uicide is the result
of an act deliberately initiated and performed by a person in
the full knowledge or expectation of its fatal outcome.
Suicide is now a major public health problem. Taken as an
average for 53 countries for which complete data is available,
the age-standardized suicide rate for 1996 was 15.1 per 100
000. The rate for males was 24.0 per 100 000 and for females
6.8 per 100 000. The rate of suicide is almost universally
higher among men compared to women by an aggregate ratio of
3.5 to 1.
Over the past 30
years, for the 39 countries for which complete data is
available for the period 1970-96, the suicide rates seem to
have remained quite stable, but the current aggregate rates
hide important differences regarding the sexes, age groups,
geography and longer time trends.
Geographically, changes in suicide rates
vary considerably. Trends in the mega-countries of the world
those with a population of more than 100 million are likely
to provide reliable information on suicide mortality.
Information is available for seven of eleven such countries
for the last 15 years. The trends range from an almost 62%
increase in Mexico to a 17% decrease in China, with the United
States and the Russian Federation going in opposite directions
by the same 5.3%, as shown in
Figure 2.4.
Two remarks are needed: first, probably only the size of their
populations puts these countries in the same category, as they
differ virtually in every other aspect. Second, the magnitude
of the change does not reflect the actual magnitude of suicide
rates in those countries. In the most recent year for which
data are available, suicide rates range from 3.4 per 100 000
in Mexico to 14.0 per 100 000 in China and 34.0 per 100 000 in
the Russian Federation.
It is very
difficult, if not impossible, to find a common explanation for
this diverse variation. Socioeconomic change (in any
direction) is often suggested as a factor contributing to an
increase in suicide rates. However, although this has been
documented on several occasions, increases in suicide rates
have also been observed in periods of socioeconomic stability,
while stable suicide rates have been seen during periods of
major socioeconomic changes. Nevertheless, these aggregate
figures may hide important differences across some population
segments. For instance, a flat evolution of suicide rates may
hide an increase in men's rates statistically compensated for
by a decrease in women's rates (as occurred, for example, in
Australia, Chile, Cuba, Japan and Spain); the same would apply
to extreme age groups, such as adolescents and the elderly
(for example, in New Zealand). It has been shown that an
increase in unemployment rates is usually, but not always,
accompanied by a decrease in suicide rates of the general
population (for example, in Finland), but by an increase in
suicide rates of elderly and retired people (for example, in
Switzerland).
Alcohol consumption
(for example, in the Baltic States and the Russian Federation)
and easy access to some toxic substances (for example, in
China, India and Sri Lanka) and to firearms (for example, in
El Salvador and the United States) seem to be positively
correlated with suicide rates across all countries
industrialized or developing so far studied. Once again,
aggregate figures can hide major discrepancies between, for
example, rural and urban areas (for example, in China and the
Islamic Republic of Iran).
Suicide is a leading cause of death for
young adults. It is among the top three causes of death in the
population aged 1534 years. As shown in two examples in
Figure 2.5,
suicide is predominant in the 1534-year-old age group, where
it ranks as the first or second cause of death for both the
sexes. This represents a massive loss to societies of young
persons in their productive years of life. Data on suicide
attempts are only available from a few countries; they
indicate that the number of suicide attempts may be up to 20
times higher than the number of completed suicides.
Self-inflicted
injuries including suicide accounted for about 814 000 deaths
in 2000. They were responsible for 1.3% of all DALYs according
to GBD 2000.
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