Suicide is a well-recognized public health challenge throughout the world. WHO estimates that globally about 800000 people die due to suicide every year, which is one person every 40 seconds (WHO 2016). Suicidal behavior shows marked differences between genders age groups, geographic regions, and socio-political realities and variably associated with different risk factors (Gustavo & David 2017). More than half of the deaths due to suicide occurs in Asian countries. It is estimated that about 2.5% of loss of disability-adjusted life year (DALY) is due to suicide and deliberate self-harm (WHO). Depending on the nation cited by WHO, suicide is one of three leading causes of death in people aged 10-2 years or 15-44 years, and often is an especially large burden late in life, when suicide rates are highest in, many countries (Paul S F, Saman et al 2017). Suicide not only cause death, but it also causes the loss in manpower reduction of the country, loss of many potential years of life substantial loss of economic and emotional costs, disrupting families, communities and society (Law CK, Yip et al. 2011).
Below is some nomenclature for Suicidal Behavior you should know (Gustavo & David 2017 in Suicide and suicidal behavior).
Suicide: A fatal self-injurious act with some evidence of intent to die.
Suicide attempts: A potentially self-injurious behavior associated with at least some intent to die. Comment about this is; Some younger suicide attempters will report that their main motivation is other than to die, such as to escape an intolerable situation, to express hostility, to get attention; however, may nonetheless acknowledge the possibility that their behavior could have resulted in death. Suicide Attempt is characterized by greater functional impairment than non-suicidal self-injury.
Active suicidal ideation: Thoughts about taking action to end one’s life, including identifying a method, having a plan, and/or having the intent to act. Comment for this definition is; more specific suicidal intention like having made a plan or having intent is associated with a much greater risk of a suicidal attempt with 12 months.
Passive suicidal ideation: Thoughts about death, or wanting to be dead with any plan or intent.
Non-suicidal self-injury(NSSI): Self-injurious behavior with no intent to die. Comment for this is; NSSI and Suicidal attempt differ in terms of motivation, familial transmission, age of onset, psychopathology and functional impairment. NSSI most commonly consists of repetitive cutting, rubbing, burning or picking. The main motivations are either to relieve distress, “feel something,” induce self-punishment, get attention, or to escape a difficult situation.
Suicidal events: The onset or worsening of Suicidal ideation or an actual Suicidal Attempt or an emergency referral for Suicidal ideation or Suicidal Behavior. Comment for this is; this endpoint is often used in pharmacological studies. The inclusion of rescue procedures in this umbrella category is because a patient with ideation who then received emergency intervention might have made an attempt had he or she not been recognized and treated.
Deliberate self-harm (DSH): Any type of self-injurious behavior, including SAs and NSSI. Comment for this is; the combination of Suicidal Attempt and NSSI into a single category reflects their high comorbidity, shared diathesis, and the fact that NSSI is a strong predictor of eventual Suicidal Attempt.
Not all events classified as a Suicidal Attempt are motivated by a true desire “to die,” but rather by desires to attract attention, to escape, and to communicate hostility. However, when only DSH is reported, Suicidal Attempt and NSSI cannot be subsequently disaggregated.
Suicide patterns in different countries
As there are patterns for CVD, stroke, and hypertension worldwide, there is substantial variation in population patterns of suicide, violence, and depression (Murray L Lopez & WHO). For instance, the pattern of suicide in China is recognized worldwide and is distinct from Western trends in that more women kill themselves than men, commonly through poisoning from pesticides (Phillips MR 2002). Another example can be taken from New Zealand, Canada and the United States, where higher than average suicides rates are associated with early substance use (hunter E & Harvey D 2002). In Japan, high rates of suicide among men in their middle years may result from the interaction of long-held cultural beliefs concerning suicide and loss of social status following unemployment (Lamar J 2000)
Here is the rank of most suicide rates by country in 2019 given by World population review.com.
Top 10 countries
|Rank||Country||Crude Suicide Rate|
|1||Lithuania||31.9 suicides per 100,000|
|2||Russia||31 suicides per 100,000|
|3||Guyana||29.3 suicides per 100,000|
|4||South Korea||26.9 suicides per 100,000|
|5||Belarus||26.2 suicides per 100,000|
|6||Suriname||22.8 suicides per 100,000|
|7||Kazakhstan||22.5 suicides per 100,000|
|8||Ukraine||22.4 suicides per 100,000|
|9||Latvia||21.2 suicides per 100,000|
|10||Lesotho||21.2 suicides per 100,000|
Some other countries, their ranks and rates
|14||Japan||18.5 suicides per 100,000|
|17||France||17.7 suicides per 100,000|
|18||Switzerland||17.2 suicides per 100,000|
|21||India||16.3 suicides per 100,000|
|27||United states||15.3 suicides per 100,000|
|39||Australia||13.2 suicides per 100,000|
|44||Canada||12.5 suicides per 100,000|
|51||South Africa||11.6 suicides per 100,000|
|63||Uganda||9.9 suicides per 100,000|
|75||Nepal||8.8 suicides per 100,000|
There is a huge link between suicide and mental disorders in many countries, there are many suicides happening impulsively in moments of crisis with a breakdown in the ability to deal with life stress, such as financial problems, relationship breakup, or chronic pain and illness.
Many countries have initiated suicide prevention programs. For the prevention of suicide public health approach is the best way that focuses on individuals in known high risk groups and promote population oriented strategies to broadly reduce risk, in keeping with Rose’s theorem (Kerry L et al. 2004); which tells that many people at low risk might give rise to more cases than would a small number at high risk (Paul; Saman; et al. 2012) .
Media can play a vital role in the strategy development process. Keeping stakeholders informed about the progress made and generating a wider understanding of the issue, thus creating a broad sense of ownership and increasing participation
Some of the simple measures to be taken are:
- Reducing access to the means of suicide (pesticides, firearms, certain medications);
- Reporting by media in a responsible way
- Introducing alcohol policies to reduce the harmful use of alcohol;
- Training of non-specialized health workers in the assessment and management of suicidal behavior;
References (Some major links are given here rest are just mentioned on the main body where used)
- WHO Mental Health
- The Global Burden of Disease: A Comprehensive Assessment of Global Mortality and Disability From Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020.Geneva, Switzerland: World Health Organization; 1996.