Intended Death: A look at suicidal behavior

The World Health Organization (WHO) noted that suicide is taking the lives of more and more people worldwide. In the year 2000, the WHO revealed that approximately one million people died from suicide, representing a mortality rate of 16 per 100,000 or one death every 40 seconds.

In the last 45 years, it also noted that suicide rates have increased 60 percent worldwide; suicide is now among the three leading causes of death among those aged 15-44 (both sexes). These fi gures, however, do not include suicide attempts that are up to 20 times more frequent than completed suicide.

Further, suicide worldwide is estimated to represent 1.8 percent of the total global burden of disease in 1998, and 2.4 percent in countries with market and former socialist economies in 2002. Although suicide rates have been traditionally highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of both developed and developing countries.

In a 2008 global survey conducted by the WHO, Japan, whose culture allows people to commit seppuku (ritual suicide by disembowelment), had a suicide rate of 48 per 100,000, based on available figures for 2006.

The Philippines, meanwhile, had one of the lowest suicide incidences at 2.10 per 100,000 population. In its guideline for the assessment and treatment of patients with suicidal behaviors, the American Psychological Association (APA) defined suicide as self-infl icted death with evidence (either explicit or implicit) that the person intended to die. People wanting to die will do so by various means, either by poisoning themselves, by hanging or by other means such as throwing themselves on an approaching train.

Suicide is commonly associated with mood disorders, particularly depression and substance abuse. The WHO noted that mental disorders are associated with more than 90percent of all cases of suicide. On the face of it, the usual symptom that can be a cause for concern for lay persons is the prolonged depressive episode observed in their loved ones. APA, however, said that despite the presence of a number of literature pointing to possible factors that can induce someone to take their life, it is still hard to be certain as to whether a person wanting to kill himself would make good of his plan. However, that person may drop hints, such as giving away his things. Dr. Lars Mehlum of the International Association for Suicide Prevention suggested that concerned individuals should ask a depressed person point blank if he is planning to commit suicide; in most cases, it provides the person with a chance to talk about his problems.

As a matter of precaution, experts advise that a person suffering from severe depression and who has become withdrawn be brought to a psychiatrist so a professional evaluation can be undertaken.

APA said a number of factors may increase or decrease risk for suicide. These factors include the presence of psychiatric illness; specifi c psychiatric symptoms such as hopelessness, anxiety, agitation or intense suicidal ideation; unique circumstances such as psychosocial stressors and availability of methods; and other
relevant clinical factors such as genetics and medical, psychological, or psychodynamic issues.

The WHO also noted that suicide results from many complex sociocultural factors and is more likely to occur particularly during periods of socioeconomic, family, and individual crisis situations. To prevent the rise in the number of suicide attempts,
the WHO has proposed a number of strategies. It said there is a need to adopt strategies involving restriction of access to common methods of suicide which has been proven to be effective in reducing suicide rates.

It said there is also a need to adopt multisectoral approaches involving other levels of intervention and activities such as crisis centers. Also, it noted that there is a compelling evidence indicating that adequate prevention and treatment of
depression, alcohol and substance abuse can reduce suicide rates. School-based interventions involving crisis management, self-esteem enhancement and the development of coping skills and healthy decisionmaking have demonstrated to reduce the risk of suicide among the youth.

Recognizing the need to combat the increasing number of suicide cases, the WHO itself launched its own Suicide Prevention (SUPRE) project to reduce mortality and morbidity due to suicidal behaviors, to break the taboo surrounding suicide, and to bring together national authorities and the public in an integrated manner to overcome the challenges. The project’s strategies are to organize global, regional, and national multisectoral activities to increase awareness about suicidal behaviors and their effective prevention and strengthening of countries' capability to develop and evaluate national policies and plans for suicide prevention.

The WHO, however, acknowledged that there is a long way to go to prevent suicide. It noted that worldwide, the prevention of suicide has not been adequately addressed due to lack of awareness of suicide as a major problem and the taboo in many societies to discuss openly about it. In fact, it noted that only a few countries have included prevention of suicide among their priorities.

Responsible reporting of suicide

The media can be an important ally in educating the public about suicide; however, the sensational coverage of suicide cases may actually do more harm than good.

Experts are largely polarized on the issue of whether reports of suicide cases spawn copycat suicides, particularly when the suicide involves a celebrity. In Japan, however, there have been three documented cases of copycat suicides following the death of rock guitarist Hideto Matsumoto. Experts also looked into the number of suicide cases after rock star Kurt Cobain killed himself, fearing that it could trigger copycat suicides. To their relief, there was no spike in suicide cases and they largely attributed this to the responsible reporting of the media, which did not
glamorize the singer’s death.

To encourage responsible reporting, suicide prevention advocates should lobby to media organizations to include a guideline in handling suicide cases in their manuals. The following tips from “Preventing suicide: a resource for media professionals” released by the World Health Organization in 2000 are useful in such an advocacy:

• Avoid sensational coverage, particularly when a celebrity is involved. In reporting the suicide, the WHO advises media outlets to mention in the report if the person had a history of mental illness. For newspapers, do not put the article in the front page.
• Do not detail how the suicide was carried out or where it was done.
• Do not glamorize or glorify the person.
• For failed suicide, include in the report the physical effects of the attempt, such as brain damage.
• Do not oversimplify the reporting by attributing the suicide to a single event. The resource noted that suicide is a complex issue with many contributing factors.
• Whenever possible, include in the report the thoughts of families and friends left behind.
• Include helpful information such as the contact details of agencies and organization that can help a depressed person, as well as the tell-tale signs of depression, which could trigger a suicide attempt.


This article is culled from Issue No. 14 of Health Alert Asia Pacific newsletter produced by Health Action Information Network.

Sources:
http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/index.html

http://www.nimh.nih.gov/health/publications/suicide-in-the-usstatistics-and-prevention.shtml#prevent

http://www.psychiatryonline.com

Assavanonda, Anjira. “Media caution urged on reporting suicide.” Asia Media. http://www.asiamedia.ucla.edu/article.asp?parentid=15634

Pelham, Brett and Zsolt Nyiri. “In More Religious Countries, Lower Suicide Rates.” Gallup. http://www.gallup.com/poll/108625/More-Religious-Countries-Lower-Suicide-Rates.aspx