For World Suicide Prevention Day and beyond, and as part of Springer Nature’s commitment to the Sustainable Development Goals (SDGs), we are endeavouring to help raise awareness of SDG 3.4.2 – reduce suicide mortality rate. To achieve this, it is important to understand factors contributing to why someone might wish to end their own life, as well as be able to identify those at risk of doing so.
Here expert David Gunnell provides insight into the research and wider dialogue around this important topic. Plus, check out more content we've made available in support of World Suicide Prevention Day.
Please note – Springer Nature is a publishing company and therefore does not provide direct medical advice. Whilst the research provided below is a useful resource, it should not replace direct consultation with a medical practitioner. Additional information and contact details can be found on the World Suicide Prevention Day homepages here.
What has research shown are the biggest risk factors for suicide, and what are the most effective prevention strategies?
From a population health perspective, some of the main risk factors are mental illness, easy access to high lethality suicide methods (e.g. pesticides and firearms), substance misuse (alcohol / illegal drugs), socioeconomic adversity (e.g. debt, job loss) and bullying / abuse. From a more clinical perspective, someone who has previously attempted suicide and survived is at greatly increased risk compared to the general population. Some of these issues are potentially more tractable than others. For example, regulatory controls / bans on highly toxic pesticides and firearms, in countries where these are relatively easily available, may prevent many deaths.
Suicide is preventable, and it is important that all countries develop prevention strategies targeting the key issues for their context. Key approaches include restricting access to commonly used, high lethality suicide methods; appropriate assessment and treatment of people who survive suicide attempts; making treatments for mental illnesses accessible to all; destigmatising mental illness and encouraging help-seeking amongst people experiencing suicidal thoughts and, related to this, helping people recognize and respond to suicide risk in others. Partnership working with the news media is important both to encourage responsible reporting of suicide and to destigmatize mental illness.
Should the media’s reporting of suicides be self-regulated or monitored?
I’m a firm believer in freedom of the press. But there is now a considerable body of research evidence that some reporting of real-life suicide deaths (e.g. of celebrities) and fictional portrayals of suicide (e.g. in films / TV programmes) may lead to increases in the number of suicide deaths or raise awareness of high-lethality suicide methods, with potentially disastrous consequences for suicide rates. Research evidence also indicates that clustering of suicides – a thankfully rare, but tragic phenomenon that young people are particularly vulnerable to – may be triggered or promoted by some forms of reporting. So, if self-regulation fails, I think there could be a case made for legislative intervention.
How can/should technology be used to prevent suicide?
New technologies (big data, use of mobile phone technology, genetic epidemiology) hold out great promise both for increasing our understanding of suicidal behaviour and factors influencing risk as well as intervening to reduce risk. This promise is yet to be fully realized, despite considerable hype, but I hope this situation will change over the next decade. We must remember that use of such technology presents several challenges both in terms of personal privacy (e.g. for surveillance approaches implemented via social media) and high false-positive rates, but it presents great opportunities for reaching out to hard-to-reach groups, bearing in mind that in countries such as the UK less than a third of all people who die by suicide are in current or recent (last 12 months) contact with specialist mental health services.
Certain populations are at higher risk of contemplating, attempting, and dying by suicide. What factors contribute to this increased risk and what measures might be taken to reduce the incidence in these populations? (For example race/ethnicity, age, sex/gender, sexual orientation, geographic region, place of residence, etc.).
That’s a complex question as there are so many high-risk groups and these groups vary in different locations. For example, the risk of suicide for males is three times higher than that for females in the UK and most high-income countries; but in China – the ratio of male to female suicides is closer to 1:1.
The presence of mental illness is often not sufficient cause to lead to suicide – most people with mental health problems do not take their own lives. So, we need to better understand and respond to triggers such as relationship breakdown, job loss, debt, etc. Intriguingly, research shows that the risk factors for suicidal thoughts are not the same as those for acting on those thoughts. An example of a practical intervention that a group of us from Sri Lanka, the UK, Denmark, Australia, Korea and Taiwan have worked on over several years is the prevention of pesticide self-poisoning: a method that accounts for up to 1 in 5 of global suicides. Households engaged in agriculture in low-income countries have easy access to pesticides, and many pesticide products are highly lethal when ingested. The case-fatality from self-poisoning in high-income countries, where the most commonly ingested poisons are pain killers, sleeping pills and antidepressants, is <2%, but for some of the pesticide products readily available and commonly ingested in suicide attempts in low-income countries, such as some weedkillers, the death rate from self-poisoning may be over 50%. There is now a considerable body of research which shows that introducing national regulation / bans of the most highly hazardous pesticides saves lives and may bring down overall suicide numbers, because most people who survive a suicide attempt don’t make another attempt.
Suicide and gun violence are closely related. Should addressing the latter be a key focus of suicide prevention?
I think one can make a very strong case for tightening regulations on firearms. This is likely to bring down suicide rates and most likely the incidence of homicide too. Many of us working in countries outside the USA are surprised that whilst the US has a focus on suicide prevention (and a concern about rising suicide rates), it appears reluctant to take action to reduce the high levels of gun ownership in its communities. Large-scale research led by my colleagues Michael Eddleston, Flemming Konradsen and Melissa Pearson in Sri Lanka, demonstrated that encouraging the safe-keeping of pesticides was ineffective in bringing down the incidence of pesticide suicides. I suspect that this so-called safe-storage approach will have minimal impact on firearm suicides too; guns need to be taken out of communities.
How is suicide risk related to burnout? How can healthcare professionals and others who work with at-risk populations care for their own mental health?
I’m not sure I’m best placed to answer this question as it is now over 20 years since I worked in clinical practice. But it is important that both clinicians and researchers who spend time working on these issues look after their own and their colleagues’ mental health. There can be few things more distressing than losing a family member, friend, colleague or patient to suicide or of managing suicide risk day-in, day-out. Saying that, recent studies indicate that the risk of suicide amongst doctors, for example, is no higher than in the general population. Key high-risk groups include those working in low paid, insecure jobs, such as in the construction industry.
About David Gunnell