Centering decriminalization of suicide in low – and middle – income countries on effective suicide prevention strategies (original) (raw)
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A Population Health Perspective on Suicide Research and Prevention
Crisis, 2015
The recently published WHO suicide report indicates that the global incidence of suicide is declining (World Health Organization [WHO], 2014. This is welcome news for all working in this field and for the vast number of people affected by the suicide of a family member, friend, or colleague. However, much remains to be done. The report shows that there are more than 20-fold differences in the rate of suicide between high-and low-incidence countries and threefold differences across low-and middle-income countries (LAMIC) in the different WHO regions (WHO, 2014). If all countries had the same incidence of suicide as LAMICs in the Americas, there would be over 300,000 fewer suicides worldwide every year. Nevertheless, the potential for suicide reductions is far greater in some countries (e.g., those where particular high-lethality methods such as pesticides or firearms are commonly used or with high levels of alcohol misuse) than in others. This editorial summarizes, from a population (public health) and UK perspective, some thoughts about the contribution of suicidology to suicide prevention and, arising from this focus, some suggested priorities for research and policy over the next decade.
Global Suicide: the problem of health systems
International Archives of Medicine, 2015
It is estimated that over 800 000 people die by suicide and that there are many suicide attempts for each death. Young people are among those most affected. The numbers differ between countries, but it is the low-and middle-income countries that bear most of the global suicide burden, with an estimated 75% of all suicides occurring in these countries. The importance of each risk factor and the way it is classified will depend on each context. These factors can contribute to suicidal behaviours directly but can also contribute indirectly by influencing individual susceptibility to mental disorders. From the analysis of the rate of suicide, the numbers of suicide preventions successful with the number of hospitalizations and hospitalized for attempted suicide, it becomes possible to determine a path in order to create social change in three important factors to be followed to be fulfilled: knowledge (scientific and practical), public support (political will) and a social strategy, showing up as a national response to achieve the goals of suicide prevention.
Suicide Prevention in Asia: Future Directions
The goals of the Strategies to Prevent Suicide (STOPS) project in Asia of Suicide Prevention International (SPI) are to understand the current status of suicide and suicide prevention work in each of the participating countries and, based on this information, to develop and undertake high-priority projects that are likely to make a difference. Previous chapters have reviewed the extent of the problem in each of the countries, the cultural context in which suicide occurs, what suicide prevention initiatives are being undertaken to address the problem, and what evidence there is that these interventions are effective. The current chapter summarizes these findings and describes some suicide prevention projects in Asia that SPI is undertaking as an outgrowth of the STOPS initiative.
Epidemiology of Suicide and the Psychiatric Perspective
International Journal of Environmental Research and Public Health, 2018
Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low-and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating-and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.
Suicide Prevention: does it work?
Archives of Medical and Biomedical Research, 2016
The risk factors of suicide which occur in people of all genders, ages and ethnicities, although complex to fully understand, share certain characteristics that include depression (other mental disorders, psychosis or substance abuse disorder), a prior suicide attempt, family history of a mental disorder or substance abuse, family history of suicide, family violence (including physical or sexual abuse), having guns or other firearms in the home, incarceration and exposure to others' suicidal behavior (such as that of family members, peers, or media figures). Research suggests that people who attempt suicide differ from others in many aspects of how they think, react to events, and make decisions. This paper reviews the global trends on suicide and the prevention of suicide according to program evaluation, risk and protective factors, type of intervention, level of intervention and the interface between clinical and public health levels. The major interventions for the prevention of suicide are reasonable care and treatment of mental and addictive disorders, restricted access to lethal means of suicide such as firearms, pesticides, etc., improvement of media portrayal of suicide, school-based programs, availability of hotlines and crisis centers, and training of primary health care personnel.
Approximately 75% of suicides occur in low-and middle-income countries (LMICs) where rates of poverty are high. Evidence suggests a relationship between economic variables and suicidal behaviour. To plan effective suicide prevention interventions in LMICs we need to understand the relationship between poverty and suicidal behaviour and how contextual factors may mediate this relationship. We conducted a systematic mapping of the English literature on poverty and suicidal behaviour in LMICs, to provide an overview of what is known about this topic, highlight gaps in literature , and consider the implications of current knowledge for research and policy. Eleven databases were searched using a combination of key words for suicidal ideation and behaviours, poverty and LMICs to identify articles published in English between January 2004 and April 2014. Narrative analysis was performed for the 84 studies meeting inclusion criteria. Most English studies in this area come from South Asia and Middle, East and North Africa, with a relative dearth of studies from countries in Sub-Saharan Africa. Most of the available evidence comes from upper middle-income countries ; only 6% of studies come from low-income countries. Most studies focused on poverty measures such as unemployment and economic status, while neglecting dimensions such as debt, relative and absolute poverty, and support from welfare systems. Most studies are conducted within a risk-factor paradigm and employ descriptive statistics thus providing little insight into the nature of the relationship. More robust evidence is needed in this area, with theory-driven studies focussing on a wider range of poverty dimensions, and employing more sophisticated statistical methods.
Suicide prevention by limiting access to methods: a review of theory and practice
Social Science & Medicine, 2010
This review discusses the limitation of access to suicide methods as a way to prevent suicide, an approach which forms a major component of many national suicide prevention strategies. An important distinction is made between efforts that attempt to limit physical access to suicide methods and those that attempt to reduce the cognitive availability of suicide. Physical imitations will be reviewed with reference to restricting access to domestic gas, catalytic converters, firearms, pesticides, jumping, paracetamol and methods used in prisons. Impacts of cognitive availability will be discussed mainly with regard to the media in terms of providing access to technical information and sensational or inaccurate portrayals of suicide. Drawing on psychological models of suicidal ideation and behaviour, this review explores how processes leading to suicidal behaviour and issues around method choice may relate to the effectiveness of limiting access to methods. Potential problems surrounding method limitations are explored, in particular the factors contributing to substitution, the risk that alternative methods of suicide may be used if one is restricted. It is concluded that in appropriate contexts, where substitution is less likely to occur, and in conjunction with psychosocial prevention efforts, limitation of both physical and cognitive access to suicide can be an effective suicide prevention strategy.