Each year, the World Federation of Mental Health chooses a theme for World Mental Health Day, which is Oct. 10. This year’s theme is “Mental Health Promotion and Suicide Prevention.”
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About 800,000 people die by suicide every year, according to the World Health Organization. Suicide is the second-leading cause of death among people aged 15-29 years.1
Most suicide occurs in low- and middle-income countries, the WHO reports. In addition, almost two-thirds of those deaths around the world occur in males, a recent study shows.2 The study, conducted by Danah Alothman and Andrew Fogarty, MBBS, of the NIHR Biomedical Research Center at the University of Nottingham (England), looked at sex-specific suicide rates for 182 countries in 2015.
They found that the highest difference between male:female suicide rates were in the Americas (median, 4:1/100,000), and the lowest were in Africa and Asia (median for both continents, 2.7:1/100,000).
“The implication is that as societies become richer and more educated, males have a higher risk of dying as a consequence of suicide relative to females,” they wrote in the Journal of Affective Disorders.
For clinicians who treat patients with mental illness, particularly those of us who practice in the Americas, this sex differential is concerning. We know that women are more likely to be diagnosed the depression.3 But perhaps this has something to do with the way men are socialized around the world. In other words, as John S. Ogrodniczuk, PhD, and John L. Oliffe, PhD, wrote,4 depression in men “often manifests as irritability; anger; hostile, aggressive, abusive behavior; risk taking, substance abuse; and escaping behavior.” They argue that the outward behavior shown by some men with depression might, in fact, “serve as a cover-up mechanism to hide the internal turmoil” they are experiencing. We certainly know that some men adhere to masculine norms such as stoicism, which in turn, heightens self-stigma. Unfortunately, men seek help for depression less often than do women.5 So one key question becomes: What can we as mental health professionals do to better meet the treatment needs of our male patients?
One example of a program that could hold promise in this area is one called Men at Risk. That program, developed by the nonprofit Centre for Suicide Prevention, in Grande Prairie, Alta., helps men who work in the oil, forestry, and agriculture sectors talk about their challenges and encourages them to let go of stigma.6
Factors other than male gender also might increase the likelihood of suicide. It has rightly been said that genetics and environment play a big role on the psyche of the individuals, and the act of suicide is no different when we discuss the etiologic factors that lead to perpetration of such an act. Genetic vulnerability is a factor that cannot be modified or altered in an easy way, hence, control of environmental factors is more pertinent.
Poverty and violence are two major detrimental factors that have reached alarming proportions and can lead people end their lives.
The developing countries, and now to a significant extent, developed countries, face terrorism that affect the human psyche and can lead to depression, psychosis, and substance abuse, and hence, increase the vulnerability toward the act of suicide. In our offices, we psychiatrists come across patients with borderline personality disorder, for example, who present to emergency departments with multiple and repeated suicidal attempts. There is a big role of genetics here – and role of specific interventions, such as dialectical behavior therapy. Pharmacologic treatment can play a vital role.
In order to make the world a safe place, joint global efforts are required. Enhanced security steps, improved immigration screening, and political will are essential to curb this heartbreaking act. Responsible reporting on the part of the media is needed to make suicide contagion less likely.7
Dr. Amin A. Muhammad
Among other important measures are reducing access to guns and other firearms, and increasing health education about consumption of alcohol and other substances. We also need early identification and prompt treatment of mental illnesses; alleviation of poverty; mobilization of community supports; activation of multiple crisis lines; increased availability and affordability of psychotropic medications; reduction of waiting times for seeking treatment of mental illness; enhanced training of crisis workers; and refresher courses for psychiatrists, family physicians, and other allied mental health workers. Above all, strategies are needed to address the stigma associated with seeking help for mental health issues.
Suicide is a global public health issue, and it is of the utmost importance that a collaborative effort be placed in perspective by individual countries within their own health-related policies and parameters.
Good-quality data on suicide prevalence rates would be of the utmost help in understanding the magnitude of this grave problem. The WHO Mental Health Action Plan 2013-2020 indicates the commitment of member states to work toward the global target of reducing the suicide rate in countries by 10% by 2020.
Individual and collective efforts should become the priority to achieve this target going forward.
References
1. World Health Organization. Suicide. 2019 Sep 2.
2. Alothman D and A Fogarty. J Affect Disord. 2020 Jan 1. doi: 10.1016/j.jad.2019.08.093.
3. Albert PR. J Psychiatry Neurosci. 2015 Jul;40(4):219-21.
4. Ogrodniczuk JS and JL Oliffe. Can Fam Physician. 2011;57(2):153-5.
5. Seidler ZE et al. Clin Psychology Rev. 2016;49:106-18.
6. Ellwand O. Men at risk program helping men in Alberta trades, industry, agriculture struggling with mental health issues. Edmonton Sun. 2016 Mar 27.
7. American Association of Suicidology, et al. Recommendations for reporting on suicide.
Dr. Muhammad is clinical professor of psychiatry and consultant psychiatrist at Niagara Health Service, St. Catharines, Ont.