Introduction

Suicide remains a critically important global public health issue, with approximately 727,000 deaths worldwide each year, ranking as the third leading cause of death among individuals aged 15-29 (1). Around 73% of suicides occur in low- and middle-income countries. The causation is multifactorial, involving social, cultural, biological, psychological, and environmental factors (2). Major contributors include mental health disorders, substance abuse, trauma, social isolation, financial hardship, relationship conflicts, and chronic illness (3). Globally, poisoning is the most prevalent suicide method, followed by hanging and self-immolation (4). Vulnerable groups such as daily wage earners, women, students, and farmers disproportionately bear the burden. Suicide rates vary significantly among countries, with Greenland, Guyana, and Lithuania reporting some of the highest rates per 100,000 population, while India, Australia, and the United States have moderate rates (5). Males are at higher risk, with suicide mortality nearly double that of females (6).

India recorded 171,418 suicides in 2023, a marginal increase of 0.29% from 170,924 in 2022, with a slight decline in the suicide rate from 12.4 to 12.3 per 100,000 population (7,8). This marks the second highest suicide rate in India since 1966. Most affected populations include youth aged 15-39 years, with 71% of suicides under 44 years, contributing to a significant socio-economic burden (9). The male-to-female ratio remains around 72.5% to 27.4% (10). The states with the higher suicide rates include Kerala (30.6), Telangana (27.7), and Chhattisgarh (26.0), with Maharashtra, Madhya Pradesh, Tamil Nadu, and Karnataka reporting the highest absolute numbers of suicides (11). Regional disparities stem from factors like literacy rates, socio-economic conditions, and cultural norms.

Student suicides have notably increased, reaching 13,892 deaths in 2023, a 6.5% rise from the previous year and a 34.4% increase since 2019. Daily wage earners remain the largest affected group. Family issues and illnesses are the leading causes of suicide, followed by failure in examinations and love affairs among younger populations. Some Union Territories like Andaman & Nicobar Islands (49.6) and Sikkim (40.2) report the highest suicide rates, while northern states generally show lower rates (12). Data discrepancies between the National Crime Records Bureau (NCRB) and Health Management Information System (HMIS) in India highlight challenges in suicide reporting (7). NCRB shows a slight increase in suicides, whereas HMIS indicates a growing trend, emphasizing the need for improved data collection for targeted prevention efforts (13). The overall Indian suicide landscape mirrors global patterns of rising rates, with critical vulnerable groups and significant regional variability requiring focused intervention strategies (14). The objective of this study is to examines the temporal trends in suicide rates across India from 2020 to 2023 using NCRB data, identify key socio-demographic and etiological risk factors, and assess their implications for prioritizing suicide prevention within national public health framework.

Methodology

This study employed a comprehensive secondary data analysis approach, integrating findings from official national suicide statistics, epidemiological research, and qualitative studies to examine the multi-dimensional impact of suicide in India (15). Suicide mortality data from the National Crime Records Bureau (NCRB) reports between 2020 and 2023 were analyzed to identify temporal trends, regional disparities, and demographic patterns, including age and primary causative factors. Complementary literature reviews were conducted utilizing peer-reviewed publications from electronic databases such as PubMed, Scopus, and Google Scholar, focusing on psychosocial, economic, and cultural determinants of suicide as well as bereavement impacts. Qualitative insights from recent Indian studies exploring familial, social, and community repercussions of suicide were synthesized to contextualize statistical findings (16). Cross-sectional, case-control, and ecological study designs reported in the literature provided a heterogeneous but comprehensive perspective on suicide risk factors and postvention challenges (17).

Results

Types of Factors for Suicide in India

The suicide in India is multifaceted and deeply intertwined with socio-economic, cultural, and psychological factors (18). According to the 2023 NCRB report, family problems and illnesses emerge as the leading causes, accounting for nearly one-third and one-fifth of suicides, respectively (19). Beyond these primary factors, a spectrum of issues ranging from substance abuse and marriage-related conflicts to financial distress, academic pressures, and mental health disorders contribute significantly to the overall suicide burden (Table.1) (20). These causative factors vary across different demographic groups and regions, reflecting India’s diverse societal fabric. Understanding the types and prevalence of these factors is essential for developing targeted suicide prevention strategies that are sensitive to the complex realities faced by vulnerable populations (21).

Family Problems: It is the most frequently reported cause of suicide, accounting for approximately 31.9% of cases (22). This category encompasses a wide range of interpersonal conflicts, including but not limited to martial disharmony, domestic violence, and other familial disputes (23). Such conflicts often lead to emotional distress and a sense of isolation, significantly elevating suicide risk.

Illness: Physical and mental illnesses collectively contribute to 19% of suicides (24). Chronic physical conditions such as cancer, paralysis, and chronic pain, alongside mental health disorders like depression and bipolar disorder, are prominent risk factors (25). The 2023 data indicate an increasing in suicides linked to illness, underscoring the critical intersection of health and mental well-being (26).

Substance Abuse: Addiction to drugs and alcohol accounts for 7% of suicides (27). Substance abuse exacerbates existing psychological stressors and can impair judgement, thereby increasing vulnerability to suicide behavior (28). It often coexists with other causal factors, compounding overall risk.

Marriage-Related Issues: Legal and social complications related to marriage, including dowry disputes, contentious divorces, and marital conflict, represent about 5.3% of suicide cases (29). These stresses are particularly pronounced among women, reflecting entrenched cultural and societal pressures.

Love Affairs: Romantic relationship failures and conflicts contribute to 4.7% of suicides (30). The emotional turmoil arising from breakups, unrequited love or social disapproval can precipitate suicidal ideation and actions, especially among younger demographics (31).

Bankruptcy or indebtedness: Financial distress, encompassing bankruptcy and indebtedness, accounts for 3.8% of suicides (32). The stress associated with economic instability frequently erodes psychological resilience and exacerbates feelings of hopelessness (33).

Academic Pressure: Academic failure and the intense stress surrounding examinations and educational achievement contribute to approximately 1.4% of suicides (34). This cause predominantly affects adolescents and young adults, highlighting the need for supportive mental health interventions in educational settings (35).

Unemployment and Professional Issues: Unemployment accounts for 1.8% of suicide, while professional or career-related difficulties contribute an additional 1.2% (30). These factors disproportionately affect middle-aged males and are linked to the loss of social status and economic security, leading to increased psychological distress (36).

Mental Health Disorders: Psychiatric illnesses such as depression, anxiety disorders, and other mental health conditions are strongly correlated with suicide risk (37). These disorders impair cognitive and emotional functioning, often precipitating suicidal behavior if untreated.

Violence and Abuse: Exposure to domestic violence and other forms of trauma or abuse is a significant factor in suicides, particularly among women and adolescents (38). Such experiences contribute to chronic psychological distress and a heightened risk of suicide.

Social and Cultural Pressures: Societal expectations, rapid modernization, and the challenges of social change exacerbate vulnerability to suicide (39). These pressures are especially notable in more developed states, where the dissonance between traditional values and contemporary lifestyles may induce psychological strain (40).

Previous Suicide Attempt: A history of prior suicide attempts represents the most potent individual risk factor for completed suicide (41). Individuals with such histories require targeted and sustained interventions to mitigate ongoing risk (42).

Other factors: Additional but less frequently reported causes include property disputes, bereavement, poverty, suspicious or illicit relationships, decline in social reputation, and issues related to infertility or impotency (43). Though accounting for a smaller proportion of suicides, these factors contribute to the multifaceted nature of suicide risk.

State-wise Suicide Rates in India

State-wise suicide rates in India exhibit substantial heterogeneity, shaped by complex socio-economic, cultural, and demographic factors (44). Recent data reveal that while populous states such as Maharashtra, Tamil Nadu, Madhya Pradesh, Karnataka, and West Bengal contribute nearly half of all suicides nationally, smaller states and union territories like Andaman & Nicobar Islands, Sikkim and Kerala report some of the highest suicide rates per 100,000 population (Table.2) (45). This regional disparity is influence by factors including literacy, economic conditions, social norms, and data reporting accuracy, necessitating nuanced, region-specific prevention strategies. The suicide rate trends from 2020 to 2023 across Indian states demonstrate significant regional and temporal disparities (46). Notably, Andaman & Nicobar Islands recorded the highest rate in 2023 although preceding data remain unavailable (47). Sikkim and Kerala consistently show elevated rates with gradual increases, reflecting persistent underlying challenges (48). States such as Telangana and West Bengal exhibit significant upticks, whereas populous northern states like Bihar and Uttar Pradesh, despite lower absolute rates, manifest the largest percentage growths, indicating emerging vulnerabilities (49). Meanwhile, Maharashtra, Karnataka, Tamil Nadu and Madhya Pradesh maintain relatively stable, yet high, rates, underscoring a sustained public health concern (49). These patterns highlight the heterogeneous nature of suicide epidemiology in India, emphasizing the critical need for regionally tailored prevention strategies and enhanced surveillance systems to address this multifaceted issue effectively.

Andaman and Nicobar Islands: The Andaman and Nicobar Islands reported the highest suicide rate in India in 2023 at 49.6 per 100,000 population, significantly surpassing the national average of 12.3 (49). This represented a 17% increase from the previous year, indicating a concerning upward trend (49). Factors influencing this high suicide rate include socio-economic challenges, limited access to mental health services due to geographic isolation, high unemployment, and social stressors exacerbated by the small population and close-knit community dynamics (50). Substance abuse and family conflicts are also reported as contributing causes. The territorial administration faces significant challenges in deploying adequate mental health infrastructure and preventive measures tailored to the unique geographic and socio-cultural context of these islands (51). Addressing these multifaceted issues through targeted mental health programs, improved healthcare accessibility, and community engagement initiatives is critical for reducing the suicide burden in the Andaman and Nicobar Islands.

Sikkim:Sikkim state has consistently reported the highest suicide rates in India over recent years, with 293 suicides in 2022 corresponding to a rate of 43.1 per 100,000 population, a 10.2% increase from 2021 (52). Historical district-wise data (2004-2014) show significant regional disparities, 50.6% of suicides occurred in eastern districts, followed by western (25.3%), southern (21.9%), and northern (2.2%) districts, aligning with population distributions (53). Males represent approximately 65.5% of suicides, predominantly among young adults aged 21-30. Hanging constitutes the most common method (94.8%) (54).

Multiple factors contribute to Sikkim’s elevated suicide rates, including high unemployment particularly among educated youth and academic pressures within a competitive educational system (55). Substance abuse, notably opioid and alcohol use, is prevalent and strongly linked to suicide risk. Mental health issues such as bipolar disorder and eating disorders are common, exacerbated by a shortage of mental health professionals and pervasive social stigma (56). Social and family conflicts, rapid socio-economic transitions, rural isolation, and youth vulnerability further compound the risks. Effective suicide prevention in Sikkim demands multifaceted, culturally sensitive interventions that address socio-economic hardships, enhance mental health infrastructure, reduce stigma, and provide community support tailored to the region’s unique demographic and geographic context (57).

Kerala:Kerala has consistently recorded higher suicide rates compared to the national average, with a steady rise observed over recent years. The suicide rate increased from 26.9 per 100,000 population in 2021 to 28.5 in 2022, and further to 30.6 in 2023, positioning Kerala as the third highest in the country (58). In 2023, the state witnessed 10,972 suicides, marking an 8% increase from the previous year. Suicide incidence is notably high among the unemployed youth, with Kerala reporting the highest number of suicides in this demographic nationally (58). Family issues remain the predominant reason, accounting for about 43.1% of suicides, surpassing the national average (7). Health-related problems also contribute significantly, involved in approximately 21.9% of cases (59). Most victims are males (82%), primarily within the 30-60 age group. Hanging and poisoning are the most common suicide methods (60).

Several factors influence the high suicide rates in Kerala. Socio-economic pressures, including high unemployment rates (7.2% in 2023-24, exceeding the national average of 3.2%), particularly among women, contribute to psychological distress (61). Academic and occupational stress, family conflicts, and mental health conditions such as depression are prevalent (23). Despite relatively advanced health infrastructure, Kerala faces challenges in mental health service accessibility and stigma around mental illness. Regional disparities also exist within the state, where Thiruvananthapuram, Idukki, and Kollam report some of the highest suicide rates (62). Addressing these multifaceted factors through enhanced mental health resources, social support systems, and targeted prevention program is imperative to mitigate Kerala’s sustained suicide burden (63).

Telangana: Telangana recorded 10,580 suicides in 2023, marking a 6% increase from 9,980 cases in 2022 (52). The suicide rate stood at 27.7 per 100,000 population, ranking fifth among Indian states and significantly above the national average of 12.3 (8). Family related problems were the predominant cause, accounting for 44.2% of suicides, notably higher than the national average (49). Mental and physical illnesses contributed to 18% of cases, while substance abuse-related suicides numbered 119. Men constituted roughly 78% of suicides, with poison ingestion as the leading method followed by hanging (49).

Occupationally, daily wage earners represented the largest group of victims at 27.5%, followed by self-employed individuals (49). Student suicides numbered 582, notably exceeding farmer suicides, which have declined in recent years (49). Four mass or family suicide incidents involving 11 individuals were also reported. The high suicide rate in Telangana is influenced by family conflicts, mental health issues, socio-economic stressors, and substance abuse (64). Targeted mental health programs, social support services, and public awareness campaigns are essential to address this complex public health challenge effectively.

Tamil Nadu:From 2020 to 2023, Tamil Nadu consistently reported one of the highest numbers of suicides in India (65). In 2020, the state recorded approximately 18,000 suicides, increasing gradually to about 19,483 cases in 2023, accounting for roughly 11-12% of all suicides nationally (49). The suicide rate in Tamil Nadu stood higher than the national average, with Chennai and other major districts reporting substantial numbers (65). The predominant causal factors for suicide in Tamil Nadu during this period included family problems, which contributed to about 50% of suicides, followed by illness accounting for around 18-21% (52). Mental illness and prolonged physical ailments were significant contributors, with a noted increase in suicides linked to chronic illnesses (66). Other factors identified were economic stress, substance abuse, personal relationship issues, and pandemic related psychological distress such as loneliness, fear and uncertainty during COVID-19 (67).

Long-term effects of Suicide on families and communities

Emotional and Psychological impact on families: The emotional and psychological impact on families bereaved by suicide is profound and multifaceted. Such families experience higher risks of mental health disorders including depression, anxiety, post-traumatic stress disorder (PTSD), and complicated grief, which often persist longer and present with greater severity than grief from other causes (68). Survivors frequently endure intense feelings of guilt, shame, self-blame, anger, and confusion, exacerbated by social stigma and isolation specific to suicide. This bereavement can be traumatic, with some family members developing suicidal ideation or engaging in high-risk behaviors like substance misuse (69). Children within these families are particularly vulnerable, often facing increased risks of mental health difficulties, impaired academic performance, and substance abuse, with potential long-term and intergenerational consequences if unaddressed (70). These complex emotional and psychological burdens necessitate culturally sensitive support systems and targeted mental health interventions to facilitate healing and prevent adverse outcomes among survivors.

Social and Relational Consequences: Suicide profoundly disrupts family and social relationships, often resulting in increased conflict, breakdown of familial bonds, and social withdrawal as survivors struggle to cope with loss (71). The pervasive stigma surrounding suicide and the reluctance to openly discuss its causes frequently exacerbate feelings of isolation, impeding access to vital support systems (72). Additionally, families dealing with suicide face significant financial burdens, including funeral expenses, loss of income and costs associated with seeking professional mental health care (73). These social and relational consequences compound the challenges of recovery and highlight the importance of comprehensive support frameworks for suicide survivors and their families.

Community-Wide Ripple Effects: Suicide’s impact extends far beyond the deceased and their immediate family, affecting a wide network of friends, acquaintances, colleagues, and community members, some with limited contact with the individual (74). Research indicates that approximately 135 people are significantly affected by each suicide, illustrating the extensive social ripple effect (75). This broad impact can lead to collective feelings of fear, anxiety, and a breakdown in community trust and cohesion. Importantly, exposure to suicide increases the risk of suicidal thoughts and behaviors in those closely connected to the deceased, potentially perpetuating cycles of trauma and suicide clusters within communities (76).

Discussion

Geographically, Indian states reveal heterogeneous suicide patterns with varying rates and determinants. States like Kerala and Sikkim exhibit persistently high suicide rates, influenced by socio-economic stress, mental health challenges, and substance abuse (77). In contrast, states such as Bihar and Uttar Pradesh, though presenting lower absolute rates, demonstrate significant proportional increases indicative of emerging vulnerabilities (78). The Andaman and Nicobar Islands report the highest suicide rate nationally, attributed to geographic isolation and limited mental health infrastructure (45). Telangana presents considerable suicide mortality with predominant causes including family conflicts and mental illnesses, compounded by occupational and socio-economic stressors (79).

Temporal analyses from 2020 to 2023 reflect a nationwide upward trend in suicide rates, with young adults aged 18-30 years constituting the most affected demographic (80). Primary drivers encompass family problems, health-related issues, substance abuse, and economic insecurity (81). These multifactorial determinants necessitate tailored, region-specific intervention frameworks addressing the complex interplay of individual, familial, societal and structural factors. The social and relational consequences of suicide further exacerbate these challenges (82). Bereavement can precipitate the erosion of family structures, heightened interpersonal conflicts, and social withdrawal (83). Societal stigma and reluctance to disclose the circumstances of death intensify survivors’ isolation, limiting their access to supportive resources (84). Financial hardships, arising from funeral costs, loss of income, and healthcare expenses, compound familial distress (85). These factors collectively impede recovery, underscoring the necessity for accessible, stigma-sensitive support mechanisms.

Beyond the immediate familial sphere, suicide’s ripple effects cascade into broader communities, impacting friends, colleagues, and acquaintances with varying degrees of connection to the deceased (86). Empirical evidence indicates that a single suicide can affect as many as 135 individuals, engendering community-wide fear, anxiety, and diminished social cohesion (87). The phenomenon of suicide contagion, wherein exposure increases the risk of suicidal behavior among connected individuals, highlights the potential for cyclical trauma and suicide clusters, necessitating vigilant community-level mental health surveillance and preventive outreach (88).

The phenomenon of suicide exerts a profound and multifaceted impact extending beyond the individual to their family, social networks, and communities, necessitating a comprehensive understanding for effective prevention and postvention interventions (89). Families bereaved by suicide are disproportionately vulnerable to a spectrum of adverse psychological outcomes, including major depression, anxiety disorders, post-traumatic stress disorder (PTSD), and complicated grief (68). These manifestations often exceed those observed in other forms of bereavement, characterized by increased intensity and duration. Survivors frequently experience complex emotions such as guilt, shame, self-blame, anger, and confusion, which are compounded by social stigma and isolation unique to suicide bereavement (90). Notably, some family members develop suicidal ideation and engage in high-risk behaviors like substance misuse, underscoring the intergenerational and cyclical nature of suicide impact, especially among vulnerable populations like children whose mental health and academic trajectories may be adversely affected (91).

India’s National Suicide Prevention Strategy (NSPS), formally launched in 2022 by the Ministry of Health and Family Welfare, represents a pivotal multisectoral framework designed to curtail suicide mortality by 10% by 2030, aligning with global Sustainable Development Goals (92). This fosters community-centric crisis intervention mechanisms, and promotes cross-sectoral partnerships involving health, education, agriculture, and media domains. By addressing systematic gaps in suicide surveillance and response, the NSPS adopts an evidence-informed approach grounded in epidemiological data from the National Crime Records Bureau (NCRB) and the National Mental Health Survey (7).

Central to the NSPS are expanded District Mental Health Programmes (DMHPs), now operational in 767 districts covering approximately 90% of India’s districts under the National Health Mission, delivering outpatient services, psychotherapeutic interventions, pharmacotherapy, and outreach at community health centres and primary health centres (23). Complementary tele-mental health initiatives, such as the Tele-MANAS platform with over 53 operational cells, have managed more than one million calls since inception, facilitating 24/7 crisis support and referrals (93). Educational components emphasize mental well-being curricula in schools and colleges, alongside workplace stress management and life skills training, to cultivate resilience among youth and vulnerable professionals (94).

The strategy prioritizes restricting access to prevalent suicide means, notably pesticides in agrarian contexts, through regulatory measures and safe storage protocols, while tailoring interventions for high-risk demographics including farmers, women, and adolescents (95). Media guidelines advocate responsible reporting to mitigate contagion effects, drawing from World Health Organization protocols adapted to Indian contexts (96). State-specific adaptations, such as localized helplines and culturally attuned awareness campaigns in regions like Karnataka, exemplify the NSPS’s decentralized ethos, enhancing regional relevance amid diverse socio-economic challenges (97).

The comprehensive data underscore the critical need for integrated suicide prevention strategies encompassing robust mental health services, stigma reduction initiatives (98). Enhanced surveillance, culturally sensitive bereavement support, and targeted public health policies are paramount to breaking the cyclical nature of suicide and mitigating its profound psychosocial consequences in India (92).

Limitations

The limitations of this study primarily stem from data reliability and methodological challenges inherent in suicide research in India. Official statistics from the National Crime Records Bureau (NCRB) are prone to underreporting and inconsistencies due to varied data collection procedures, social stigma, and legal constraints surrounding suicide. These factors often lead to misclassification or non-disclosure, hindering accurate prevalence estimates and cross-regional comparisons. The predominance of quantitative registry data also limits exploration of the nuanced socio-cultural and psychological dimensions of suicide and bereavement. Additionally, many studies focus on localized populations, restricting the generalizability of findings nationwide. The absence of longitudinal and intervention-based research further constraints understanding of effective preventive measures. Addressing these limitations requires standardized data collection, mixed-methods research, and culturally tailored, evaluated interventions for more comprehensive insights and effective suicide prevention in India.

Preventative Measures

India’s suicide prevention efforts are centered on integrating mental health services into primary healthcare, expanding tele-mental health platforms (23), and scaling national helplines to improve immediate access to support. Educational institutions implement life skills training and counselling to address youth vulnerability. Targeted programs focus on high-risk groups, including farmers, women and students, while restrictions on access to lethal means such as pesticides are enforced. Community engagement, stigma reduction, and responsible media reporting complement multisectoral collaboration across health, education, agriculture, and civil society. These coordinated strategies, guided by the National Suicide Prevention Strategy (2022), emphasize culturally sensitive, evidence-based interventions utilizing technology, capacity building, and data-driven policy to reduce suicide mortality and enhance mental health resilience nationwide.

Conclusions

The rising suicide rates in India, particularly in states such as Sikkim, Kerala, and Telangana underscore a pressing public health challenge driven by a complex interplay of demographic, socioeconomic, regional, and psychological factors. Young adults and certain regions bear a disproportionately high burden, amplifying the need for targeted mental health interventions and public health strategies. Regional disparities highlight the importance of contextually tailored, empirically grounded policies. Furthermore, the substantial emotional and psychological toll on bereaved families, compounded by stigma and social disruption, necessitates accessible and culturally sensitive support systems. The broad ripple effect of suicide on communities further emphasizes the need for comprehensive prevention approaches addressing both individual and societal dimensions. Strengthening data quality, advancing longitudinal research, and integrating prevention with postvention programs will be crucial for mitigating suicide’s impact and improving mental health outcomes across India.

Conflicts of Interest

There are no conflicts of Interest to declare.

Acknowledgment

The authors are extremely grateful to all authors of case studies, National Crime Records Bureau (NCRB), Assettype.com, International Association for Suicide Prevention, Health.org, Periodic labour force survey, WHO, Tripurainfo.com, Worldpopulationreview.com, Global Suicide Statistics, Healthdata.org, included in this study. The authors gratefully credit DBT-BUILDER Project, Govt. of India in the form of BT/INF/22/SP43045/2021, dt: 22.11.2021 and JSS AHER, Mysuru.

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