World Health Organization’s First Suicide Report Underscores Prevention

Health Letter, March 2015

By Azza AbuDagga, M.H.A., Ph.D.

suicide prevention
Image: Triff/Shutterstock.com

Suicide is a personal tragedy that prematurely takes a life and has devastating and far-reaching effects on families and communities. A leading cause of death worldwide, this serious problem has remained a low public health priority in many countries for a long time.[1]

The World Health Organization’s (WHO) first report on suicide, released in September 2014[2] and titled Preventing Suicide: A Global Imperative,[3] aims to change that. The main objectives of the report are to raise awareness of suicide and to prioritize suicide prevention in global public health and public policy agendas.[4]

Suicide: A global phenomenon

According to WHO, over 800,000 people worldwide die every year due to suicide. Significantly, there are indications that for each individual who dies of suicide, there may be more than 20 others attempting suicide.

Suicide affects men and women of various ages worldwide. Suicide rates are highest among people aged 70 years and over in almost all regions of the world. Adolescents and young adults are also especially susceptible to suicide; it is currently the second-leading cause of death for people ages 15 to 29 worldwide.

Contrary to the belief that suicide is a problem mostly affecting affluent countries, low- and middle-income countries bear most of the global burden of suicide, with an estimated 75 percent of all suicides occurring in these countries.

The Centers for Disease Control and Prevention reports that suicide is the 10th-leading cause of death among all age groups in the U.S. It is the second-leading cause of death in the 15- to 24- and 25- to 34-year-old age groups, the fourth among the 35- to 54-year-old age group, and the eighth among the 55- to 64-year-old age group.[5]

There were over 39,000 suicide deaths in the U.S. in 2011, and more than 483,000 people were treated for self-inflicted injuries (including suicide attempts) in emergency rooms in 2012.[6] Cumulatively, suicide and self-inflicted injuries result in more than $41 billion in combined medical and work-loss costs in the U.S.

Who’s at risk?

The WHO report clarifies that no single factor can explain why people take their own lives. Instead, the authors note that suicidal behavior — which includes thinking about suicide, planning for suicide, attempting suicide and committing suicide — is a complex phenomenon that is influenced by several interrelated factors: personal, social, psychological, cultural, biological and environmental. The connection between suicide and mental illnesses — especially, depression and alcohol abuse — is well established.[7]

The report indicates that most people who engage in suicidal behavior are uncertain about wanting to die at the time of committing suicide, and some suicidal acts are impulsive responses to crisis situations.

Particularly, conflict, disaster, violence, abuse, loss and a sense of isolation are related to suicidal behavior in complex ways: Suicide rates sometimes rise due to disaster or conflict, but can also dip during these times of crisis, as people focus on meeting the most urgent needs or turn to each other for support. Suicide rates are high among vulnerable groups who experience discrimination, such as refugees, migrants, indigenous peoples (including Native Americans), prisoners and others.

In the U.S., there is strong evidence that risk of suicide is heightened among persons currently serving in the military and those with a history of military service.

Importantly, individuals who have made prior suicide attempts are at much higher risk of dying by suicide than those who have not.

Means of committing suicide

According to the WHO report, understanding the means of committing suicide is critical for planning suicide prevention efforts. The report indicates that suicide by firearm accounts for the majority of suicides in some countries, including the U.S.; there is a close association between the proportions of households owning firearms and the proportion of firearm suicides.[8]

In most European countries, self-poisoning with medication is a major method of suicide, whereas pesticide self-poisoning is the major method of suicide deaths in rural areas in low- and middle-income countries. Additionally, jumping — from bridges, from high buildings or in front of trains — and hanging are other common suicide methods in many countries.

Key message of the report

The report’s key message is that suicide is preventable. Nonetheless, the report notes that only a few countries have included suicide prevention among their health priorities and only 28 countries have a national suicide prevention strategy. Therefore, WHO calls for suicide prevention to be a public health priority for all countries, and proposes that governments should establish and implement a suicide prevention strategy with specific goals and interventions to prevent suicide.

The report includes roles for many parties in the creation of national plans to prevent suicide. It encourages coordination and collaboration among multiple sectors: health, education, labor, agriculture, law, the media and others. These efforts must be comprehensive and integrated, as no single sector alone can address the complex problem of suicide.

The report recommends the following overarching suicide prevention strategies:

  • Community awareness. Increased community awareness of suicide and mental illness is needed to break down the stigma associated with both of these problems. Awareness encourages people thinking of taking their own lives to seek help and enables them to receive the help they need.
  • Reduced access to suicide means. Many impulsive suicides can be prevented by developing appropriate policies to restrict access to suicide means (for example, limiting access to pesticides and firearms; putting barriers on subways, bridges and iconic buildings; and changing packaging regulations for medications).
  • Responsible reporting by media. Inappropriate reporting that sensationalizes or glamorizes suicide can increase the risk of “copycat” suicides (suicides imitating the means of a previous suicide) in vulnerable individuals. Therefore, inappropriate media reporting practices that dramatize or normalize suicide as an acceptable response to crisis or hardship should be avoided.
  • Suicide prevention as a core component of health care services. Improved quality of care — particularly, identifying and helping people at risk of suicide — is essential for reducing the number of suicides that arise as a result of mental illness, alcohol abuse and other risk factors. Mental health and alcohol policies should prioritize care, promote the successful integration of such care into overall health care services and support sufficient funding for the improvement of these services.
  • Follow-up care for people who have attempted suicide. Identifying high-risk individuals with previous suicide attempts and providing them with follow-up care and support should be a main component of all comprehensive suicide prevention strategies.
  • Community-based support. Effective social support within communities — from family and friends — can be very helpful in preventing suicide. Family and friends can improve the ability of suicidal people to cope with difficulties. They can pick up on warning signs, detect individuals at risk and intervene to prevent suicides. They can also help when a suicide attempt has occurred by providing follow-up.

Actions you can take to prevent suicide

Be aware of the warning signs of suicide, which can include increasing alcohol or substance use and major changes in mood, diet or sleeping patterns. Individuals may also talk about wanting to hurt themselves. When these signs occur, quickly connecting the person to supportive services is critical to preventing suicide.

If you or someone you know is thinking about suicide, contact the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255).


References

[1] World Health Organization. Preventing Suicide: A Global Imperative. Geneva: World Health Organization; 2014.

[2] Fleischmann A, De Leo D. The World Health Organization’s report on suicide: A fundamental step in worldwide suicide prevention. Crisis. 2014;35(5):289-291.

[3] World Health Organization. Preventing Suicide: A Global Imperative. Geneva: World Health Organization; 2014.

[4] World Health Organization. Preventing Suicide: A Global Imperative. Geneva: World Health Organization; 2014.

[5] Centers for Disease Control and Prevention. Understanding suicide. http://www.cdc.gov/violenceprevention/pdf/suicide_factsheet-a.pdf. Accessed January 27, 2015.

[6] Ibid.

[7] World Health Organization. Preventing Suicide: A Global Imperative. Geneva: World Health Organization; 2014.

[8] Centers for Disease Control and Prevention. Understanding suicide. http://www.cdc.gov/violenceprevention/pdf/suicide_factsheet-a.pdf. Accessed January 27, 2015.