Background

Suicide is a major preventable public health issue across the globe. Over 800,000 people die by suicide each year and it is the second most common cause of death among 15 to 29 year olds. Three-quarters of suicides occur in low and middle income countries. In addition to completed suicides, suicidal behaviour (including suicide attempts) represents a significant public health issue; it is estimated that for every completed suicide that occurs another 20 suicide attempts take place. Research on suicide has greatly increased our understanding of its risk factors. However, no one factor causes suicide; it is the result of the complex interaction between biological, social, psychological, environmental and cultural factors.

We will begin by considering the recent World Health Organization report: ‘Preventing suicide: A Global Imperative. The report provides a comprehensive overview of the epidemiology of suicide and its prevention around the world. It is a very long report - you can download the full report from here, but the Executive Summary is available here as a pdf file.

Mental illness and suicide

We have seen that risk factors for suicide and suicidal behavior include poverty, job loss, chronic illness and family history of suicide. One of the key predictors of completed suicide, however, is the presence of a mental illness and those who die by suicide are often in severe psychological distress. Please read the article by Nock et al. (2009). ‘Cross-National Analysis of the Associations among Mental Disorders and Suicidal Behavior: Findings from the WHO World Mental Health Surveys in PLoS Medicine to find out which psychiatric disorders are predictive of suicidal behaviour.

Decriminalisation of suicide

Suicide was not always considered to be a public health issue. Historically, many countries punished those who attempted suicide, often with jail sentences. The majority of countries nowadays consider suicide to be a key health concern as those who attempt or complete suicide often have a mental health condition. However, the World Health Organization reports that over 30 countries still have laws that punish those who attempt suicide, including life imprisonment. Please read the short Lancet editorial about the decriminalisation of suicide in India: ‘Suicide in India: from criminalisation to compassion.’ in The Lancet and the review by Ranjan et al. (2014). ‘(De-) criminalization of attempted suicide in India: A review in the Industrial Psychiatry Journal

Prevention of suicide

Suicide is often preventable, but a comprehensive multisectoral suicide prevention strategy is required for effective co-ordination of suicide prevention efforts at the national level. Please read the report by the World Health Organization (2012). ‘Public health action for the prevention of suicide: A framework’. This is a very long report which provides information on the development of a national suicide prevention strategy, which will help in answering the discussion question. It concludes:

"Suicide is a priority condition globally and has been identified as such by the WHO. A national suicide prevention strategy should be developed through a stepwise approach. Such a strategy acknowledges, as a first step, that suicide is a major problem and that it is preventable. The process of developing a national strategy provides an impetus to suicide prevention by improving awareness among government representatives and local communities. The lack of resources – human or financial – can no longer remain an acceptable justification for not developing or implementing a national suicide prevention strategy. National governments have to focus on ways to use the available resources optimally and collaborate with state and local jurisdictions, as necessary. Once approved by the government, the implementation of the strategy, with its concrete action plans and programmes, will greatly benefit from the broad participation in its development. Suicide prevention is a collective responsibility, and must be spearheaded by governments and civil society throughout the world."

You might also like to access Public health strategies to ensure reduction in suicide incidence in middle and low income nations, which concludes: "Although, it is a well-acknowledged fact that suicides are completely preventable, the public health authorities have failed to halt the rising trend of the suicide because of the presence of various social and health related factors. As suicide is a complex issue, in the low and middle-income nations, the most cost-effective approach is to ensure the integration of suicide prevention program into the primary health care network."

One of the most effective ways to prevent suicide at the population level is ‘means restricting’, which aims to limit the access to lethal methods of suicide which are most commonly used (for example, changing the composition of cooking gas or putting barriers up at locations where people have been known to jump off). Please read the summary or full article by Yip et al. ‘Means restriction for suicide prevention in The Lancet, which provides an overview of means restriction for suicide prevention and some of the challenges of implementing such an approach.

Last modified: Tuesday, 30 July 2019, 9:24 AM