Substance Use
Effect of State-Wide Alcohol Ban in Bihar, India on Suicides: A Synthetic Difference-in-Difference Analysis Siddhesh Zadey* Siddhesh Zadey Zadey Zadey Zadey Columbia University
Statement of Purpose: Suicides have a large mortality burden in low- and middle-income countries. Chronic and acute alcohol use can increase the suicide risk through complementary pathways, by driving more frequent suicidal ideation and attempts. Whether a population-level reduction in alcohol consumption reduces suicide incidence in this context remains an open question. In 2016, the northern Indian state of Bihar enforced a statewide alcohol ban. The aim of this study was to assess the effect of this ban on the overall suicide death rates and the proportions of deaths involving alcohol.
Methods: The Indian National Crime Records Bureau provided annual, uninterrupted state-level counts of overall suicide deaths and those involving alcohol/drug use from 2012 to 2022. We used 2012-2015 as the pre-intervention period and 2017-2022 as the post-intervention period, with Bihar as the intervention state and 28 other states and union territories as control states. Given the limited pre-intervention period and the potential bias in effect estimates arising from choosing control states, we estimated the average treatment effect on the treated using synthetic difference-in-differences (synthdid package in R 4.4.3).
Results: The alcohol ban was not associated with a significant reduction in overall suicide rate (ATT [95% CI]: -0.23 [-8.94, 8.49]) or proportion of suicide deaths involving alcohol injuries (-0.21 [-8.48, 8.06]).
Conclusion: We found that the Bihar alcohol ban did not significantly reduce the proportion of alcohol-involving suicides or the overall rate of suicide deaths. While the ban has been known to have affirmative impacts on other health outcomes, we did not observe effects related to suicide prevention.
Significance: This is the first study investigating the impact of Bihar’s alcohol ban on suicides.