The number of countries with national suicide prevention strategies has increased in the five years since the publication of WHO’s first global report on suicide, said the UN agency on World Suicide Prevention Day yesterday. But the total number of countries with strategies, at just 38, is still far too few and governments need to commit to establishing them.
“Despite progress, one person still dies every 40 seconds from suicide,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Every death is a tragedy for family, friends and colleagues. Yet suicides are preventable. We call on all countries to incorporate proven suicide prevention strategies into national health and education programmes in a sustainable way.”
The rate of suicide is higher in high-income countries as the second leading cause of death among young people, the agency noted. The global age-standardized suicide rate for 2016 was 10.5 per 100 000 but rates varied widely between countries, from five suicide deaths per 100 000 people to more than 30 per 100 000 persons.
While 79 per cent of the world’s suicides occur in low and middle income countries, high income countries had the highest rate, at 11.5 per 100 000 people. Nearly three times as many men as women die by suicide in high-income countries, in contrast to low and middle-income countries, where the rate is more balanced.
WHO says suicide was the second leading cause of death among young people aged 15-29 years, after road injuries. Among teenagers aged 15-19 years, suicide was the second leading cause of death among girls (after maternal conditions) and the third leading cause of death in boys (after road injuries and interpersonal violence).
The most common methods of suicide are hanging, pesticide self-poisoning, and firearms. Key interventions that have shown success in reducing suicides are restricting access to the means of suicide and educating the media on responsible reporting of suicide.
Other strategies include implementing programmes among young people to build life skills that enable them to cope with life stresses, along with early identification, management and follow-up of people at risk of suicide.
The kind of intervention that has the most imminent potential to bring down the number of suicides is restricting access to pesticides that are used for self-poisoning, the agency noted. The high toxicity of many pesticides means that such suicide attempts often lead to death, particularly in situations where there is no antidote or where there are no medical facilities nearby.
The WHO publication released yesterday ‘preventing suicide: a resource for pesticide registrars and regulators’ shows that there is now a growing body of international evidence indicating that regulations to prohibit the use of highly hazardous pesticides can lead to reductions in national suicide rates.
The best-studied country is Sri Lanka, where a series of bans led to a 70 per cent fall in suicides and an estimated 93 000 lives saved between 1995 and 2015. In the Republic of Korea – where the herbicide paraquat accounted for the majority of pesticide suicide deaths in the 2000s – a ban on paraquat in 2011-2012 was followed by a halving of suicide deaths from pesticide poisoning between 2011 and 2013.
The timely registration and regular monitoring of suicide at the national level are the foundation of effective national suicide prevention strategies. Yet, only 80 of the 183 WHO member states for which estimates were produced in 2016 had good quality vital registration data. Most countries without such data were low and middle-income, the agency noted, affirming that better surveillance will enable more effective suicide prevention strategies and more accurate reporting of progress towards global goals.
On commemoration day, WHO in collaboration with global partners, the World Federation for Mental Health, the International Association for Suicide Prevention and United for Global Mental Health, launched the 40 seconds of action campaign. The culmination of the campaign will be on World Mental Health Day, 10th October, the focus of which this year is also suicide prevention.