Suicide: a Global Issue

By Thomas Insel, Director, National Institutes of Mental Health

Released today, the World Health Organization (WHO)'s report, "Preventing Suicide: A global imperative ," provides the first global view of how often suicide attempts and deaths occur, and how suicide-related behaviors affect all ages, nationalities, economic levels, and cultures. Every year around the world more than 800,000 people die by suicide. Globally, suicide is the second leading cause of death in 15- to 20-year-olds. WHO reports that for every person who dies as a result of suicide, there may be more than 20 who survive an attempt.

The WHO report offers some important insights by comparing suicide statistics across countries. Policies vary, with suicide considered a crime in some countries and a public health issue in others. In countries where suicide is illegal, decriminalization appears to lower suicide rates. Risk factors differ among countries as well. Research suggests, for example, that mental disorders play less of a role in China and India than in the West. The report also recommends several approaches to reducing suicide, including the importance of surveillance, raising awareness, and educating the media to reduce sensational coverage that can trigger suicides in the wake of news stories.

Throughout, the report emphasizes the importance of reducing access to lethal means. The means used in suicide deaths vary country to country. Worldwide, an estimated 30 percent of suicides are the result of pesticide self-poisoning. Reducing access to lethal means works because suicide is often an impulsive act that is situation specific. Research in Australia provides a provocative example.¹ A 2012 study reported a marked decline in suicide deaths in the late 1990’s. One factor in this decline was a sharp decrease in deaths as a result of motor vehicle exhaust poisoning. The attempt rate did not change, but lethality did, likely the result of changes in automobile engineering that lowered carbon monoxide emissions.

Some of the recommendations in this WHO report reinforce points made in the Prioritized Research Agenda for Suicide Prevention  (pdf), a U.S. report issued earlier this year by the Research Prioritization Task Force of the National Action Alliance for Suicide Prevention. This earlier report identified three strategies that, if fully implemented, could save many thousands of lives in the United States. As 51 percent of suicides are carried out using firearms in this country, reduction in access to firearms was a key strategy. Other recommendations were installing devices to prevent deaths from motor vehicle exhaust and providing evidence-based psychotherapy to individuals who have made suicide attempts. Careful data collection and modeling of the impact of these strategies provides a way forward for accomplishing what has been frustratingly difficult to date: achieving a significant reduction in suicide rates in the United States.

Despite the increased availability of mental health care and medications for depression, the U.S. suicide rate has remained largely unchanged. There are measures we can and must take right away to help prevent suicide—encouraging responsible media reporting, promoting suicide prevention help lines, reducing access to lethal means, raising awareness and getting at-risk individuals to appropriate care. There are also many unanswered questions about suicide that will require rigorous research. A better understanding of risk, prevention, and treatment along with scientifically based policies will make the difference in reducing the numbers of suicide deaths. As this new WHO report demonstrates, the need is global.

Reference

¹ Spittal MJ et al. Declines in the lethality of suicide attempts explain the decline in suicide deaths in Australia.  PLoS One. 2012;7(9):e44565.