Public Health AffairsSuicide, a Preventable Public Health Problem [Archives:2005/876/Health]
By Dr. Saleh Al-Habshi
Msc. in Public Health
Following the successful launch last year – World Suicide Prevention Day, International Association for Suicide Prevention (IASP), in collaboration with the World Health Organization (WHO) announced 10th September 2005, to be the third World Suicide Prevention Day (WSPD). This year the IASP and WHO invite the public, communities, societies, individuals, professionals and volunteers to conduct activities on this day to promote and demonstrate the joint responsibility to save lives that would otherwise be lost to suicide. The WSPD aims at changing public attitudes and increase awareness of suicide as a major public health problem that's largely preventable. Despite the complexity and severity of the problem, suicide prevention cannot be seen as the responsibility of governments and concerned organizations alone; rather, preventing suicide is every one's business.
Suicide is one of the world largest public health problems, accounting for almost half of all violent deaths every year, as well as economic costs in the billions of dollars. It profoundly affects individuals, families, workplaces, neighborhoods and societies.
According to WHO annual estimates approximately one million people die from suicide and 10 to 20 times more people attempt to suicide worldwide. This represents one death every 40 seconds and one attempt every 3 seconds, on average. Furthermore WHO estimates suggest fatalities could rise to 1.5 million by 2020.
Suicide represents 1.4% of the Global Burden of Disease, but the losses extend much further. In the Western Pacific Region they account for 2.5% of all economic losses due to diseases. In most European countries, the number of suicides is larger than the annual traffic fatalities. More lives are lost to suicide than in all wars and homicides. There are three times more suicides each year than enormous and catastrophic loss of human lives in the tragic Tsunami disaster in South East Asia in December 2004. More lives are lost to suicide every day than the loss of lives in the terrorist attack on New York, September 11.2001. This indicates that more people are dying from suicide than in all the several armed conflicts around the world and more than those dying from traffic accidents.
Some WHO Member States have been reporting on suicide cases since 1950, whereas other countries started sending this information later on. A WHO report on 2002 revealed that the global rates of suicide tend to increase with age to be more among males than females, but there has recently been an alarming increase in suicidal behaviors amongst young people aged 15-25 years, worldwide. An opposite change in the age distribution of suicide cases occurred between 1950 and 2000. On 1950 eleven countries reported that 40% of suicide cases were among age group (5-44) years, while 60% of them were among people of 45 years and more. On 2000 contrary to that forty-seven countries reported 55% of suicide cases among (5-44) age group, while 45% of them were among people of 45 years and more.
Among countries reporting suicide, the highest rates are found in Eastern Europe and the lowest are found mostly in Latin America, in Muslim countries and in a few of the Asian countries. There is little information on suicide from African countries.
Countries of previous Soviet Union showed the highest rates of suicide especially among males. It was 80.7, 69.3, 60.3 and 52.1per 100000, in Lituania, Russian Federation, Bilarus and Ukraine respectively. Comparatively reports on 2000 reflected that suicide rate was higher in Switzerland than the United States especially among males, while it was also higher in Austria than Azerbaijan on 2002. Among the highest rates of suicide in South East Asia – that which was reported from Sri Lanka, 44.6 per 100000 among males and 16.8 per 100000 among females (1991). Iran has the lowest suicide rate among Muslim countries reporting on suicide, 0.3 per 100000 among males and 0.1 per 100000 among females (1991).
Suicide does occur in Yemen, but until now there is no reliable data that explain the situation about such public health problem.
Suicidal behavior has a large number of complex underlying causes, including poverty, unemployment, loss of loved ones, arguments, breakdown in relationships and legal and work-related problems. A family history of suicide, as well as alcohol and drug abuse, childhood abuse, social isolation and some mental disorders including depression and schizophrenia, also play central role in a large number of suicides. Physical illness and disabling pain can also increase suicide risks.
” It is important to realize that suicide is preventable, and that having access to the means of suicide is both an important risk factor and determinant of suicide.” Said professor Lars Mehlum, President of IASP and Professor at University of Oslo.
Fortunately, suicide is not an inevitable burden that must be accepted by society. There are many ways in which suicide can be prevented. Adopting policies addressing suicide by governments is crucial. There is an urgent great need for intensified, effective, coordinated and comprehensive suicide preventive initiatives throughout the world to reduce the enormous number of completed suicides, suicide attempts and problems related to suicide and self-destructive behaviors. Effective suicide prevention calls for an innovative, comprehensive multi-sectorial approach, including health and non-health sectors, education, labour, police, justice, religion, law, politics and the media. The role of experts is certainly needed in addressing this public health problem (medical personnel and mental health workers); these professionals play a crucial role in risk assessment, emergency services and providing short-and long-term treatments. They are also important in the development of knowledge base through research and evaluation of suicide preventive measures. However, suicide cannot be effectively prevented through the efforts of these experts alone. Suicide prevention is every body's business. All community members should be part of the solution. Every one can do something to help reduce the number of people who try to solve their problems with suicidal behaviors. Sharing responsibility is very important.
Protective factors include high self-esteem and social “connectedness”, especially with family and friends, having social support, being in a stable relationship and religious or spiritual commitment. Early identification and appropriate treatment of mental disorders is an important preventive strategy. There is also evidence that educating primary health care personnel in the identification and treatment of people with mood disorders may result in a reduction of suicide amongst those at risk. In addition, establishing suicide prevention centers and school-based prevention programmes are all promising strategies.
WHO has produced, with the assistance of experts from around the world, a series of guidelines for different audiences that have a critical role to suicide prevention, including health workers, teachers, prison officers, media professionals and survivors of suicide. These resources are now available in many languages on websites. The media can also play a major role in reducing stigma and discrimination associated with suicidal behaviors and mental disorders. The above-mentioned efforts are needed and any other efforts to put suicide prevention on the local public agenda. Every individual must initiate by the least contribution, not all suicide prevention activities cost money; to lend a helping hand, to be a good friend or colleague does not necessarily imply financial costs.
——
[archive-e:876-v:13-y:2005-d:2005-09-12-p:health]
