rates among children and adolescents in India over the past 26 years and the estimate shows an increasing trend through the next decade (Fig. 7). The scenario is particularly concerning among the late adolescents where it shows a stiff rise among females as well as at the overall level (Fig. 3).

The study identifies the means of reported suicide among these populations in India, where hanging was observed as the most common method of suicide among children below 14 years, followed by suicide by consuming poison. These findings highlight the need for stricter regulations and enforcement measures to restrict access to these lethal means, especially among vulnerable populations. Here, it may be mentioned that adolescents from native and indigenous ethnic minority groups are at three times higher risk of suicide than the general population [21]. Globally, similar trends have also been observed in other countries [22, 23]. WHO reported consuming poison as the main method of suicide in an estimated 20% of global suicide cases, most of which are from LMIC countries [24].

The present study reveals an important perspective on gender-wise suicide rates in India in the last 8 years (2014 onwards). While the worldwide suicide trend shows a higher number of suicides occurring among males, in India, this number among female adolescents surpassed males (Fig. 2). This sift is attributed to various causes of suicide, including academic failure, family problems, and illness, emphasizing the complex interplay of social, psychological, and environmental factors contributing to suicidal behavior among both males and females. Suicide due to illness, a major and mostly preventable risk caused a total of 1408 reported suicides in 2021 (NCRB, 2022). Among these illness-associated suicide completers, mental health was observed as a major reason for suicide. It was observed that suicide due to suffering from diseases is more common among females than that of males (Fig. 6) which may have its root in the gender disparity in access to healthcare [25] and well-being in Indian society. This similar pattern is also seen in other countries where cultural attitudes toward mental health contribute to gender differences in healthcare [26,27,28]. There is a persistent gender paradox globally that, females are more likely to have suicidal thoughts and attempts, while males have higher rates of completed suicide [28, 29].

Similarly, In the context of prolonged illness, adolescents suffer from painful physical distress for a longer period of their lives and lose patience for living; in the absence of adequate resilience skills and social support, they desperately try to escape the pain, causing the adoption of suicide as a major option. Another reason is that due to prolonged illness, expensive medical care expenditures become unaffordable [31, 32] and the financial burden increases the risk of these vulnerable groups slipping into extreme poverty [33, 34].

Furthermore, in the context of the Child Labour (Prohibition and Regulation) Amendment Act 2016 defining the legal age for employment in non-hazardous occupations as 15 years [35], the NCRB report on poverty and unemployment-associated adolescent suicide deaths necessitates the timely and effective implementation of comprehensive social welfare policies and program. Niti Aayog, report 2021 further substantiates this need by indicating the fact that, 7% of India’s population is being pushed into poverty every year due to out-of-pocket expenditures [33], and raising the risks of poor mental health in the country. Similar observations have been reported in a systematic review from South Korea that highlighted low income, unemployment, and financial difficulties as the significant risk factors for suicide [36].

However, there have been several welfare programs initiated under different ministries in the last decade to increase the spending capacity of Indians by making healthcare more affordable for all. “Ayushman Bharat” is a similar umbrella health program at the national level by the Ministry of Health, Government of India while several other programs are available there initiated by various state governments. Though the public subsidy has improved in favor of the poor, it is also a fact that the inequality in the availability and accessibility of healthcare persists which is becoming a major risk factor in mental health care among children and youths in the marginalized section. Additionally, according to the National Mental Health Survey of India 2016, there is a large treatment gap associated with mental health in the country [34]. In the case of adolescents, the lack of proper knowledge and support about mental health creates ambiguity and hampers their scope of going for treatment in everyday life; impaired decision-making increases suicidal tendencies and suicides [36].

In the above context, the national mental health and suicide prevention programs need to explore such barriers and gaps in program implementation towards control and prevention of suicide. National Suicide Prevention Strategy, 2022 has been brought up, primarily aiming for a holistic address of the problem [34]. Developed countries like the United States of America, Canada, and several European countries follow strategies to minimize suicide among adolescents which include different active and passive strategies, such as providing general education about suicide, establishing crisis addressing centers and hotlines, promoting self-esteem and stress management, and developing well-support networks along with regular counseling [37,38,39,40]. Such experiences from other countries indicate that the interventions in India require realizing the emerging needs and adopting timely strategies. It is vital to emphasize that there are several major vulnerable communities and sections that are yet to be evaluated on their mental health care and support needs [41].

One major challenge in India is the lack of systematic reporting of mental health problems among children and adolescents. Similarly, there is a major lack of evidence around the risks and rate of suicide among children and adolescents in various settings. For example, a study in Arunachal Pradesh found that there were only two incidents of officially recorded suicide among the Idu Mismi community in a government report out of more than 250 cases collected through investigation during the same time [42]. We understand the low rate of official reporting of suicide has the reasons in follows: (1) it is a taboo/shame for the family to report suicide; (2) Many times, the attributed causes of suicide carry a significant stigma; (3) Suicide is often considered a deviant behavior from community customary perspective in several traditional societies and resolved through traditional councils rather than bringing to the formal system; (4) Suicide deaths/attempts, while reported in local hospitals, are required to be reported as medico-legal cases, which draws a lot of uneasiness. In this scenario, strengthening the reporting process of suicide in vulnerable populations will itself be an advocacy for the community [43].

Among younger children, suicide attempts are often impulsive. It might also be linked to hyperactivity, issues of lack of concentration as well as emotions like depression, confusion, anger, and stress [44]. Adolescents, on the other hand, face higher stigma and feelings of shame after a suicide attempt, which can drive them to repeated attempts [45]. The barriers to accessing mental health services burdened with various regressive cultural and religious beliefs and practices further lead to the rising trend of suicide among adolescents [46]. Bullying is another major public health issue in the context of mental health among adolescents, associated with serious negative outcomes such as depression, anxiety, delinquency, and suicidal thoughts [47, 48]. In India, it has been a major problem in recent times [49].

Social and economic changes, such as rapid urbanization along with increasing inequality, can contribute to feelings of isolation and hopelessness among young people [50]. Changes in family structures, including higher rates of single-parent households and increased parental expectations, may also play a negative role [51]. Academic pressures, fuelled by the competitive nature of the education system, can lead to stress and anxiety, further exacerbating mental health issues [52]. Additionally, the persistent stigma surrounding mental health in India can prevent young people from seeking help [53]. Improving access to mental health services, particularly in rural areas where resources are scarce, is crucial for early intervention and prevention of suicide [34].

This study underscores the need for a comprehensive approach to addressing the complex factors contributing to the rise in suicide rates among children and adolescents in India. By exploring and understanding these factors, policymakers, healthcare professionals, and communities can develop targeted interventions and support systems to prevent suicide and promote mental health among young people.

Health programs and policies in India around mental health

The Mental Healthcare Bill 2016, which was passed in the Lok Sabha in March 2017 decriminalized suicide and provides mental healthcare and services for persons with mental illness [54]. In recent years, India has initiated and redefined a variety of health programs intended to improve mental health. The National Mental Health Policy (NMHP) of 2014, the Mental Healthcare Act of 2017, Rashtriya Kishore Swasthya Karyakram (RKSK) of 2014, School Health Program (Ayushman Bharat)– 2018, Sarva Shiksha Abhiyan (SSA)– 2011 and National Youth Policy (NYP)-2014, have all been implemented with efforts to enhance the mental health of the children and adolescents of the nation (Table 3). However, as the scenario indicates there is a long way to go to effectively address the obstacles around access and health-seeking behavior around mental health among the children and adolescents in the country [12]. Along with public health supports, social and cultural barriers are to be addressed to ensure the health services be utilized effectively. In the year 2019, India has recorded annual youth suicide rates as 80 per 100,000 in females and 34 per 100,000 in males (compared to 10.4 per 100,000 in the general Indian population) [55]. Though Sect. 309 of the Indian Penal Code (which defines suicide as a criminal act and a non-cognizable offense) has been removed, suicide-related news is still published along with crime news in various Indian newspapers [56]. Similarly, the retrospective data of NCRB India describes a consistent rise in suicide among children and youth in the country (Fig. 7).

Table 3 Government programs and policies addressing adolescent mental health issues in India

Way forward

Addressing the rising rate of suicide among children and adolescents in India requires a comprehensive and multifaceted approach. A focused strategy on illness-related suicide is essential, involving healthcare providers, public helplines, psychologists, teachers, and parents practicing empathy and offering timely support to at-risk children and adolescents. Training in life skills, resilience, optimism, and social support should be integrated into daily routines to help individuals cope with stressors effectively [57,58,59]. Regular health screening, particularly in vulnerable and underprivileged populations, is crucial for the early detection and treatment of health issues that could lead to suicidal behavior. Free counseling services at school and community levels, along with strengthening tele-counseling facilities, including a crisis hotline should be readily accessible to all children and adolescents during their needs [60]. Ensuring gender equity in healthcare access is vital to address disparities and improve mental health outcomes for both males and females. Strengthening the Rashtriya Kishor Swasthya Karyakram (RKSK) like programs through regular evaluation can enhance their effectiveness towards mental health care. Additionally, targeted interventions to reach out to school dropouts are necessary to provide support and prevent associated mental health risks. Implementing strict anti-bullying policies and timely interventions can create a safer environment in schools and colleges. Actively incorporating life skill development activities like yoga and meditation into school curricula can promote resilience from an early age. Continuous evidence generation and third-party evaluations of government programs are essential for refining strategies and effectively addressing adolescent mental health issues.

Conclusion

This study gives an in-depth understanding of the historical and recent context of rising suicide rates among Indian children and adolescents over the last 26 years. The findings highlight the urgent need for targeted interventions to address the multifaceted factors contributing to this public health crisis. The prevalence of suicide among this vulnerable population is deeply concerning, especially considering India’s status as home to the largest adolescent population globally. The study highlights the need for strict regulations and enforcement measures to restrict access to lethal means of suicide, such as hanging and poisoning. It also emphasizes the importance of addressing the underlying causes, including academic pressure, family problems, relationship factors, mental health issues, poverty, unemployment, and mainly inadequate support systems which contribute to the growing trends of children/adolescent suicide in India. The study highlights the importance of a holistic approach to suicide prevention. Efforts should focus on raising awareness, decreasing stigma, timely planning, and developing early intervention programs. It was understood that a comprehensive approach is required at government agencies, healthcare providers, educational institutions, policymakers, educators, and the community level to create and implement effective suicide prevention strategies.

Strengths and limitations of the study

The strength of this study lies in its longitudinal analysis, which spans 26 years from 1995 to 2021, offering a comprehensive examination of trends in child and adolescent suicide rates in India. By utilizing the ARIMA (0,2,1) model, the study also forecasts the suicide rate for the next decade, providing valuable insights into potential future scenarios. This foresight can help policymakers and healthcare professionals prepare for potential challenges and allocate resources effectively. Similarly, by using negative binomial regression, we have been able to highlight the trends of suicide over the period.

However, the study also has limitations. The study relies on data from the National Crime Records Bureau (NCRB), which may have limitations in terms of accuracy and completeness. Additionally, the study focuses on children and adolescents, one from 1995 to 2013 and another from 2014 to 2021, as the NCRB’s age-wise reporting may be insufficient. The study does not explore regional variability in children and adolescent suicide rates within India, which could provide additional insights into the factors contributing to suicide. Furthermore, the lack of contextual evidence for the increase in suicide rates weakens the discussion of trends over time.

Despite these limitations, the study’s strengths, particularly its comprehensive analysis and forecasting, offer important information about suicide among children and adolescents in India.