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.