In an Indian study, it was reported that predominant suicidal victims were unemployed males, middle-aged and high school-educated subjects; and they were mostly from a rural background.[6] Even people with low suicidal intention may end up in completed suicides as a result of using more lethal methods and inadequate treatment.[7] In India, it is the comparatively younger people who are suicide victims.[8–9] This phenomenon of successful completion of suicide is a dangerous trend in India. While the population increase in the last decade was 25%, the suicide rate increased by 60%.[10]

In our country, there is a paucity of studies regarding psychological autopsy of suicide victims. Various psycho-social characteristics of suicide victims in the northwest region of India, which had been witnessing a large number of suicides, are inadequately studied. In the year 2003, Chandigarh, which is a small city with a population of 10 lakhs with the highest per capita income, witnessed a large number of suicides. One hundred thirty cases of suicide were reported in the media, and many more must have gone unreported. Many suicide victims were young school-going children. These developments raised an alarm for Chandigarh administration, and it was decided to investigate the problem and initiate interventions at different levels. Department of Psychiatry, Government Medical College and Hospital, Chandigarh, was made the nodal agency for assessment, training, and treatment. Hence in the present study, an attempt was made to investigate suicide cases that occurred in the year 2003, with the following aims and objectives:

In this study, 57.4% of the subjects had migrated from other parts of India and abroad, and 22.4% of the migrated population was from Uttar Pradesh (U.P.). This was followed by Punjab (17.2%), Himachal Pradesh (10.3%), Bihar (6.8%), and Haryana (6.8%). From abroad, the migrated subjects came from Nepal (8.6%). According to the place of migration, a large number of suicide victims were from Aligarh (18.9%), a district of U.P. This was followed by the migrants from Kathmandu (8.6%). Among the migrated sample, a large number of subjects were unmarried (53.4%) and educated up to 12^th class (63.7%). On chi-square analysis, there was no significant difference between the migrant population and the local population with regard to age, marital status, and educational qualifications (P > 0.05).

Hanging was the most common method (72.2%), while 15.8% of the victims used poisoning as a method of suicide. Self-immolation was used by 5.9% of the sample, and 2% of the subjects jumped from roofs of their houses. As many as 50.4% of the subjects committed suicide during daytime (8 A.M.-5 P.M.), 23.7% in early morning (midnight to 4 A.M.), and 13.8% between 8 P.M. and midnight.

As many as 8.9% of the victims had past history of attempting suicide. Psycho-social stressors were found in 61 (60.3%) suicide victims; while 47.5% of the subjects believed interpersonal stressors were the cause of suicide, and 8.9% of suicide victims had financial stressors. Occupational stressors were found in 3.9% of the suicide victims [Table 1]. Ten (9.9%) suicide victims had clashes with law, and 19 (18.8%) victims had pending court litigations. Psychiatric illness was found in 34 (33.6%) cases. However, out of them only 16 (48.5%) suicide victims had sought treatment prior to the attempt. Fourteen subjects were on regular treatment; out of them, only 4 subjects were taking treatment from mental-health professionals. As many as 16.8% of the subjects had epilepsy, while 11.9% of them had depressive episode. Alcohol/substance abuse was found in 23.7% of the subjects.

Behavioral change before attempt of suicide was seen in 57.4% of the subjects. Among the behavioral changes, 35.6% of the subjects became withdrawn, with loss of interest in the surroundings; and 15.8% were irritable and aggressive [Table 1]. Six (5.8%) suicide victims gave hint about their intention to commit suicide to their family members and friends. Half of these cases talked to their spouses about the suicide. Suicide note was found only in five subjects.

In the present study, a male preponderance was observed in the subjects who attempted or committed suicide (male; 57.4% vs female; 42.6%). The commonest age group committing suicide in our study was in the third decade (59.4%), followed by the fourth decade. Shukla et al.[9] and other Indian workers[8,9,11–14] have reported similar findings. Ponnudurai,[14] after reviewing 12 studies on suicidology from different parts of India, has concluded that second and third decade of life seems to be the most susceptible period for Indian suicides. In our study, unmarried victims constituted 57.4% of the total sample. A large number of subjects in our study belonged to low socioeconomic category, and a high percentage of subjects were unemployed. Chandigarh being the capital of two states and being a union territory also, a large number of people from neighboring states migrate here in search of a job. In the present study, a large number of suicide victims (57.4%) were not permanent residents of Chandigarh and had migrated from other states. They were living on the outskirts of Chandigarh in slum colonies. A recent or repeated change of residence is often found to be more prevalent among people who kill themselves than among other people. These findings suggest the importance of social ties in relation to people's propensity to commit suicide. Similar findings were reported in a number of earlier studies.[15,16] Our study endorses the previous research findings that unmarried persons, unemployed persons, and persons with poor socioeconomic status are at high risk of committing suicide.[15,17–18] A job can provide many things. It may offer not only money but also social contacts, social position, support possibilities, and stable routines. The connection between unemployment and suicide is largely dependent on what exactly unemployment means for the individual. In the current scenario in India, employment opportunities are shrinking, and various government and non-government agencies must frame and implement adjustable policies of self-employment to address this emerging problem. The burden of suicide in the northern region of India can no longer be ignored. Recent reports of large numbers of farmers committing suicide in Punjab have raised many eyebrows. It has been observed that the farmers who committed suicide were under huge debts, and the income from agriculture was not adequate to repay the borrowed money. In the absence of any help, these farmers perhaps chose to end their lives. This phenomenon is imposing a challenge not only to mental-health professionals but also to political, religious, and social reformers. Suicide can be the tragic end point of interplay of a wide array of factors, including biological, genetic, social, cultural, psychological, and behavioral factors.[3] It is imperative that multiple approaches be adopted for intervention with the goal of suicide prevention. Government of India enacted the National Rural Employment Guarantee Act on August 25, 2005. Starting April 1, 2008, this act now in 330 districts, is being extended to cover the remaining districts across India. The Government of India guarantees employment upto 100 days to every rural household that demands work. In future, proper implementation of such schemes can prove to be beneficial in tackling the growing menace of unemployment.

Hanging was the commonest method used by the subjects in this study. Similar findings were reported by many authors from Indian studies.[8,9] Some hospital-based Indian studies had revealed that insecticide poisoning was the commonly employed method in committing suicide.[19–21] The present study was conducted in a city where majority of the population is non-agriculturist. Chandigarh being the capital of two states (Punjab and Haryana), law-enforcing agencies implement strict rules and regulations with regard to sale of insecticides in this region. In this study, the time of committing suicide among majority of suicide victims was during office hours (8 A.M.-5 P.M.). The suicide victims might have been alone in their homes during this time to complete the act. In hanging, chances of successful suicide are high; as compared to other methods, no investment and preparation are required for hanging.

Interpersonal stress appears to be the common cause of suicide in this study. Similar observations have been made by several other researchers.[4,8–9] Psychiatric illness was found in 33.6% (n = 34) of the subjects in this study. This figure was higher than the reported rate (23%) in a previous Indian study.[9] We found that 11.9% (n = 12) of the victims had depressive episode, 23.7% had alcohol/substance abuse, and 16.8% of the subjects had epilepsy. As many as 57.4% of the subjects had shown behavioral change before the suicidal act. In our study, less than half (48.5%) of the subjects who were suffering from mental illness and alcohol/substance abuse sought treatment prior to the act, and only 11.8% sought treatment from mental-health professionals. In many international studies, psychiatric illness has been thought to be the most important cause of suicide. In these studies, the proportion of suicide victims with psychiatric illness ranged from 73% to 100%.[2–3] In Chandigarh, there are many public health dispensaries which cater to the general health needs of the local residents. However, general physicians working in these dispensaries have very little exposure to psychiatry during their undergraduate training. In Chandigarh, there is a need of a suicide prevention program to decrease the incidence of suicide in this region. Physicians’ and general practitioners’ education for assessment of suicide risk may be organized through professional medical associations, for example, the Indian Medical Association (IMA), Association of Physician of India (API) etc.