Introduction:
This study is trying to reveal recent trends in socioeconomic determinants of suicide from south India. Suicide is a public health problem all across the culture irrespective of gender; age race etc., Suicide in ancient times was primarily motivated by sacrificing for respect, religious and socio-cultural values rather than psychological and other immediate factors[1].However, factors contributing to suicide have been changing for decades[2].Health inequity between individuals or groups is one of the most significant causes due to their socioeconomic conditions[3].Socioeconomic variables are currently highly complex and uncertain and this can cause various types of health problems between individuals or groups. Owing to poor socioeconomic conditions, people are unable to make use of resources and opportunities for good health[4].
Suicide is one of the leading causes of death around the globe. Hungary has the highest suicide rate in the world at 66 per 100 thousand[5]. Studies have shown that Finland has the second-highest suicide rate of 43 per 100 thousand and Austria has the third-highest suicide rate of 42 per 100 thousand [6,7]. It is also found that in Asian countries such as India, Japan, and Vietnam, suicide rates are higher than in non-Asian societies[8].The suicide rate in the USA is 10-12 per 100 thousand [6,9]. In India, the suicide rate was 7.8%, in 1967. It rose to 11% in 2013 and it was 15.4 in 2019, according to the survey. In 2017 The National Crime Record Bureau (NCRB) states in India 65 percent of young people who commit suicide are in the age group of 15 to 24 years and it is due to mental illness and most of them are from excluded sections only. The overall social and economic costs of suicide have been measured for approximately $2.3 billion in the world[10].
Studies have already shown that the suicide rate has closely related to poor social and economic conditions including poverty, low levels of education, economic crises, and psychological problems [5,9,11]. In the case of suicide risks associated with socioeconomic status, the highest relative and risk of suicide has been reported for males in unskilled occupation, lower-income, and individuals with low schooling[3, 10, 11]. Among women, the relative risk is highest for psychological issues, and low-schooling as per the study[12]. Studies have noticed that people from the disadvantaged sections commit suicide more recurrently for financial and health reasons [6,13,14]. In addition to this, population-based studies have shown a strong link between poverty, maternal deprivation, vulnerability, and suicide[11,15]. The inverse association between suicide and social cohesion, alienation, and loneliness has also been established in several studies [16,17]. There is a strong correlation between poor social and economic conditions and psychopathology[1,6]. Also, there is a clear association between work loss and failed occupational aspiration, and suicide [4].Altogether depraved social and economic circumstances and psychological problems make the situation much worse[15]. It is also found that the effect of income inequality and low social capital on mental health has contributed a lot to suicide[18].
India is a society based on different castes (a caste is an endogamous group). In India, highly disadvantaged castes have been grouped such as Scheduled caste (SC), Scheduled Tribe (ST), and Other Backward Castes (OBC) for welfare purposes. More than 3800 different individual castes will belong to any three groups and all such cases are marginalized, excluded, and underserved as per the Indian constitution[18].The majority of people belonging to these caste groups have a very low socioeconomic profile[20]. People who belong to these castes will be having the highest percentage of maternal deprivation, hunger, illiteracy, unemployment, homelessness, low-paid occupation, poor income level, and social exclusion [18,20]. Consequently, the suicide rate also is higher in these groups[12,20] and in these issue new studies are required on urgent basis. The major aim of this study is to uncover the socioeconomic determinants of suicide victims from a district in a south Karnataka- India using police records, and the paper has been organized to include the methods, results, discussion, conclusion, and limitations of the study.
Methods
This study is conducted in the Mysore district (includes both city and rural parts) of Karnataka state India. Mysore is predominantly an urban area with a population of approximately 9,21 lakh in the 2011 census and a geographical area of 155,7 km2. This research is conducted on suicide cases in the districts of Mysore for the 2017-2021 reference periods. As per the police record, a total of 923 people had committed suicide in Mysore city and rural areas in the above references period. Out of the 593 are belong to the urban and the rest of them are to the rural areas. Among them, 684 are males and 239 are females. The age range was from 16 to 60 and above. Among them, 300 people from the age group 21-30 and 240 were from the age group of 31-40 years. Out of the total reported cases, 589 are married and 334 are unmarried. Around 684 people belong to the low-income group/below the poverty line (BPL). Around 384 people are from the microscopic communities (other backward castes) and 131 were Dalit’s. In the case of education, 203 are illiterates and 146 have studied up to the primary level only. In the case of occupation, 396 were unskilled, 226 were skilled and 47 were unemployed. More than ¾ respondents are from the nuclear family type. Data were collected on the occurrence of suicide, age, gender, residence (urban or rural), caste and religion, educational qualifications, and occupation of victims from the police stations. The copy of the First Information Report (FIR- to be submitted to the court) in a certain case was retrieved from police reports with permission to find out the exact reason for suicide received from family members or a suicide note by the police. For cross-check, the police report, autopsy, and toxicological reports have been collected in some cases to determine the exact cause of death. To obtain more clarity, we have discussed this report with forensic experts, psychologists, and clinical sociologists.
For the current study, the motive/reason for suicide has been classified as health, loan, mental illness, personal, agricultural, alcohol, education as independent variables. Major socio-economic determinants including income, education, and occupation have been considered as dependent variables and caste as a cofounding factor. We have had an informal interview with the next to the kin of the suicide victim using a structured schedule as referred by the World Health Organization (WHO) verbal autopsy instrument [12]. Ethical approval for the limited interview with the victims has been obtained from the ethical committee of a legally registered body ‘Karnataka Kidney Health Foundation Trust (www.kkhf.in/F.No KKHF 18/2020-2021). Death rates have been calculated with a confidence interval of 95% using SPSS 18.0 version (IBM). We found a significant Cramer’s V value for all major variables. It was calculated by dividing the number of suicides by the number of individuals corresponding to the classification given. The key findings of this study were the correlation between suicide rates with selected socio-economic determinants.
Results
| Table 1: Geographical Distribution and Reasons Found for Suicide |
Reasons |
Mysuru Urban |
Mysuru Rural |
Total |
Health |
108 (54.5%) |
90 (45.5%) |
198 (100.0%) |
Debt crisis |
49 (33.3%) |
98 (66.7%) |
147 (100.0%) |
Mental illness |
282 (69.1%) |
126 (30.9%) |
408 (100.0%) |
Personal reasons |
53 (71.6%) |
21 (28.4%) |
74 (100.0%) |
Agriculture failure |
3 (5.6%) |
51 (94.4%) |
54 (100.0%) |
Alcoholic |
19 (73.1%) |
7 (26.9%) |
26 (100.0%) |
Education |
12 (75.0%) |
4 (25.0%) |
16 (100.0%) |
Total |
526 (57.0%) |
397 (43.0%) |
923 (100.0%) |
|
Chi-Sq Value- 129.095 |
Significant- p<0.000 |
|
Cramer’s V Value-.374 |
Significant- .000 |
 |
 |
Fig 1: Gender Analysis of Reasons for Suicide |
Fig 2: Gender and Age of the Victims |
| Table 2: Age wise Reasons of the Suicide |
Reasons |
<20 |
21-30 |
31-40 |
41-50 |
51-60 |
60+ |
Total |
Health |
14(7.1%) |
61 (30.8%) |
51(25.8%) |
36 (18.2%) |
20(10.1%) |
16(8.1%) |
198 |
Loan |
4(2.7%) |
57 (38.8%) |
48(32.7%) |
21 (14.3%) |
15(10.2%) |
2(1.4%) |
147 |
Mental illness |
38(9.3%) |
144 (35.3%) |
114(27.9%) |
58 (14.2%) |
34(8.3%) |
20(4.9%) |
408 |
Personal reasons |
5(18.5%) |
10(37.0%) |
6(22.2%) |
4(14.8%) |
0(0.0%) |
2(7.4%) |
27 |
Agriculture |
2(3.7%) |
15 (27.8%) |
13(24.1%) |
13(24.1%) |
11(20.4%) |
0(0.0%) |
54 |
Alcoholic |
47(64,3) |
10(13,6) |
7(9.5%) |
4(5.4%) |
4(5.4%) |
1(6.2%) |
73 |
Education |
11(68.8%) |
3(18.8% ) |
1(6.2%) |
1(6.2%) |
0(0.0%) |
0(0.0%) |
16 |
Total |
121(13.1%) |
300(32.50%) |
240(26.0%) |
137(14.8%) |
84(9.1%) |
41(4.4%) |
923 |
|
Chi-Square Value- 161.816 |
Significant- p<0.000 |
Cramer’s V Value- .016 |
Significant- .011 |
| Table 3: Income Level of the Suicide Victims |
Reasons |
Lower |
Middle |
Upper |
Total |
Health |
126 (63.6%) |
60(30.3%) |
12(6.0%) |
198 (100.0%) |
Loan |
132 (89.8%) |
13(8.8%) |
2(1.3%) |
147 (100.0%) |
Mental illness |
300 (73.5%) |
78 (19.1%) |
30(7.3%) |
408 (100.0%) |
Personal |
42 (56.8%) |
27 (36.4%) |
5 (6.7) |
74 (100.0%) |
Agriculture |
51 (94.4%) |
3 (5.6%%) |
--- |
54 (100.0%) |
Alcoholic |
23 (88.5%) |
2 (7.6%) |
1 (3.8%) |
26 (100.0%) |
Education |
10 (62.5%) |
5 (31.2%) |
1 (6.2%) |
16 (100.0%) |
Total |
684 (74.1%) |
188(20.3) |
51 (5.5%) |
923 (100.0%) |
|
Chi-Sq Value- 55.101 |
|
Significant- p<0.000 |
|
Cramer’s V Value- .244 |
|
Significant- .000 |
| Table 4: Caste and Religion of the Suicide Victims |
Reasons |
Scheduled Caste |
Scheduled Tribe |
Other backward caste |
Upper Caste |
Muslim |
Christian |
Total |
Health |
48 (24.2%) |
36 (18.2%) |
76 (38.4%) |
26 (13.1%) |
9 (4.5%) |
3 (1.5%) |
198 |
Loan |
29 (19.7%) |
30 (20.4%) |
66 (44.9%) |
14 (9.5%) |
6 (4.1% |
2 (1.4%) |
147 |
Mental illness |
93 (22.8%) |
65 (15.9%) |
166 (40.7%) |
51 (12.5%) |
24 (5.9%) |
9 (2.2%) |
408 |
Personal |
13 (17.6%) |
14 (18.9%) |
26 (35.1%) |
10 (13.5%) |
8 (10.8%) |
3 (4.1%) |
74 |
Agriculture |
4 (7.4%) |
11 (20.4%) |
31 (57.4%) |
7 (13.0%) |
1 (1.9%) |
0 (0.0%) |
54 |
Alcoholic |
8 (30.8%) |
3 (11.5%) |
12 (46.2%) |
2 (7.7%) |
0 (0.0%) |
1 (3.8%) |
26 |
Education |
4 (25.0%) |
1
(6.3%) |
7
(43.8%) |
1 (6.3%) |
2 (12.5%) |
1 (6.3%) |
16 |
Total |
193 (20.9%) |
157 (17.0%) |
384 (41.6%) |
111 (12.0%) |
50 (5.4%) |
19 (2.1%) |
923 |
Chi-Sq Value- 42.816 |
Significant- p<0.000 |
Cramer’s V Value- .096 |
Significant- .0061 |
| *Scheduled Caste(SC), (Scheduled Tribe/ST )and Other backward caste(OBC/Backward Microscopic communities) |
 |
Fig 3: Association between Occupation and Reason for Suicide |
| Table 5: Association between Level of Education and Reason for Suicide |
Reasons |
Illiterate |
Primary |
Upper Primary |
High School |
College |
University |
Total |
Health |
52
(26.3%) |
23
(11.6%) |
34
(17.2%) |
42
(21.2%) |
30
(15.2%) |
17 (8.6%) |
198 |
Loan |
46
(31.3%) |
25
(17.0%) |
16
(10.9%) |
33
(22.4%) |
18
(12.2%) |
9 (6.1%) |
147 |
Mental illness |
92
(22.5%) |
63
(15.4%) |
51
(12.5%) |
73
(17.9%) |
83
(20.3%) |
46 (11.3%) |
408 |
Personal |
6
(8.1%) |
12 (16.2%) |
7
(9.5%) |
18
(24.3%) |
25
(33.8%) |
6 (8.1%) |
74 |
Agriculture |
16
(29.6%) |
16 (29.6%) |
12 (22.2%) |
7
(13.0%) |
2
(3.7%) |
1 (1.9%) |
54 |
Alcohol |
10
(38.5%) |
6 (23.1%) |
3
(11.5%) |
6
(23.1%) |
0
(0.0%) |
1 (3.8%) |
26 |
Education |
0
(0.0%) |
1
(6.3%) |
1
(6.3%) |
4
(25.0%) |
8
(50.0%) |
2 (12.5%) |
16 |
Total |
222
(24.0%) |
146 (15.8%) |
124 (13.4%) |
183 (19.8%) |
166 (18.0%) |
82 (8.9%) |
923 |
Value- 90.110 |
Significant- .000 |
Cramer’s V Value-- .140 |
Significant- .000 |
Discussion
Suicide is a key issue to public mental health. The study was conducted to provide empirical evidence focusing on key socio-economic determinants and caste to be linked to augmented suicide cases in Mysore districts, Karnataka state South India during the years 2017-2021 using police records. Studies have demonstrated that economic and social determinants such as low schooling, unemployment, and low income have a key link to mental illness and increasing suicide rates [6,13,18,22-24]. The present study adds more supports to the current evidence that mental illness, debt, and health problems are the main cause of suicide in all age groups and these are closely linked to key socio-economic disadvantages. Focusing on geographical distribution (Table 1) the study found a more suicidal rate among urban people (57%) than rural areas (43%) and suicides occur in urban areas due to mental illness, personal reasons, health issues and loan. More competitive environment, insecurity, urban ecology, materialistic life, complex and tough life structure, social conflicts and unrest, affecting on the mental health in urban areas.[6,12]. In rural areas, suicide rates are more due to debt and agricultural failure as we found.
In the case of gender it is observed from (Fig 1/Cramer’s V Value- .244) that the rates of male suicide (74%) were outnumbered, females (26%) we found that among rural males, loan and agricultural failure and poor mental health are the leading causes of suicide, whereas, in urban areas, mental illness and loan are the leading causes of suicide among males. Debt and agricultural failure is causing more mental illness as per the study. In the case of females (urban) suicide are occurring more for personal reasons including clash between tradition and modern family system, love failure, failed jobs, family harassments, dowry system, loss of aspirations, identity crisis, over-ambition, poor mental health, decision making. Mental illness is a second major factor for committing suicide among females here. Further, the findings show a high female suicide rate in rural parts engaged in agricultural-related jobs and this may be attributed to low schooling, early marriage strict patriarchal norms etc. [14,16,18,20]. The current study found that the link between suicide risk and related factors somewhat varied by gender, but was stronger in case of males than females[4].
The study also found that there are more suicide rates in the age group 21-30 due to due to loan, personal reason and mental illness and has a key link to the socio economic background of the family (Table 2). Also it may be attributed to more stress and strain in the age group for the youth who are from the excluded and vulnerable households [25]. Experts call rising number suicide among these age group is 'quarter-life crisis’[10,11,26,27]. Agricultural failure is a key reason for suicide among the middle aged group in rural parts. It's worth for new study that NCRB reports fond 65 percent of suicides in India occur between the ages of 15 and 25. However, according to present study, 31.5 per cent of people between the ages of 21 and 30 commit suicide, while only 13.1 percent of people under the age of 20 committing suicide. Similarly, we observed that children who have experienced childhood poverty, parental treatment, broken marriages of the parents, single parenting etc can lead to the tendency to commit suicide in the latter part of life [18]. In case of gender, early middle aged (31-40) women are committing suicide more because of health and mental illness and has link to the poor economic structure of the household. We find a lower rate of suicide among the elderly, living with their children making them using Government old-age pension schemes. Interviews with the parents have revealed that over expectations of parents, love failure, unemployment, early martial life crisis, pressure to build the life are some of the triggering factor causing mental illness and leads suicide among young people today[18,20].
Regarding income (Table 3), it is found that the suicide rate is higher among people with lower income due to debt, mental illness, and health. Poor health status is also a reason for low income and vice versa. Here males are more in number than females. Because of low income, people are struggling hard to make the life leading to more tension, stress and anxiety etc causing mental illness and it is quite prevalent among people working in unorganized sector [14]. Even a good education may not get decent income jobs. The present study found that the lower the socio-economic factors of the family (especially income and education level and the long-term unemployment of the parents), the higher the incidence of suicides among children or youth in the later part because of the non-fulfilment of the desires and ambitions. Low income may lead deprivation, drug use, violence and crime etc a risk factor for suicide. Upper-class parents normally have a good education and income, which is different from the way they raise children. Some parents opined suicidal cases will be lower for children/youth who grow up emotionally with their parents [28,29].
Caste and religion are perhaps the most critical issues of social life in India, which have been overlooked in many studies [19,20]. In case of caste analysis, a higher suicide rate is (41 per cent) observed among other backward castes where a significant number of the microscopic and marginalized castes can be seen (Table 4) and the cause of suicide attributes due to agricultural failure, loans, and alcoholic. It is observed that there are major cultural variations in suicidal behavior in diverse caste and religious orientation and consequently, the associations of risk factors with suicidal behaviors can be varied [13]. This study has observed that higher suicide rates among the excluded sections like SC, ST, and OBC populations (71%) relative to the general population. Long-standing low socioeconomic profile including exclusion, material deprivation, inequality, stigma, social isolation, identity crisis, depression, low social capital, hopelessness, and low self-esteem has a close nexus with forerunners of poor mental well-being and it may contribute to suicidal tendencies among them [18-20] and here males outnumbered females. Poverty and debt crisis are more severe among excluded or disadvantaged sections and leads negative attitude towards life, a form of mental disorder [19]. This study revealed higher socioeconomic status, lesser suicidal behavior, as seen in most forwarded castes In the case of religion, Muslim and Christian suicide was generally lower than that of Hindus and it might be due to religious prohibition on suicide.
Poverty leads to low schooling and it may end up unskilled and poor-paid jobs and it is common particularly among underserved and excluded castes. Here males outnumbered females. The study found(Fig 3/ Cramer’s V Value- .232) a significant number of suicides among unskilled employees due to loan, alcoholic and material deprivation[10,11,24]. Also we found low wage or irregular payment leads to poverty, livelihood crisis, tension, deprivation etc, leading towards mental illness and finally ends up in suicidal tendencies[6,11,19]. We found debt crisis and habitual alcoholic are more common among people working in unorganized sectors. It shows poverty is also one of the major factors for suicide. Studies have proved a confident and strong link between the apparent level of stress because of financial situations and suicidal ideation[4,7]. However data is not available to prove the link between suicide and macro level parameters [21]. Anthropologists ‘say unemployment problems lead to social cohesion and social fragmentation and finally self-killing’[30]. Further, the study (Table 5) shows a strong association between a low schooling level and suicide rate as more suicide incidents can be seen among people having low level of education. Suicide victims, both males and females aged 20 to 60+, had lower educational attainment when compared to their sex and age counterparts who died for other reasons. We found the higher rate of suicide associated with illiterate people who normally end up with low wage and seasonal jobs in unorganized sectors and struggle hard and depend on loan for livelihood. We found loan, mental illness and the habit of alcohol as key reasons for rising number of suicide among illiterates[5,10]. Also In case of college educated people mental illness as a key reason for suicide again. The study also found that people frequently read about suicide in media; watching it on TV, which can provoke suicide. We also found that youth are committing suicide in the same manner that their favorite film stars, role models, etc., have committed suicide, which requires an urgent multidisciplinary research [19,26]. Also, this study indicates that the annual suicide rate has risen sharply from 2017-2021 in the studied district.
Rapid westernization is pushing us to make a lot of functional changes, both sociologically and psychologically, that have an effect on our society, civilization, solidarity, ideology and inequality etc. on all walks of life. It is proposed that inclusive services aimed at socio-economic inequality targeting the unemployed, people with low income and persons with lower educational levels focusing better or alternative income and educational attainments that help families escape poverty and debt can help to improve their impaired mental health [6,14]. Govt. must have programmes for the better mental health of its citizens and gender based preventive approaches. All these mitigate to remove suicidal behavior among the risky groups. We suggest more study on cultural and geographically specific multilevel models of suicide prevention that are expected to minimize suicide rates and must focus especially on social exclusion and caste on suicidal behavior. Regarding higher suicide rates among excluded castes, we propose that ‘minority stress theory’ should be focused on further research [7,2]. The findings of this study cannot be applied to the other districts of the Karnataka state as the results may not be consistent in district-specific analysis having a different composition of socio-economic, cultural, and other development indexes.
Limitations
The main of this study is the inability to determine accurately all individuals who witnessed the outcome since the analysis is based on the data found in the police reports only. Also, police records had some data problems. The information needed was a little unclear in the police reports. Moreover, under-enumeration of cases due to non-reporting with the police cannot be ruled out also. We could not assess the role of different mental disorders leading to suicide. Also, we didn’t focus on how a different physical and mental health problem leads to low socio-economic issues. We have not contacted the suicidal survivors.
Conclusion
In a transition society like India, people largely believe that suicide is a valid way to escape from difficulties and it has social acceptance also. The linkage between suicide and socio-economic causes could be more nuanced than previously assumed. The outcomes of the present study underscore low education, low occupation, poor income along with other confounding factors such as poverty, social exclusion, material deprivation common among the excluded castes and all these issues leads to poor mental illness and debt crisis, contributing to a suicidal tendency. If the education and income of such people are increased, the effect of other potential causes of suicide would be minimized mainly mental health among lower castes. Intergenerational social and material inequality must be minimized so that families can quickly rebound from poverty. Evidence-based, impactful, and cost-effective social policies are the need of the hour.
Acknowledgements: To the Mysore city police (Karnataka)
Funding:
Nil.
Competing interest:
None
References
- Song J, Park S, Lee K, Hong HJ. Influence of Area-Level Characteristics on the Suicide Rate in Korean Adolescents. Psychiatry Investig. 2019 ;16(11):800-807.
- Joyce P. Chu, Peter Goldblum, Rebecca Floyd, Bruce Bongar .The cultural theory and model of suicide. Applied and Preventive Psychology. 2010;14(1–4): 25-40.
- Rehkopf DH, Buka SL. The association between suicide and the socio-economic characteristics of geographical areas: A systematic review. Psychol Med. 2006; 36(2):145-57.
- Armstrong G, Pirkis J, Arabena K, et al. Suicidal behaviour in Indigenous compared to non-Indigenous males in urban and regional Australia: Prevalence data suggest disparities increase across age groups. Aust N Z J Psychiatry. 2017;51(12):1240-1248.
- Lopez-Contreras N, Rodriguez-Sanz M, Novoa A, et al. Socio-economic inequalities in suicide mortality in Barcelona during the economic crisis (2006-2016): A time trend study. BMJ Open. 2019; 9 (8): e028267.
- Milner A, Page A, LaMontagne AD. Duration of unemployment and suicide in Australia over the period 1985-2006: An ecological investigation by sex and age during rising versus declining national unemployment rates. J Epidemiol Community Health. 2012;67(3):237-44.
- Taylor R, Page A, Morrell S, Carter G, Harrison J. Socio-economic differentials in mental disorders and suicide attempts in Australia. British Journal of Psychiatry. C 2004;185(6): 486-493
- Naher AF, Rummel-Kluge C, Hegerl U. Associations of suicide rates with socioeconomic status and social isolation: Findings from longitudinal register and census data. Frontiers in Psychiatry. 2020;10:898.
- Langley J. New Zealand Injury Prevention strategy: significant shortcomings after 5 years. New Zealand Medical Journal. 2010;123 (1327): 114-20.
- Curtis B, Cate C, Robert F. Socio-economic factors and suicide: The importance of inequality. New Zealand Sociology. 2013;28(2): 77-92.
- Sauvaget C, Ramadas K, Fayette JM, et al. Completed suicide in adults of rural Kerala: Rates and determinants. National Medical Journal of India. 2009;22(5): 228–233.
- Blakely TA, Collings SCD, Atkinson J. Unemployment and suicide. Evidence for a causal association? Journal of Epidemiology and Community Health. 2003;57(8): 594-600.
- Qin P, Agerbo E, Mortensen PB. Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981-1997. Am J Psychiatry. 2003;160(4):765-72.
- Gjerustad, C, Von ST. Socio-economic status and mental health – the importance of achieving occupational aspirations. Journal of Youth Studies. 2012; 15(7): 890-908.
- Arya V, Page A, River J, Armstrong G, Mayer P. Trends and socio-economic determinants of suicide in India: 2001-2013. Soc Psychiatry Psychiatr Epidemiol. 2018; 53(3):269-278.
- Vijayakumar L Hindu religion and suicide in India. In C. Wasserman & D. Wasserman (Eds.), Oxford textbook of suicidology and suicide prevention: A global perspective. Oxford: Oxford University Press;2009. p.345-34.
- Page A, Morrell S, Taylor R, Carter G, Dudley M. Divergent trends in suicide by socio-economic status in Australia. Soc. Psych Epidemi. 2006;41(11):911-7.
- Nayar KR. Social exclusion, caste & health: a review based on the social determinants framework. Indian J Med Res. 2007;126(4):355-63.
- Rey Gex C, Narring F, Ferron C, Michaud PA. Suicide attempts among adolescents in Switzerland: prevalence, associated factors and comorbidity. Acta Psychiatr Scand 1998;98(1):28-33.
- Arya V, Page A, Dandona R. et al. The geographic heterogeneity of suicide rates in India by religion, caste, tribe, and other backward classes. Crisis. The Journal of Crisis Intervention and Suicide Prevention. 2019;40(5): 370– 374.
- Breuer C. Unemployment and Suicide Mortality: Evidence from Regional Panel Data in Europe. Health Econ. 2015; 24(8):936-50.
- Votta E, Manion I. Suicide, high-risk behaviors, and coping style in homeless adolescent males adjustment. Journal of Adolescent Health. 2004;34(3): 237-243.
- Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. International Journal of Epidemiology. 2003;32(6): 902–909.
- Gofman A. Durkheim’s Theory of Social Solidarity and Social Rules. In: Jeffries V. (eds) The Palgrave Handbook of Altruism, Morality, and Social Solidarity. New York: Palgrave Macmillan; 2004. p. 210-28.
- Bartley M. Unemployment and ill health: Understanding the relationship. Journal of Epidemiology and Community Health. 1994;48(4): 333-337.
- Page A, Stephen M, Coletta H et al. Suicide in young adults: psychiatric and socio-economic factors from a case–control study. BMC Psychiatry. 2014;14 (1):68-73.
- Taylor R, Page A, Morrell S, Carter, G, Harrison J. Socio-economic differentials in mental disorders and suicide attempts in Australia. British Journal of Psychiatry. 2004;185(6): 486-93.
- Fergusson, DM, Woodward LJ. Mental health, educational and social role outcomes of adolescents with depression. Arch Gen Psychiatry. 2002; 59(3):225-231.
- Thornley C, Walton V, Romans-Clarkson S. Screening for psychiatric morbidity in men and women. NZ Med J. 1991;104(925):505–7.
- Kawachi I, Berkman L. Social cohesion, social capital, and health. In: Berkman L, Kawachi I, eds. Social epidemiology. New York: Oxford University Press; 2000.p.174–90.
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