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HELP FIGHT THE STIGMA

© 2019 by Paula Fontenelle

Suicide is a global public health problem. The World Health Organization (WHO) estimates that approximately 800,000 people die by self-inflicted death every year, which represents one person every 40 seconds. One-third of the victims are young; it is the second-leading cause of death among 15- to 29-year-olds. The numbers are high but they do not mirror the reality that goes grossly underreported by countries that do not have efficient surveillance systems or by the societies or that either criminalize or stigmatize suicide. For each self-inflicted death, WHO calculates that there are approximately 20 attempts. In some countries, it can go as high as 100 attempts.

Global statistics are monitored annually by WHO, but given that the institution depends on the voluntary sharing of data, the information is far from reliable. Of the 172 member states, it is estimated that only 60 have good-quality registration of suicide. More importantly, the remaining 112 account for 71 percent of all global self-inflicted deaths. 

What makes suicide so underreported? The answer involves several factors. Compiling data involves multileveled layers of governmental bodies, cultural elements, and various medical and legal concerns. These are some of the caveats to be taken into account when interpreting the numbers presented here. It also needs to be said that the collecting of world suicide rates has been improving over the last few decades. In 1950, a mere 21 countries reported their data. Quality of data is in the rise as well, partly due to initiatives taken by WHO, as well as the rising awareness that the theme has been receiving over the last few years.

According to WHO, the most common misclassifications of suicide are: “death of undetermined intent,” “accident,” “homicide,” and “unknown causes.” In the Brazilian classification system, for instance, self-inflicted death belongs to the “External Causes” category, which includes deaths caused by violence and accidents. Due to incorrect reporting, it is estimated that the Brazilian death logs are two to ten times larger than what is publicly disclosed. Unfortunately, this is not a localized phenomenon. Inaccuracy is widespread. 

Apart from official misclassification of voluntary death, there are several reasons why data collection is difficult. Prejudice and stigma stand out. Families may plead for suicide to not be mentioned on death certificates, either because they don't want the label associated with their history, or for more practical reasons, such as concern that life insurance companies will not pay benefits. This is the case in many countries. Another common occurrence is the fact that, on death certificates, coroners usually state the nature of the wound, not the underlying cause or intent. A shot to the heart, for example, may have three different causes—accident, homicide, or self-inflicted death—but be documented the same way.

Suicide as a crime

 

One more aspect should be mentioned. Some countries outlaw suicide, with penalties that vary from fines to life in prison, which is the case in the Bahamas. In an article published in the International Journal of Law and Psychiatry, Brian Mishara, director for the Center for Research and Intervention on Suicide and Euthanasia, in Montreal, Canada, and David Weisstub, professor of Legal Psychiatry at the University of Montreal, found that 25 countries and states consider self-inflicted death illegal. In addition, twenty follow Islamic or Sharia law, which usually means jail time for those who attempt to kill themselves.  Encouraging or aiding someone to take their own lives is often criminalized as well. The authors analyzed criminal codes from 192 localities.

To see the complete list of countries where suicide is a crime, CLICK HERE.

For a Quick Facts Sheet about global suicide, CLICK HERE.

World Scenario

The highest suicide rates in the world are found in countries located in Southeast Asia, Europe, and Africa. In Southeast Asia, Thailand, Myanmar, and Singapore are at the top of the list. Narrowing down to individual countries - in the first position, with 30.2 voluntary deaths per 100,000 inhabitants, is Guyana, in South America, followed by Lesotho (28.9), the Russian Federation (26.5), Lithuania (25.7), Suriname (23.2), Côte d’Ivoire (23.0), Kazakhstan (22.8), Equatorial Guinea (22.0), Belarus (21.4), and the Republic of Korea (20.2), all well above the global rate, which is 10.53 per 100,000 inhabitants.

WHO world suicide rate map 2016.png
WHO suicide rates by regions.png
Suicide Rates Asia WHO.png

Age Groups

Suicide affects all age groups, and the annual rates will vary in different countries, but according to Our World in Data, which comprises numbers from the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD), and the World Health Organization, people over the age of 70 have higher risks of dying by suicide. To see the global suicide rates by age group, go to the World Data Page.

 

The graph below shows the global suicide rates from 2000 to 2017, which have decreased in all age groups. 

Our World Data suicide rates by age .png

1. Rates are measured by the number of deaths per 100,000 people.

2. Age-standardized adjusts for differences in age distributions, allowing for comparisons between countries.

For the complete list of countries with their total number of deaths by suicide from 1990 to 2017, CLICK HERE.

For the complete list of countries with their suicide rates from 1990 to 2017, CLICK HERE.

For the Our World Data webpage, CLICK HERE. 

To access the World Health Organization's world suicide rates page CLICK HERE.

United States

 

These three countries are highlighted because they all have reliable data and world-recognized efforts toward suicide prevention.

 

In the United States, suicide rates have been rising steadily over the years. From 1999 to 2017, there was a 33-percent increase in the number of deaths going from 10.5 (29,199 people) to 14.0 (47,173) per 100,000 (see table 6). Females were particularly affected in 2017 compared to 1999 in the following age groups: 10-14 (1.7 and 0.5, respectively), 15-24 (5.8 and 3.0), 25-44 (7.8 and 5.5), 45-64 (9.7 and 6.0), and 65-74 (6.2 and 4.1). The rates in rural areas were 1.8 times higher than in most urban counties (20.0 and 11.1 per 100,000, respectively). 

Since 2008, suicide has been the 10th leading cause of death in the USA. For the 10-34 age group, it has been the second-leading cause since 2016, and the fourth for ages 35-54. The most significant percentage growth has occurred since 2006. From 1999 to 2006, rates grew on average by about 1 percent per year, then, 2 percent per year through 2017. For females, the gain has been an impressive 53 percent, from 4.0 in 1999 to 6.1 in 2017. For males, it went up 26 percent, from 17.8 in 1999 to 22.4 in 2017.

Click on image to be redirected to the Australian Bureau of Statistics.

Suicide Rates in the US (CDC).png

For US suicide rates by gender and age group, CLICK HERE.

Australia

 

According to the country’s Bureau of Statistics, 2017 had 9.1 percent more deaths by suicide than the previous year, totaling 3,128. The 12.6-per-100,00 rate is the same as in 2015, the highest recorded in the past ten years. In 2017, Suicide was the 13th-leading cause of death in that country, moving up from 15th position in 2016. Again, men, with a rate of 19.1 per 100,000, are the majority, accounting for 75.1 percent of the cases. For females, the rate is 6.2.

Data from 2017. Click on image to be redirected to the CDC site.

Australia suicide rates  Gender.png

The United Kingdom

In the UK, statistics show promising trends. In 2017, the Office for National Statistics registered 5,821 deaths, a suicide rate of 10.1. For males (15.5), it was the lowest since their time series began, in 1981. For females, the rates have been consistent (4.9) within the last decade. Three-quarters of the cases in 2017 (4,382) were male, a ratio that has been constant since the mid-1990s. For this population, the most affected age group has been from 45 to 49 (24.8); for females, from 50 to 54 (6.8). When looking at the countries that make up the United Kingdom - England, Scotland, Wales and Northern Ireland – Scotland is at the top, with 13.9 deaths per 100,000, and England the bottom, with 9.2. Northern Island was not included in the numbers.

UK Suicide rates Gender.png
UK Suicide rates graph.png

Source: The Office for National Statistics (click on graphics to be redirected)