Text by Henrylito D. Tacio
Photos courtesy of WHO
More than 700,000 people worldwide died by suicide in 2019, according to a new report released by the Geneva-based World Health Organization (WHO). That’s equivalent to one in every 100 deaths. For each death, there are more than 20 suicide attempts.
“Every year, more people die as a result of suicide than HIV, malaria or breast cancer – or war and homicide,” said the report, Suicide worldwide in 2019.
This is indeed alarming. “We cannot – and must not – ignore suicide,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the United Nations health agency. “Each one is a tragedy.”
With the world still facing the tragedies and economic losses that the coronavirus disease 2019 bring, suicide – defined as the deliberate taking of one’s own life – is as prevalent and relevant as ever.
“Our attention to suicide prevention is even more important now, after many months living with the COVID-19 pandemic, with many of the risk factors for suicide ̶ job loss, financial stress and social isolation – still very much present,” the WHO official said.
In the Philippines, statistics from the National Center for Mental Health (NCMH) have supported this claim. From May 2019 to February 2020, NCHM’s helpline got 400 calls every month or an average of 13 to 15 calls per day. At the start of the pandemic in March, 672 calls were received.
The calls grew steadily in the following months until there were 1,034 calls in July and 440 for half of August. This more than doubled the monthly average from March to August to 876 calls – or 32 to 37 calls daily.
“I know how difficult it has been for Filipinos enduring the setbacks brought about by the COVID-19 pandemic and of the quarantine to prevent further transmission of COVID-19,” observes Dr. Rabindra Abeyasinghe, the WHO representative in the Philippines, agrees. “Many people haven’t been able to work or have lost their jobs, some may have had difficulty going back to their home provinces or are impacted by the loss of loved ones or are separated from loved ones.”
Globally, 79% of suicides occur in low- and middle-income countries; however, high-income countries have the highest rates of suicide.
More than twice as many males die due to suicide as females (12.6 per 100,000 males compared with 5.4 per 100,000 females), according to the WHO report. Suicide rates among men are generally higher in high-income countries (16.5 per 100,000). For females, the highest suicide rates are found in lower-middle-income countries (7.1 per 100,000).
Brian Mishara of the International Association for Suicide Prevention said more people kill themselves each year than are killed in all wars, terrorist acts, and homicides. “Yet, we give a large attention every time there is a death by homicide and very little attention to the million lives lost worldwide to suicide,” he deplored.
The WHO report said that among young people aged 15-29, suicide was the fourth leading cause of death after road injury, tuberculosis, and interpersonal violence.
But not to be discounted are the older men, who are described as “the highest risk group.” In fact, “there is no indication that the suicide rates for this group of people have been declining.”
It’s very rare, Mishara pointed out, that countries target the elderly as a risk group in national prevention efforts, most of which focus on young people.
Social support has been cited as one of the main reasons why suicide is so high among the elderly. “The elderly who die by suicide are more often men who have lost their wives and are socially isolated,” Mishara explained. “Elderly who are living surrounded by family and getting good social support are much less at risk.”
In addition, elderly people are “under-treated” for problems like depression, even though research shows that older people respond as well or better to treatment than younger people.
Another issue is that some of the kinds of medications prescribed to the elderly – for example, those for Alzheimer’s disease, an irreversible, progressive brain disorder – have depression as a common side-effect.
It is estimated that around 20% of global suicides are due to pesticide self-poisoning, most of which occur in rural agricultural areas in low- and middle-income countries. Ingesting poisons is described as a “highly effective strategy.” “Due to the high toxicity of many chemicals used in suicide attempts, this method often results in death,” the WHO said.
Other common methods of suicide are hanging and firearms.
Suicide is found in every culture and may be the result of complex social, cultural, religious, and socio-economic factors, in addition to mental disorders. Suicide itself is not a mental disorder, but one of the most important causes of suicide is mental illness. “If we change our attitude to mental health, we change the world,” said UN Secretary-General Antonio Guterres.
While the link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.
“Experiencing conflict, disaster, violence, abuse or loss and a sense of isolation are strongly associated with suicidal behavior,” the WHO says.
Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants, indigenous peoples, lesbian, gay, bisexual, transgender, intersex (LGBTI) persons, and prisoners.
“By far the strongest risk factor for suicide is a previous suicide attempt,” the WHO points out.
Currently, only a few countries have included eliminating suicide among their health priorities, and only 38 countries report having a national prevention strategy, the WHO says.
“Suicides are preventable,” the WHO says. “There are a number of measures that can be taken at population, sub-population, and individual levels to prevent suicide and suicide attempts.
The UN health agency recommends the following critical effective evidence-based interventions: limit access to the means of suicide (examples: pesticides, firearms, certain medications); interact with the media for responsible reporting of suicide; foster socio-emotional life skills in adolescents; and early identify, assess, manage and follow up anyone who is affected by suicidal behaviors.
“These need to go hand-in-hand with the following foundational pillars: situation analysis, multisectoral collaboration, awareness raising, capacity building, financing, surveillance and monitoring and evaluation,” the WHO says.
Suicide prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labor, agriculture, business, justice, law, defense, politics, and the media.
“Media play an important role when it comes to suicide,” the WHO explains. “Media reports of suicide can lead to a rise in suicide due to imitation (or copycat suicides) – especially if the report is about a celebrity or describes the method of suicide.”
Though suicides are preventable, stigma and taboo surrounding mental health have not been addressed in many societies.
“Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need,” the WHO says. “The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it.”
Raising community awareness and breaking down the taboo is important for countries to make progress in preventing suicide, the UN health agency adds.