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Introduction

World Suicide Prevention Day (WSPD) is an awareness day observed on 10 September every year, in order to provide worldwide commitment and action to prevent suicides, with various activities around the world since 2003.

The International Association for Suicide Prevention (IASP) collaborates with the World Health Organisation (WHO) and the World Federation for Mental Health (WFMH) to host World Suicide Prevention Day.

In 2011 an estimated 40 countries held awareness events to mark the occasion. According to WHO’s Mental health Atlas released in 2014, no low-income country reported having a national suicide prevention strategy, while less than 10% of lower-middle income countries, and almost a third of upper-middle and high-income countries had.

On its first event in 2003, the 1999 WHO’s global suicide prevention initiative is mentioned with regards to the main strategy for its implementation, requiring:

1. “The organisation of global, regional and national multi-sectoral activities to increase awareness about suicidal behaviours and how to effectively prevent them.”
2. “The strengthening of countries’s capabilities to develop and evaluate national policies and plans for suicide prevention.”

As of recent WHO releases, challenges represented by social stigma, the taboo to openly discuss suicide, and low availability of data are still to date obstacles leading to poor data quality for both suicide and suicide attempts: “given the sensitivity of suicide – and the illegality of suicidal behaviour in some countries – it is likely that under-reporting and misclassification are greater problems for suicide than for most other causes of death.”

Background

An estimated one million people per year die by suicide or about one person in 10,000 (1.4% of all deaths), or “a death every 40 seconds or about 3,000 every day”. As of 2004 the number of people who die by suicide is expected to reach 1.5 million per year by 2020.

On average, three male suicides are reported for every female one, consistently across different age groups and in almost every country in the world. “Conversely, rates of suicide attempts tend to be 2-3 times higher in women than in men, although the gender gap has narrowed in recent years.” More people die from suicide than from murder and war; it is the 13th leading cause of death worldwide. According to the WHO there are twenty people who have a suicide attempt for every one that is fatal, at a rate approximately one every three seconds. Suicide is the “most common cause of death for people aged 15 – 24.”

According to the WHO, suicide accounts for nearly half of all violent deaths in the world. Brian Mishara, IASP president, noted that, “more people kill themselves than die in all wars, terrorist acts and interpersonal violence combined.” As of 2008, the WHO refers the widest number of suicides occur in the age group 15 – 29, while the lowest in the 80+ although representing as well the one with the highest rate (per 100,000) of all age groups, with 27.8 suicides and 60.1 for females and males respectively. In 2015 the reported global age-standardised rate is 10.7 per 100,000.

Social norms play a significant role in the development of suicidal behaviours. Late 19th century’s sociological studies recorded first ever observations on suicide: with statistics of the time at hand, sociologists mentioned the effects of industrialisation as in relations between new urbanised communities and vulnerability to self-destructive behaviour, suggesting social pressures have effects on suicide. Today, differences in suicidal behaviour among different countries can be significant.

Themes

• 2003 – Suicide Can Be Prevented!.
• 2004 – Saving Lives, Restoring Hope.
• 2005 – Prevention of Suicide is Everybody’s Business.
• 2006 – With Understanding New Hope.
• 2007 – Suicide prevention across the Life Span.
• 2008 – Think Globally, Plan Nationally, Act Locally.
• 2009 – Suicide Prevention in Different Cultures.
• 2010 – Families, Community Systems and Suicide.
• 2011 – Preventing Suicide in Multicultural Societies.
• 2012 – Suicide Prevention across the Globe: Strengthening Protective Factors and Instilling Hope.
• 2013 – Stigma: A Major Barrier to Suicide Prevention.
• 2014 – Light a candle near a Window.
• 2015 – Preventing Suicide: Reaching Out and Saving Lives.
• 2016 – Connect, Communicate, Care.
• 2017 – Take a Minute, Change a Life.
• 2018 – Working Together to Prevent Suicide.
• 2019 – Working Together to Prevent Suicide.
• 2020 – Working Together to Prevent Suicide.

Priorities

Suicide prevention’s priorities, as declared on the 2012 World Suicide Prevention Day event, are stated below:

• We need to continue to research suicide and non-fatal suicidal behaviour, addressing both risk and protective factors.
• We need to develop and implement awareness campaigns, with the aim of increasing awareness of suicidal behaviours in the community, incorporating evidence on both risk and protective factors.
• We need to target our efforts not only to reduce risk factors but also to strengthen protective factor, especially in childhood and adolescence.
• We need to train health care professionals to better understand evidence-based risk and protective factors associated with suicidal behaviour.
• We need to combine primary, secondary and tertiary prevention.
• We need to increase use of and adherence to treatments shown to be effective in treating diverse conditions; and to prioritise research into effectiveness of treatments aimed at reducing self-harm and suicide risk.
• We need to increase the availability of mental health resources and to reduce barriers to accessing care.
• We need to disseminate research evidence about suicide prevention to policy makers at international, national and local levels.
• We need to reduce stigma and promote mental health literacy among the general population and health care professionals.
• We need to reach people who do not seek help, and hence do not receive treatment when they are in need of it.
• We need to ensure sustained funding for suicide research and prevention.
• We need to influence governments to develop suicide prevention strategies for all countries and to support the implementation of those strategies that have been demonstrated to save lives.

Factors

Suicide has a number of complex and interrelated and underlying contributing factors … that can contribute to the feelings of pain and hopelessness. Having access to means to kill oneself – most typically firearms, medicines and poisons – is also a risk factor.

The main suicide triggers are:

• Poverty;
• Unemployment;
• The loss of a loved one;
• Arguments; and
• Legal or work-related problems.

Suicide results from many complex sociocultural factors and is more likely to occur during periods of socioeconomic, family and individual crisis (e.g. loss of a loved one, unemployment, sexual orientation, difficulties with developing one’s identity, disassociation from one’s community or other social/belief group, and honour).

In richer countries, three times as many men die of suicide than women do, but in low- and middle-income countries the male-to-female ratio is much lower at 1.5 men to each woman.

In the United States, for example, males are four times more likely to die from suicide than are females. However, females are more likely to attempt suicide than are males.

The disparity in suicide rates has been partly explained by the use of more lethal means and the experience of more aggression and higher intent to die in men than women.

Physical and especially mental health disabling issues such as depression, are among the most common of the long list of complex and interrelated factors, ranging from financial problems to the experience of abuse, aggression, exploitation and mistreatment, that can contribute to the feelings of pain and hopelessness underling suicide. Usually substances and alcohol abuse also play a role.

Prevention strategies generally emphasise public awareness towards social stigma and suicidal behaviours.

Cultural and Religious Attitudes

In much of the world, suicide is stigmatised and condemned for religious or cultural reasons.

In some countries, suicidal behaviour is a criminal offence punishable by law. Suicide is therefore often a secretive act surrounded by taboo, and may be unrecognised, misclassified or deliberately hidden in official records of death.

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 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.

Links

• National Health Service (NHS).
• International Association for Suicide Prevention (IASP).
• World Health Organisation (WHO).
• Samaritans.