Suicide: A Grave Public Health Challenge
Padmini Murthy, MD, Preventive Medicine, 05:51PM Sept. 8, 2012
As we approach the busiest time of the year, especially in North America, children are going back to school and entering university as they take their first steps to adulthood on their own in what can sometimes be an intimidating environment. A stressful environment, lack of coping mechanisms, and peer pressure can contribute to low self-esteem among adolescents and young adults.
The World Health Organization observes 10 September as World Suicide Prevention Day.
"Suicide, though largely preventable, is one of the three leading causes of death among those in the most economically productive age group (15-44 years), and the second leading cause of death of those 15-19. At the other end of the age spectrum, the elderly are also at high risk.
Every year, almost one million people die by suicide around the world. Suicide remains a significant social and public health problem. In 1998, suicide constituted 1.8% of the total disease burden; this is estimated to rise to 2.4% by 2020 (Bertolote, 2009). Young people are increasingly vulnerable to suicidal behaviors. Worldwide, suicide is one of the three leading causes of death among those in the most economically productive age group (15-44 years), and the second leading cause of death in the 15-19 years age group (Patton et al., 2009). At the other end of the age spectrum, the elderly are also at high risk in many countries.
Suicidal behaviors can be conceptualized as a complex process that can range from suicidal ideation, which can be communicated through verbal or non-verbal means, to planning of suicide, attempting suicide, and in the worst case, suicide. Suicidal behaviors are influenced by interacting biological, genetic, psychological, social, environmental and situational factors (Wasserman, 2001).
Risk factors for suicide include mental and physical illness, alcohol or drug abuse, chronic illness, acute emotional distress, violence, a sudden and major change in an individual's life, such as loss of employment, separation from a partner, or other adverse events, or, in many cases, a combination of these factors. While mental health problems play a role which varies across different contexts, other factors, such as cultural and socio-economic status, are also particularly influential. The impact of suicide on the survivors, such as spouses, parents, children, family, friends, co-workers, and peers who are left behind, is significant, both immediately and in the long-term.
Although suicide continues to remain a serious problem in high income countries, it is the low and middle income countries that bear the larger part of the global suicide burden. It is also these countries that are relatively less equipped to prevent suicide. Unable to keep pace with the rising demand for mental health care, they are especially hindered by inadequate infrastructure and scarce economic and human resources.
These countries have also lower budgetary allocations for health in general and for mental health in particular. As a result, there are few sustained efforts and activities that focus on suicide prevention on a scale necessary to reduce the number of lives lost to suicide (Vijayakumar, 2005). Beyond financial realities, for all countries political will is an essential ingredient to bring about change at the policy and program level. Suicidal behavior is considered a criminal offence in some countries, which poses additional challenges for suicide prevention activities.
In the early 1990s, there were growing concerns in several countries about increased suicide mortality (suicidal deaths) and morbidity (suicide attempts). These concerns were in part due to effective control of other causes of death and prolonged life expectancies, which created a larger pool of individuals at risk of suicidal behavior. Accordingly, a few of those countries approached both the United Nations (UN) and the World Health Organization (WHO) asking for help in designing comprehensive national plans that would tackle the issue in a cost-effective manner." (Source: WHO, 2012)
As public health professionals, we need to be aware of the various cultural views and taboos with regard to mental health issues and views about suicide attempts and prevention.
Till my next post,
In Health and Human Rights!
Your cyber blogger,
Padmini (Mini) Murthy