Suicide remains one of the leading causes of death worldwide, according to the World Health Organization’s (WHO’s) latest estimates, published today in “Suicide worldwide in 2019.”
Every year, more people die as a result of suicide than HIV, malaria or breast cancer - or war and homicide. In 2019, more than 700,000 people died by suicide: one in every 100 deaths, prompting WHO to produce new guidance to help countries improve suicide prevention and care.
Among young people aged 15 to 29, suicide was the fourth leading cause of death after road injury, tuberculosis and interpersonal violence. Rates vary, between countries, regions, and between males and females. More than twice as many males die due to suicide as females. Suicide rates among men are generally higher in high-income countries. For females, the highest suicide rates are found in lower-middle-income countries.
Suicide rates fell in the 20 years between 2000 and 2019, with the global rate decreasing by 36%, with decreases ranging from 17% in the Eastern Mediterranean Region to 47% in the European Region and 49% in the Western Pacific. But in the Americas Region, rates increased by 17% in the same time period.
Currently only 38 countries are known to have a national suicide prevention strategy. A significant acceleration in the reduction of suicides is needed to meet the SDG target of a one-third reduction in the global suicide rate by 2030.
To support countries in their efforts, WHO’s guidance for implementing its LIVE LIFE approach to suicide prevention includes four strategies, including:
· limiting access to the means of suicide, such as highly hazardous pesticides and firearms;
· educating the media on responsible reporting of suicide;
· fostering socio-emotional life skills in adolescents; and
· early identification, assessment, management and follow-up of anyone affected by suicidal thoughts and behavior.
Given that pesticide poisoning is estimated to cause 20% of all suicides, and national bans of acutely toxic, highly hazardous pesticides have shown to be cost-effective, such bans are recommended by WHO. Other measures include restricting access to firearms, reducing the size of medication packages, and installing barriers at jump sites.
The guide highlights the role the media plays in relation to suicide. 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. The new guide advises monitoring of the reporting of suicide and suggests that media counteract reports of suicide with stories of successful recovery from mental health challenges or suicidal thoughts. It also recommends working with social media companies to increase their awareness and improve their protocols for identifying and removing harmful content.
Adolescence (10 to 19 years of age) is a critical period for acquiring socio-emotional skills, particularly since half of mental health conditions appear before 14 years of age. The LIVE LIFE guidance encourages actions including mental health promotion and anti-bullying programs, links to support services and clear protocols for people working in schools and universities when suicide risk is identified.
Early identification, assessment, management and follow-up applies to people who have attempted suicide or are perceived to be at risk. A previous suicide attempt is one of the most important risk factors for a future suicide. Healthcare workers should be trained in early identification, assessment, management and follow-up. Survivors’ groups of people bereaved by suicide can complement support provided by health services. Crisis services should also be available to provide immediate support to individuals in acute distress.
The new guidance, which includes examples of suicide prevention interventions that have been implemented across the world, in countries such as Australia, Ghana, Guyana, India, Iraq, the Republic of Korea, Sweden and the USA, can be used by anyone who is in interested in implementing suicide prevention activities, whether at national or local level, and in the governmental and nongovernmental sectors alike.