Mirela Xanthaki
UNITED NATIONS, Nov 3 2008 (IPS) – With a million people dying by suicide every year and two suicide deaths per minute, it remains a major preventable cause of death worldwide, mental health experts say.
It is tragic that in a world where more people kill themselves each year than die in all wars, terrorist attacks and homicides, there is so little attention paid to suicide prevention and only a dozen countries have a national strategy for suicide prevention, Brian Mishara, president of the International Association for Suicide Prevention (IASP), told IPS.
Former Soviet States such as Lithuania, Estonia, Belarus and the Russian Federation have the highest suicide rates per capita. However, countries in Asia account for 60 percent of suicides worldwide, with China, India and Japan constituting 40 percent.
Causes and methods of suicide vary greatly from country to country and culturally related patterns of suicide are often taken into consideration before developing a national strategy, Mishara said.
Although there are no simple root causes, it has been noted that in Asia, for example, family tensions are a more prevalent cause, as opposed to the West where clinical depression accounts for 90 percent of suicides.
The main difference between suicides in Europe, North America, Australia, New Zealand and elsewhere is that up to 90 percent of people in the countries I mentioned who die by suicide have a mental health problem, whereas, at least in Asia, this is less than 50 percent. In Asia, there are more impulsive suicides in crisis situations, Mishara said.
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Culturally specific risk factors and protective factors exist. For example, easy access to lethal pesticides increases the risk of impulsive suicides in many rural areas while living in an extended family environment protects against suicide and decreases the risk, he said.
Ingestion of pesticides was the method used in one third of Asian suicides, while it was rare in the West. Differences in methods have resulted in the design of very different prevention plans.
Dr. Alexandra Fleischmann, a mental health and substance abuse expert with the World Health Organisation (WHO), told IPS that community-driven studies of the social, cultural and psychological determinants of suicide attempts and a better understanding of the underlying reasons are key in the prevention of suicides.
A pilot programme running now in India, China and Sri Lanka limits access to pesticides and requires handling them in locked boxes. In Europe, telephone help lines are a powerful tool in suicide prevention.
Prevention can come at a national or a local level. Planning at the national level provides the political leadership and policy frameworks that are critical, to maintain a high profile and continued funding for suicide research and prevention. At a local level there are many practical prevention programmes that translate policy statements and research outcomes into effective activities at local community levels, Mishara said.
In places where we have national policies adopted and implemented, we are seeing significant declines in suicide rates five to eight years later, he said.
Official data and statistics about suicide are sent to WHO by country health ministers. The data are generally considered to be underestimates, although there may be significant variations in the extent. Mishara told IPS.
Some developing countries like Cuba and Nicaragua, for example appear to have accurate data, while others don t. Hardly any African countries report national suicide data to the WHO, although reports of some cities and hospitals are another way of knowing that suicides do occur.
A recent study conducted in Tamil Nadu in India tried to estimate the suicide rates more accurately. Trained lay interviewers conducted verbal autopsy interviews with family members for 39,000 deaths. The study found that suicide rates in the region are 10 times higher than those officially reported to WHO. If these findings apply to other countries, then the total number of suicides rises by nearly a million.
Suicide bombers generally are considered to be in a different category from those who commit suicide because of psychological reasons, and are classified as acts of war. The countries where there are suicide bombers also generally do not report suicide data to WHO, Mishara said.
As Mishara told IPS, More needs to be done on suicide prevention.
IASP was founded in Vienna in 1960 as a working fellowship of researchers, clinicians, practitioners, volunteers and national and local organisations of many kinds.
In collaboration with the WHO, it works to promote awareness that suicide is a major preventable cause of death and assist in the development of national suicide-prevention strategies.
After noting that reporting can have a positive or negative effect on suicide rates, IASP s and WHO initiatives include creating guidelines for media professionals as to how they should report on suicide. Other initiatives include preventing suicides in prisons, assisting families bereaved by suicide and the provision of adequate treatment and follow-up care for people who attempt suicide.
