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Soaring suicide rates: this is how we should step up prevention efforts

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Prevention and awareness should be the main focus in tackling suicide

Earlier in the week, a female Kenyan student doctor reportedly committed suicide at the country’s top referral hospital in the capital Nairobi. According to the Star newspaper, Dr Lydia Wahura Kanyoro injected herself with anaesthetic drugs and died in her car in the Kenyatta National Hospital (KNH) parking lot on Tuesday. Dr Wahura was pursuing her master’s degree in medicine at University of Nairobi’s College of Health Sciences at KNH. “I am so so so so sorry but I don’t expect forgiveness. I am scared of dying but I am more scared of living,” a printed note read in part. She said it was “hard to live in a skin that is not mine and life was not what I expected”.

The death brings to the fore the rising cases of depression and personal health problems among not only medics but people across the globe.

Warning signs

According to Dr Raymond Mgeni, the registrar at Psychiatric Department at Mbeya Zonal Referral Hospital in Tanzania, “There are early warning signs a person who is contemplating or planning to commit suicide shows. The person is dominated by thoughts of suicide or feels tired of living, loss of interest and hobbies, isolation, change in appetite and sleeping patterns, making negative comments about life, appearing emotionally detached changing habits and living dangerous behaviors such as excessive alcohol consumption, over speeding, seeking information on how to commit suicide, distribution of essential items, some even write notes or letters or wills about property left while some completely withdraw from their regular schedules.”

Dr Mgeni goes on to point out that, “mental health and mental health challenges have not been given the attention it deserves on the African continent. The cases of suicide are rising and more efforts are needed to raise awareness through the media to identify what is the cause, highlight the symptoms and provide immediate support to those having mental health challenges and helping survivors.” He says there is a need for the community to be made aware people facing mental health challenges in orders to eliminate the stigma associated with the same adding that many people are not exposed to mental health issues until they are directly impacted and without intervention, their chances of losing life are high hence adding to the cases of soaring suicide rates.

The World Health Organization (WHO) stated that suicide remains one of the leading causes of death worldwide, according to its latest estimates, published this week in “Suicide worldwide in 2019”. 

According to the global health agency, 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.

“We cannot – and must not – ignore suicide,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO during a virtual press conference. 

“Each one is a tragedy.  Our attention to suicide prevention is even more important now, after many months living with the COVID-19 pandemic, with many of the risk factors for suicide   ̶   job loss, financial stress and social isolation – still very much present.  The new guidance that WHO is releasing today provides a clear path for stepping up suicide prevention efforts,” Dr Tedros said.

Among young people aged 15-29, suicide was the fourth leading cause of death after road injury, tuberculosis and interpersonal violence according to WHO.

Gender statistics of suicide

According to WHO estimates, more than twice as many males die due to suicide as females (12.6 per 100,000 males compared with 5.4 per 100,000 females).  Suicide rates among men are generally higher in high-income countries (16.5 per 100 000).  For females, the highest suicide rates are found in lower-middle-income countries (7.1 per 100,000).

Suicide rates in the WHO African (11.2 per 100,000), European (10.5 per 100 000) and South-East Asia (10.2 per 100 000) regions were higher than the global average (9.0 per 100 000) in 2019.  The lowest suicide rate was in the Eastern Mediterranean region (6.4 per 100 000).

Live Life approach to prevention

WHO released a comprehensive guidance for implementing its LIVE LIFE approach to suicide prevention to support countries in their efforts.  The four strategies of this approach are:

· 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 behaviour.

Banning of the most dangerous pesticides: a high-impact intervention

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.

Responsible reporting by the media

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.

Support for adolescents

Adolescence (10-19 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 programmes, links to support services and clear protocols for people working in schools and universities when suicide risk is identified.

Early identification and follow-up of people at risk

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.

Health-care 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.

“While a comprehensive national suicide prevention strategy should be the ultimate goal for all governments,” said Dr Alexandra Fleischmann, suicide prevention expert at the World Health Organization, “starting suicide prevention with LIVE LIFE interventions can save lives and prevent the heartbreak that follows for those left behind.”