British Journal of Psychiatry (1992), 161, 365—368

Suicide and Self-burning Among Indians and West Indians in England and Wales V. SONI RALEIGH and R. BALARAJAN

Suicidelevelsin EnglandandWales during 1979-83 were low amongmalesfrom the Indian subcontinent(SMR 73) andsignificantlyhighin youngIndianwomen (age-specificratios273 and 160 at ages 15-24 and 25-34 respectively).Suicidelevelswere low inCaribbeans(SMRs 81 and 62 in men and women respectively)and high in East Africans (SMRs 128 and 148 in men and women respectively).The excessin East Africans (most of whom are of Indian origin)was largelyconfinedto youngerages. Immigrantgroupshadsignificantlyhigherrates of suicideby burning,with a ninefoldexcessamong women of Indianorigin.The pressures leading to higher suicide levels among young women of Indian origin highlight the need for making appropriate forms of support and counselling available to this community.

Differential levels of suicide among immigrants in England and Wales were identified in the first national analysis of immigrant

mortality relating to

the 1970s (Marmot et al, 1984). Local studies of attempted suicide among immigrants in this country have contributed furtherto our understandingof the causesleading to self-harm (Burke, 1976a,b; Merrill & Owens, 1986, 1987; Lockhart & Baron, 1987). In a detailedanalysisof national data covering 1970-78, we reported that suicide levels were significantly lower among male immigrants from the Indian subcontinent and significantly higher among young Indian women, as compared with levelsprevalent in England and Wales (Soni Raleigh et al, 1990). In this paper we examine the latest available national data on suicides in England and Wales among two of Britain's largest ethnic minorities, namely those of Indian and West Indian origin. We also discussthe possible causesunderlying the differentials.

Method

of highly inflammable material (E894). This part of the

analysis required the examination of individual death primaries, details of which were provided by OPCS. Categories E893 and E894 were included for examination

because they could include suicidesby burning. The analysis covers immigrants born in the Caribbean

and East African commonwealths, and the Indian sub continent (India, Pakistan, Bangladesh, and Sri Lanka). Immigrants from East Africa were included for analysis because most of them are of Indian origin (Shaw, 1988). Immigrants from the Indian subcontinent were not examined

by country because available evidence suggests that India is sometimesreferredto as undivided, pre-partitionIndia in

recordingcountryof birth at the time of death registration (Marmot eta!, 1984). Thus deaths registered as Indian-born

includesomeof peopleborn in Pakistan. In order to avoid this bias the groups from the Indian subcontinent were

aggregatedfor analysis,and are, for convenience,referred to as Indians in the text. Standardised

95°loconfidence

This study is based on mortality data for England and Wales

for the years 1979—83 tabulated by country of birth of the deceased, compiled by the Office of Population Censuses and Surveys (OPCS). Variations by country of birth in deaths classified as suicide(lCD E950-959) wereexamined, along with accidental poisoning (E850—869) and injury undetermined whether accidentally or purposely inflicted

mortality ratios (SMRs) for ages 15-64 were

computed for the country of birth groups by using the age and sex-specificratesof England and Wales for 1979-83 as standard, and the respective immigrant populations as enumeratedin the 1981census.SMRs and the corresponding intervals are presented

categories: Suicides:

for the following

E950—959

Probable suicides:

(E950—959)+ (E850—869)

Suicides by burning: Probable suicides by

E9581 E958l+ E9881+ E893+

+ (E980—989)

burning:

E894

(E980—989). The last two categories were included because researchers believe that most such deaths are self-inflicted,

SMRs for the individualcategorieswere examinedfor

but not classifiedas suicidebecauseof inconclusiveevidence

consistency, and the salient fmdings are discussed. Ten-year

about intent to die (Adelstein & Mardon, 1975; Bulusu &

age-specificratios werealso computed to examinethe risk of suicide within the 15—64 age band.

Alderson,

1984). In addition,

suicides by burning

were

examinedby analysingthe followinglCD categories:suicide

Results

by burns/fire (E9581), injury undetermined whether accidentally or purposely inflicted by burns/fire (E9881),

During 1979-83 there were 239 suicides among immigrants

accident

aged 15-64fromthe Indiansubcontinent.Thecorresponding

caused

by ignition

of clothing

(E893),

and ignition

365

366

SON! RALEIGH& BALARAJAN

Table 1 Table 3 SMRs1(ages 15—64) for suicidesand probablesuicides SMRS'(ages15-64) for suicidesby burningandprobable amongimmigrantsin Englandand Wales: 1979—83 suicidesby burningamong immigrantsin Englandand Wales: 1979-83 Country of birthMales Country of birth CISuicides2

SMR95%

Males

ClFemaSMRlea 95%

ClSuicides

SMR

95%CIFern SMRales95%

burning2Indiansubcontinent by

Indiansubcontinent73 (89)92-142East (150)62-86115 (26)97-217Caribbean81(83)65-9962 Africa128 (66)99-163148 (31)42-88England andWales100 (5338)-Probable(10 748)-100

234-690984(18)583-1556EastAfrica 418(15) 360-1650820(4)221-2100Caribbean 838(8)

637(11)318-1140361 (4)97-925England

suicides3Indiansubcontinent81(252)71-92117

andWales -100(115)—ftObable 100(179) burning3Indiansubcontinent suicides by

(148)99-137EastAfrica121 282 (20) 172-436868 (33)597-1219EastAfrica (100)98-147147(45)107-197Caribbean112(169)96-13090(72)70—113England 289-1036692(7)277-1426Caribbean 579(11)

(10)205-789England 519 (18) 307-820429

andWales100 (16 155)-100

(8626)-

andWales 100(365)

1. England and Wales 1979-83 = 100, observed number of deaths in parentheses.

2. lCD E950-959: suicide and self-inflicted injury. 3. lCD E950-959: suicideand self-inflictedinjury; lCD E850-869: accidentalpoisoning;lCDE980-989: injury undeterminedwhether accidentallyor purposelyinflicted.

figures for East Africans and Caribbeanswere92 and 114

-100(245)-

1. England and Wales 1979-83 = 100. observed number of deaths in parentheses.

2. lCDE9581: suicide byburns,fire. 3. lCD E9581: suicide by burns, fire; CD E9881: injury undeterminedwhether accidentally or purposely inflicted (burns, fire);lCDE893: accidentcausedby ignitionof clothing;lCDE894: ignitionof highlyinflammablematerial.

respectively. Suicidelevels werelow in Catibbeans(SMRs 81 and 62 in men and women respectively) and high in East Africans (SMRs 128 and 148 in men and women respectively) (Table 1). Men and women born in the Indian subcontinent showed different patterns, with levels bdng low in men (SMR

was largely confmed to younger ages (15—34years), the

73) but not in women (SMR 115). Similar patterns were

contrast,

Theexcessof suicidesin IndianwomenandEastAfricans levels in Indian and East African women aged 15-24 being more than double those recorded nationally (Table 2). In age-specific

ratios

within

ages

15—64 were

generally apparent for the broader category of probable suicides.

consistently low in men from the Indian subcontinent. Among the immigrant groups, suicides by burning

Table 2

Indiansubcontinent(20%comparedwith2% amongall women).SMRsfor suicideby burningshoweda marked

Age-specific

ratios' for suicides (E950—959) among

immigrantsin Englandand Wales: 1979-83

constituted a higher proportion of all suicides than in the general population, particularly among women from the

excess in all the selected immigrant groups (Table 3) in both sexes, with a ninefold excess in Indian and East African of15-2425-3435-4445-5455-64birthMalesIndiansubcontinent8263'7868'83East Country women (SMRs 984 and 820 respectively). Of the 18 burning

suicidesamongwomenfromthe Indiansubcontinent,13 occurred at ages under 35 years, 11 of them in women aged

25—34 (age-specific ratio 1773, 95% CI 884—3173). SMRs

for the broader category of probable suicidesby burning

Africa166'1271245865Caribbean153986953'104England showed similar patterns.

Weexaminedtheindividualcomponentsof thisextended

andWales100100100100100FemalesIndiansubcontinent273'160'966287East definition for consistency, and noted high ratios in the immigrant groups for deaths by burning where an open

verdictwas returned.Women from the Indiansubcontinent

showedthegreatestexcess(SMR721),withsixof theseven deaths occurring at ages 20-29, age-specific ratio 1963, 95%

Africa228'15553182-Caribbean9170765826'England andWales100100100100100 ‘¿P< 0.05. 1. England and Wales 1979-83=100.

CI717-4273.Mortalityratiosforignitionofclothing(E893) and inflammable material (E894) were also consistently elevated, although the number of deaths was low. The excesswas statisticallysignificantfor E893 in Indian women (SMR 879, 95% CI 321—1914) and for E894 in Caribbean

women (SMR 1014, 95% CI 114-3660).

367

SUICIDE AND SELF-BURNING Discussion

authority of elders (especially parents or in-laws), and

unquestioning compliance from younger family Information about ethnic origin is not recorded in members. Thus, interpersonal disputes particularly the censusor at deathregistration. Population-based in relation to marriage and lifestyles, the pressures estimates of immigrant mortality can therefore be of economic competition with the loss of self-esteem derivedonlybyusingcountryof birthof thedeceased associated with failure, and the anxiety attached to non-conformist behaviour have been cited as causes as a proxy for ethnic origin. Our analysis, therefore, of self-harm among the young (male and female), refers to first-generation immigrants and does not include subsequentgenerationsborn in this country, both in India and abroad (Cheetham et al, 1983; since they would be classified as UK-born. This Gehlot & Nathawat, 1983; Haynes, 1984; Kua & Tsoi, 1985; Merrill & Owens, 1986;Adityanjee, 1986; omission will be progessively greater at the younger Pillay, 1987; Marnam, 1988). By the same token, the ages. It is estimated that in 1981, 49% and 36% support and companionship provided in Indian respectively of the Caribbean and Indian populations society to elders places them at lower risk. Studies in Britain were UK-born (Population Statistics Division OPCS, 1986). East Africans are less affected of self-inflicted injury among Indian immigrant by this qualification, sincemost migration from East communities seldom cite racial prejudice as a significant contributory factor. Africa occurred more recently. These pressures are intensified in young Indian Our finding that suicideratesare low among males from the Indian subcontinentbut not among Indian

women, given their rigidly defined roles in Indian

womenis consistentwith previouslyreportedpatterns

society. Submission and deference to males and elders, arranged marriages, the financial pressures

(Som Raleigh et al, 1990). Suicide rates were consistently low in Indian men of all ages, but in

imposed

by dowries,

and ensuing

marital

and family

Indian women, low suicide levels at older ages conflicts have been cited as contributory factors to contrastedwith an excessat youngerages,particularly suicide and attempted suicide in young Indian at 15—24 yearsof age when the risk was almost three

women

times greaterthan that observednationally. Patterns in East African women were similar to those observedin Indian women, which is not surprising

relatingas much to Indiaas to immigrantcommunities abroad. The causes of self-inflicted injury among people of Indianorigin abroad are thus not dissimilar to those seen in the country of origin, suggesting that

since most immigrants from East Africa are of Indian origin and probably reflect the samecultural

in several

of

the studies

reviewed

here,

they are not particularly attributable to migration,

traditions. East African men, however, showed although they are probably exacerbated by the dissimilar patterns to Indian men, with an overall pressures following the move to a different social excessof suicides,particularly at younger ages.This environment. Epidemiological studies on psychological morbidity divergence could perhaps be explained by the fact that male migrants from the Indian subcontinent are predominantly of rural origin, whereas East African immigrants belong predominantly to the upper socioeconomic and entrepreneurial classes (Halsey, 1988). High suicideratesamong young Indian women are reported both from within India (Adityanjee, 1986) and from countries where immigrants of Indian origin have settled (Haynes, 1984; Maniam, 1988).

Similar patterns are reported for attempted suicide in Indian women from Malaysia (Maniam, 1988), Singapore(Kok, 1988), and South Africa (Cheetham

et al, 1983). Local studiesin Britain have also identified high rates of attempted suicide among

young Indian women and an absence of older Indian patients (Burke, 1976a; Merrill & Owens, 1986). Most immigrantIndiancommunitieshave main

tamed their culturalidentity and traditions even after generations of overseas residence. This tradition incorporates a premium on academic and economic success, a stigma attached to failure, the overriding

among Asians in Britain present mixed findings

(London, 1986), with some showing higher rates of hospital admissions (Carpenter & Brockington, 1980; Dean et al, 1981). This has not, however, been consistently demonstrated. On the basis of both his in-patient (Cochrane, 1977) and community studies (Cochrane & Stopes-Roe, 1981), Cochrane concluded that Indians and Pakistanis suffer less psychiatric morbidity than the general British population. He notes, however, that unmarried Indian women and those in the non-manual group have significantly

high symptom levels, although no higher than the average for Englishwomen. We believe that the levels and causes of psychological stress among young Indian women, in particular, need further detailed study. In England and Wales, hanging and poisoning are the most commonly used methods of suicide among both men and women (McClure, 1987), and burning is uncommon. Our results show that burning is a common form of suicideamong Indian immigrants, particularly among young Indian women.

368

SONI RALEIGH

The low suicide rates among West Indian immi grants are consistent with previously reported statistics (Marmot et al, 1984). Studies in Birmingham alsosuggest that,althoughattemptedsuicide ismore prevalent inWest Indianimmigrants thanintheWest

Indies, it is less prevalent than in the indigenous population (Burke, 1976b; Merrill & Owens, 1987). However,

a study in London

showed

a rise in the

incidence of attemptedsuicide among West Indians to the same levelas in the catchmentpopulation

(Lockhart & Baron, 1987).We noted a high level of suicide by burning in this immigrant group, possibly

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Soni Raleigh, PhD, Senior Research Fellow, Institute of Public Health,

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Suicide and self-burning among Indians and West Indians in England and Wales. V Soni Raleigh and R Balarajan BJP 1992, 161:365-368. Access the most recent version at DOI: 10.1192/bjp.161.3.365

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