We read with interest the editorial on suicide prevention from a life course perspective (Reference Gunnell and LewisGunnell & Lewis, 2005). It offers a broad conceptual overview of the issues related to suicide.

Recent reports from Vellore suggest that suicide rates in India are grossly underreported (Reference Joseph, Abraham and MuliyilJoseph et al, 2003; Reference Aaron, Joseph and AbrahamAaron et al, 2004; Reference Abraham, Abraham and JacobAbraham et al, 2005; Reference Prasad, Abraham and MinzPrasad et al, 2005). The average annual suicide rate was 95 per 100 000 for the years 1994-99. The rates in adolescent males and females and those over 55 years were 148, 58 and 189 per 100 000 respectively. Data from India on the contribution of mental illness to suicide rates are limited. A study from Chennai reported a higher risk of mental disorder among people who die by suicide compared with controls (Reference Vijaykumar and RajkumarVijaykumar & Rajkumar, 1999). However, other evidence suggests that chronic stress and precipitating life events rather than severe mental disorders are the major risk factors for suicide. Recent adverse life events, interpersonal stress and relationship difficulties, severe financial distress, the use of alcohol and issues related to gender have all been associated with suicide (Reference Prasad, Abraham and MinzPrasad et al, 2005). The depiction of suicide in the mass media is also contributory. Last but not least is the fact that many people seem to accept suicide as an option when faced with extreme mental distress.

Although psychiatric disorders are often associated with suicide in the West and medical models are employed, in developing countries social, economic and cultural factors must be considered when attempting to explain the persistently high rates, the impulsive and stress-related deaths and the apparent widespread ‘acceptability’ of such an option in society. Considering suicide as a single phenomenon or even as a single final pathway might be simplistic. Many diverse approaches, tailored to regional factors, will have to be implemented simultaneously to produce any global reduction in suicide rates.