A 34-year-old man with major depressive disorder presents to the emergency department after a suicide attempt. During risk assessment, which of the following is the most common method of suicide in India?

Explanation

## Most Common Method of Suicide in India **Key Point:** Pesticide poisoning (particularly organophosphate compounds) is the most common method of suicide in India, accounting for approximately 25–35% of all suicide deaths nationally, with even higher proportions in rural agricultural areas. Hanging is the second most common method. ### Epidemiological Context According to the National Crime Records Bureau (NCRB) data and WHO reports on suicide in India: - India accounts for a disproportionately large share of global pesticide-related suicides - Easy agricultural access to organophosphates and other pesticides makes this the leading method - Cultural and socioeconomic factors (rural population, farming communities) drive this pattern ### Comparative Methods in India | Method | Frequency | Notes | |--------|-----------|-------| | Pesticide poisoning | 25–35% | Most common; especially organophosphates in rural areas | | Hanging | 20–30% | Second most common; accessible in both rural and urban settings | | Jumping from height | 10–15% | More prevalent in urban areas | | Firearm use | <5% | Rare due to strict licensing laws in India | | Self-immolation | 3–5% | Specific cultural contexts | **High-Yield:** India contributes to approximately one-third of global pesticide suicide deaths. The WHO and multiple epidemiological studies (including Gunnell et al.) identify pesticide ingestion as the single largest contributor to suicide mortality in South Asia, including India. ### Clinical Pearl When assessing suicide risk in an Indian patient — especially one from a rural or agricultural background — specifically enquire about: - Access to pesticides (highest lethality, most common means) - Rope or ligature materials - Height (urban setting) Restricting access to pesticides (means restriction) is a key public health intervention recommended by WHO to reduce suicide rates in India. **Warning:** Do not apply Western epidemiology to India. Firearm suicide dominates in North America (>50%), but is rare in India. Pesticide poisoning, not hanging, is the leading method in India per NCRB and WHO data.