Changes in method specific suicide following a national pesticide ban in India (2011-2014)

Background: This paper investigates whether declines in suicide by insecticide poisoning in India following a national ban on endosulfan in 2011were associated with changes in other methods of suicide and total suicide rates. Method: Method-specific suicide rates between 2001-2014 were calculated using National Crime Records Bureau (NCRB) data by sex, age group and region, with observed rates compared to expected rates for the period post-2011. Results: There were an estimated 20,146 fewer male and 8,418 fewer female suicides by insecticide poisoning and 5542 fewer male and 2679 fewer female suicides by all other methods following the national endosulfan ban. Contemporaneously, an estimated 92% (23,812) of male and 60% (6,735) of female suicides prevented by insecticide poisoning and all other methods were offset to increases in suicides by hanging and other poisoning. Joinpoint regression indicated a decrease in suicide by insecticide poisoning following the endosulfan ban (annual percentage change (APC) of-12.18 among males and-11.89 among females between 2010-2014) while an increase in male suicide by hanging was noted between 2009-2014 (APC of 7.05). Limitation: Suicide rates based on the NCRB data might be an underestimation of the true suicide rates. Conclusion: Declines in suicide by insecticide poisoning were largely offset by an increase in hanging suicides among males, however, this phenomenon was much less prominent in females and contributed to declines in total female suicide rates. Prevention strategies must continue to focus on pesticide bans with simultaneous attention on hanging prevention policies to reduce overall suicide rates in India.