Preventing suicide, honouring life

World Suicide Prevention Day on September 10 (today) is an annual event sponsored by the International Association for Suicide Prevention, in collaboration with the World Health Organisation. This year the theme of World Suicide Prevention Day is “Suicide Prevention across the Life Span”.

SUICIDE PREVENTION: This theme has been adopted to emphasise the fact that suicide occurs in all ages and suicide prevention and intervention strategies may be adapted to meet the needs of different age groups.

There is a common misperception that suicide occurs mostly amongst the young. This belief has its origins in research in the mid-1980s which showed that suicide had increased dramatically in young males in many countries.

This trend focused attention on suicide as a major social issue for young people and led to an extensive focus on suicide research and prevention amongst young people.

While this focus was justified and led to much useful research and the development of appropriate interventions, it has tended to obscure the fact that suicide occurs across the lifespan.

In almost all countries the majority of suicides, every year, occur not in young people, but in adults and older adults. Consequently, this year’s theme for World Suicide Prevention Day is that suicide occurs across the lifespan and we must invest in suicide prevention programmes which address suicide in people of all ages.

The extent of the problem

Each year approximately one million people die by suicide worldwide. Suicide is a major public health problem in many countries and accounts for nearly 3% of all world deaths.

In very young adolescents (under age 15) suicide is the leading cause of death in China, Sweden, Ireland, Australia and New Zealand.

In teenagers and young adults aged 15-24 suicide is a leading cause of death in many countries.

In adults, suicide is a leading cause of death, accounting for more deaths than all wars and homicides combined.

In most countries, the risk of suicide increases with increasing age. In many countries suicide rates are highest amongst the very old, aged 85 and older.

However, deaths from suicide are only one part of the problem. Attempted suicide is conservatively estimated to be 10 to 20 times more frequent than suicide, especially in younger women. While suicide attempts may vary in intent and medical severity, all attempts are indications of severe distress, unhappiness and/or mental illness.

Suicide and suicide attempts have a profound impact on family and friends and are the source of much distress and suffering. For individuals bereaved by suicide the emotional impact may last for many years, and for families the consequences may extend for generations.

The economic costs of suicide to society are substantial, estimated to be in the billions of dollars, and reflect the economic potential of years of life lost, the medical and treatment costs of suicide attempts, and the burden of care and suffering of families and friends of those who die by suicide and those who engage in various forms of suicidal behaviour.

Suicidal behaviour

Fortunately, suicide is not an inevitable burden that must be accepted by society. There are many ways in which suicide can be prevented.

There is a great need for effective, coordinated and comprehensive suicide preventive initiatives throughout the world if we are to reduce the enormous numbers of completed suicides, suicide attempts and problems related to suicide and self-destructive behaviours.

Effective suicide prevention calls for an innovative, comprehensive multisectorial approach, including both health and non-health sectors, including education, labour, police, justice, religion, law, politics and the media.

In all societies suicide amongst children and young adolescents under the age of 15 is very rare and accounts for less than 2% of all suicides.

There is a greater likelihood of suicidal behaviour in children who come from families in which there is parental violence, sexual or physical abuse or neglect, or in which there are family histories of alcohol and drug abuse, depression and suicidal behaviour.

Depression in children appears to be a risk factor for suicide although depressive symptoms in children may be difficult to recognise and diagnose. Symptoms of depression may include long lasting sadness, inability to concentrate, somatic complaints and anxiety.

Some children may express depression by acting out or being angry. If children have several of these symptoms or the symptoms are intense and long- lasting they should be referred for professional consultation, particularly if they become interested in suicide or threaten suicide.

Factors such as cultural alienation, identity confusion, the impact of history through inter-generational modelling and behavioural transfer, and colonisation, may contribute to suicidal behaviour.

Although children and young adolescents very rarely die by suicide, they invariably experience suicidal behaviour, hear about it, see it on television and discuss it with other children. Since adults seldom talk about suicide with children, children’s experiences and understanding of suicide tend to come from television and from other children and therefore tend not to be realistic.

The way in which schools, organisations and communities manage the aftermath of suicide may play a role in suicide prevention. Young people are especially vulnerable to imitative suicidal behaviour and this may be encouraged by funeral and memorial services that eulogise the young who die by suicide.

Restricting access to lethal means of suicide, including firearms, pesticides, vehicle exhaust gas, drugs which are lethal if taken in overdose, and installing barriers at sites which become popular for suicide are all approaches which can reduce suicides, especially those which occur impulsively.

Older adults seem to be protected from suicide if they have a supportive, close relationship, social support and interaction, participation in organisations, interests and hobbies, strong religious or spiritual values, adequate support following bereavement and respite from family discord and conflict.

While improving recognition of depression is a major approach to suicide prevention in older adults, other approaches include: exploring the effectiveness of community gatekeepers who have contact with older people in identifying and referring those who might be at risk of depression and suicide; developing community programmes which promote social contact, interventions and support; ensuring older adults receive adequate support after bereavement; restricting access to lethal means of suicide especially firearms and medications, and developing more effective ways of maintaining contact with older adults by health services.

Who can help

Effective suicide prevention involves a multifaceted and intersectoral approach to address the multiple causes and pathways to suicidal behaviour across the lifespan.

The range of people who can be involved in suicide prevention includes heath and mental health care professionals, volunteers, researchers, families and others bereaved by suicide or affected by suicidal behaviour, and people from outside the health sector, including those who work in central and local government, education, justice, police, law, the employment sector, religion, politics, and the media.

The theme of World Suicide Prevention Day 2007, “Suicide Prevention across the Life Span”, is an opportunity for researchers, clinicians, practitioners, community and voluntary organizations to disseminate information about the nature of suicidal behaviour in different age groups, and the most effective approaches to preventing suicide.

Those who work in all areas of suicide prevention can use the day to highlight activities which increase public understanding and awareness of suicide as a preventable public health problem across the lifespan.

International Association for Suicide Prevention