In its first-ever report on suicide prevention, the World Health Organization is calling for immediate global action to reduce the 800,000 deaths by suicide every year, three-quarters of them in low- and middle-income countries. The UN health agency says suicide is preventable, and governments can tackle it effectively by getting all their sectors working together under a national strategy.
“This report is a call for action to address a large public health problem which has been shrouded in taboo for far too long,” said World Health Organization (WHO) Director-General Dr. Margaret Chan, who announced the release of the report in Geneva on Thursday.
Over 800,000 people die by suicide every year, and countless more attempt suicide: for each completed suicide, there are an estimated 100-200 suicide attempts, the report says. Suicide occurs throughout the lifespan and is the second leading cause of death among young people aged 15 to 29. Suicide is also a global phenomenon, affecting people from all regions of the world. In fact, 75 percent of global suicides occurred in low- and middle-income countries in 2012, states the landmark report.
In 2012, suicide accounted for 1.4 percent of all deaths worldwide, making it the 15th leading cause of death in 2012; by 2020, suicide is expected to account for 2.4 percent of all global deaths and contribute more than 2 percent to the global burden of disease. Significantly, these figures fail to take account of the huge impact of suicide beyond the individual and the ripple effect it has on the lives and mental health of many families and communities. Suicide among youth is of particular concern, as are emerging patterns of socioeconomic disparities.
A global view of suicide
Dr. Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at the WHO says the report is the first to present a “comprehensive overview of suicide, suicide attempts and successful suicide prevention efforts worldwide. We know what works. Now is the time to act.”
The analysis of worldwide suicide data revealed several key risk factors and high-risk groups. In general, more men die by suicide than women. In wealthy nations, specifically, the data show that three times as many men commit suicide as women, with men age 50 and over being the most vulnerable group. However, in low- and middle-income countries, young adults and elderly women face a disproportionate risk of suicide, with far higher rates than their counterparts in high-income countries.
Frequently, several risk factors act cumulatively to increase a person’s vulnerability to suicidal behavior. Risk factors associated with the health system and society at large include difficulties in accessing health care and in receiving the care needed, easy availability of the means for suicide, inappropriate media reporting that sensationalizes suicide and increases the risk of “copycat” suicides, and stigma against people who seek help for suicidal behaviors, or for mental health and substance abuse problems.
Key risk factors for suicide (Non-exhaustive list)
Risks linked to the community and relationships include war and disaster, stresses of acculturation (such as among indigenous peoples or displaced persons), discrimination, a sense of isolation, abuse, violence and conflictual relationships. And risk factors at the individual level include previous suicide attempts, mental disorders, harmful use of alcohol, financial loss, chronic pain and a family history of suicide.
The report also identified geographical patterns in suicide deaths, providing detailed assessments for each WHO region.
Suicide in the WHO African Region
In the WHO African Region, the estimated suicide rate was close to the global average of 11.4 per 100 000 in 2012. Between 2000 and 2012, suicide rates increased by 38 percent in the African Region. Suicide rates are particularly high among the elderly, but there is also a peak among the young. Suicide by intentional pesticide ingestion is among the most common methods of suicide globally, and of particular concern in rural agricultural areas in the African Region.
Suicide in the WHO Region of the Americas
Estimated suicide rates are generally lower in the America’s than in other WHO regions. However, Guyana is the country with the highest estimated suicide rate for 2012 globally, and Suriname has the sixth highest. Suicide rates in this Region show a first peak among the young, remain at the same level for other age groups, and rise again in elderly men. In high-income countries in the America’s, hanging accounts for 50 percent of suicides, and firearms are the second most common method, accounting for 18 percent of suicides. The relatively high proportion of suicides by firearms in high-income countries is primarily driven by high-income countries in the Americas, where firearms account for 46 percent of all suicides — outside of the Americas, firearms accounts for only 4.5 percent of suicides in high-income countries
Suicide in the WHO Eastern Mediterranean Region
Estimated suicide rates are generally lower in the Eastern Mediterranean Region than in other WHO regions. However, there is evidence that among certain age groups in this region, suicide rates are relatively high, particularly among young women and men aged 15–29 years, and women and men aged 60 years and above.
Suicide in the WHO European Region
Suicide rates in Europe are above the global average of 11.4 per 100, 000, and six European countries rank among the top 20 nations with the highest estimated suicide rates globally. The highest rates in the region are found in Lithuania, which has the fifth highest global suicide rate, and Kazakhstan, which has the tenth highest globally. Suicide rates in Europe show a first peak among the young, another for middle-aged men, and rise again in the elderly. Of particular concern for this region is that suicide is the main cause of death among 15- to 29-year-olds in many European countries. However, on a more positive note, many countries in the region are prominent among those that have developed suicide prevention strategies.
Suicide in the WHO South-East Asia Region
The South-East Asia Region has the highest global suicide rate. Most suicides in the world occur in South-East Asia (39 percent of those in low- and middle-income countries in South-East Asia alone), with India accounting for the highest estimated number of suicides overall in 2012. Suicide by intentional pesticide ingestion is among the most common methods of suicide globally, and is of particular concern in rural agricultural areas in the South-East Asia Region.
Suicide in the WHO Western Pacific Region
The Western Pacific has a high proportion of the world’s suicide deaths (low- and middle-income countries in the Western Pacific alone account for 16 percent of global suicides), with an estimated 180,000 suicides annually. China accounted for the second highest estimated number of global suicides in 2012, and the Republic of Korea ranked third highest for the number of global suicides.
The Western Pacific is the only region where the suicide rate is higher among women than in men, and where suicide ranks higher as a cause of death in women than it does in men. Suicide by intentional pesticide ingestion is among the most common methods of suicide globally, and of particular concern in rural agricultural areas in the Western Pacific Region. And while suicide among young people is a concern everywhere, it is particularly worrisome in countries of the Pacific.
A preventable epidemic
A key message of the report is that suicide is preventable. The idea that once a person is suicidal they remain like that for life as a myth, the authors explain. The fact is, says the WHO:
Heightened suicide risk is often short-term and situation-specific. While suicidal thoughts may return, they are not permanent and an individual with previously suicidal thoughts and attempts can go on to live a long life.
Evidence from several countries across the globe suggests that limiting access to the means that people use to commit suicide is an effective suicide-prevention strategy. For instance, suicide rates in the US are markedly higher in states with lax gun laws, even after accounting for relevant confounding variables such as underlying mental illness. The higher suicide rates result from higher firearm suicides; the non-firearm suicide rate is about equal across states, demonstrating that the overall increase in suicides is attributable to easier access to guns.
Firearms are actually among the strongest predictors of death by suicide; the risk of suicide is more than twice as high among Americans who live in a home with a firearm than among those who don’t have a gun at home. In fact, one of the most rigorous studies of its kind, published in 2013, found that “firearm ownership, independent of underlying rates of suicidal behavior, largely determine variations in suicide mortality across the 50 states.”
The evidence clearly shows that where there are more guns, there are more suicides. However, experts say the vast majority of these deaths could be prevented with a combination of gun safety laws, targeted public health policies and campaigns, and voluntary programs for gun owners. “Many lives would likely be saved if people disposed of their firearms, kept them locked away, or stored them outside the home,” say researchers at the Harvard University School of Public Health.
In a recent report by the American Psychological Association, titled Gun Violence: Prediction, Prevention, and Policy, a panel of experts outlined a series of strategies that could be used to protect people from the lethal effects of firearms. The report upholds the value of background checks, waiting periods, mandatory reporting of who sells and who buys, firearm design changes, ammunition limits, and assault weapons bans, stating that the research shows such measures successfully regulate gun access and use, and — most importantly — save lives.
And another important way to reduce deaths by suicide, says the WHO report, is having a national coordinated action plan, which currently only 28 countries have adopted. Effective suicide prevention requires that government departments work together and develop a comprehensive, coordinated national suicide prevention strategy that contextualizes the problem and outlines specific actions that can be taken at multiple levels. “High-level commitment is needed not just within the health sector, but also within education, employment, social welfare and judicial departments,” says the WHO.
Above, the WHO outlines a framework for developing a national suicide prevention strategy.
The report also urges the media to be responsible about reporting suicides. They should not use language that sensationalizes suicide, nor give details of the means that people have used. According to a study published in May in the journal Lancet Psychiatry, high- profile coverage of suicides in the newspapers is linked to copycat suicides among teenagers in the US.
Health-care services need to incorporate suicide prevention as a core component, the report says. Early identification and effective management are key to ensuring that people receive the care they need. Communities also play a critical role in suicide prevention; they can provide social support to vulnerable individuals, and engage in follow-up care, fight stigma, and support those bereaved by suicide.
“No matter where a country currently stands in suicide prevention, effective measures can be taken, even just starting at local level and on a small-scale,” says Dr. Alexandra Fleischmann, Scientist in the Department of Mental Health and Substance Abuse at the WHO.
The report’s launch comes just a week before World Suicide Prevention Day, observed on September 10 every year. The day provides an opportunity for individuals, organizations, and governments everywhere to raise awareness of suicide, dispel the myths, break the taboos, spread information, and promote action about suicide prevention around the world.
In the WHO Mental Health Action Plan 2013-2020, WHO Member States have committed themselves to work towards the global target of reducing the suicide rate in countries by 10 percent by 2020. WHO’s Mental Health Gap Action Programme, launched in 2008, includes suicide prevention as a priority and provides evidence-based technical guidance to expand service provision in countries.
Suicide is largely preventable; unlike for many other health issues, the tools to significantly reduce the most tragic loss of life by suicide are available. With collective action to acknowledge and address this serious problem, as well as commitment to effective interventions, supported by political will and resources, preventing suicide globally is within reach.