Why are more Indian girls than boys dying from self-harm?

A higher number of girls than boys are harming themselves in India, said a study published in The Lancet earlier this month as part of the medical journal’s focus on adolescent health and well being. Many of these cases were not due to mental disorders, but due to the discrimination and restrictions girls face as compared to boys, said the experts behind the study.

The study showed that nearly 50% more girls in the age group of 15 and 20 have died due to self-harm compared to boys of the same age group. Even the overall number of deaths of girls and women between the ages of 10 and 25 recorded due to self-harm in 2013 was about 8% more than the number of male deaths due to self-harm in the corresponding age group. This is despite the fact that there being fewer females in the country than males across age groups, according to the 2011 Census.

Impulsive decisions

The most important factor in cases of girls committing suicide is “the denial to exercise their autonomy”, said Dr Vikram Patel, from the Public Health Foundation of India, and one of the contributors to the Lancet study.

“Our research on this subject only stems from survivors of suicide,” said Dr Patel. “In their individual stories, we see a pattern. There is a huge aspirational gap between what young people expect and what our rigid social environment offers.”

Girls are not given the freedom to have a voice either in their academic pursuits or career choices, or peer relationships, said Dr K John Vijay Sagar, from the Child and Adolescent Psychiatry department at the National Institute of Mental Health and Neurosciences. This is one of the reasons why Dr Sagar is very keen that children are taught coping skills in school.

Dr Patel said that the majority of suicide attempts are the result of impulsive decisions, and not because of mental illness. “Many youth suicides are impulsive, and emotional,” he said. “The brains are not as well developed and they can do something that is lethal. Many young people [who have attempted suicide] are also relieved if they manage to live, and carry on with their lives.”

Social change vs attitude change

Even in suicide attempts by those who are mentally ill, social factors play a role.

Vandana Gopikumar, who runs the Chennai-based non-profit, The Banyan, which works with mentally challenged people, said that while many mental disorders are relegated as biochemical or brain disorders, it was important to examine social conditions too.

“When a girl is 15 and is growing up, they are exposed to the limited resources as compared to boys,” said Gopikumar. “They feel a sense of rejection. There is also a strong correlation between domestic violence and alcoholism. When this cycle comes alive, it clearly influences the growing child’s mind.”

One of the biggest driving factors of self-harm is relationships that conservative families deemed undesirable.

A recent report of a young couple setting themselves on fire in Agra is a classic example of repression in society, Dr Patel said. “A couple of decades ago, an adolescent of about 18 to 19 years would be married and in a sexual relationship,” he said. “Now the sexuality of an adolescent is trapped.”

To address this, India needed to force a policy-level change in its mental health programme and in programmes targeting adolescents, said Dr Sagar. “We can start young with children and teach them coping and problem solving skills at the school setting itself,” he said.

Dr Patel agreed with Dr Sagar that India’s mental health programme needed change, but added that there also had to be a larger national discourse on the social determinants of problems that are driving so many youngsters to despair. “How do we change gender attitudes?” asked Dr Patel. “This is not some corrupted idea from the West. It is a no small matter.”