By Gene Beresin and Steve Schlozman
Suicide is awful, more common than you’d think and, in many cases, highly preventable.
Perhaps most important, in virtually every culture and every ethnic group on the planet, suicide is highly stigmatized. It therefore makes sense for the international health community to designate a day when we stop to actively contemplate this potent cause of misery and death. That’s today: World Suicide Prevention Day, though the harsh facts surrounding suicide are so much bigger than a single day.
The statistics, from the International Association for Suicide Prevention, are staggering:
*There are an estimated 800,000 deaths every year throughout the world that are directly attributable to suicide.
*This number is probably under-reported, given the stigma associated with suicide, and the fact that deliberate, self-harming behavior is often misclassified as an accident. The teen that drives into a street lamp at 100 mph could very well be attempting suicide, and not be the victim of an automobile mishap.
*Suicide is the 15th leading cause of death on the planet.
*Suicide is more common among older people (70 years of age and up), but also occurs in middle-aged and younger individuals at alarming rates.
*Lower income nations endure more suicides, but suicide remains a major cause of death in developed nations as well.
*Suicide has been tied to numerous psychiatric illnesses (mostly mood disorders), to difficult economic or traumatic situations and environments, to substance use disorders (both with and without addiction), to the loss of loved ones, and to a lack of good follow-up care following suicide attempts.
*The number one predictor of death by suicide is a previous attempt.
Why So Common?
In other words, we know a lot about suicide. So if we know so much, why does suicide remain so stubbornly common?
The answer to this question is actually much less concrete than we might think. Studies on post-suicide-attempt intervention are lacking and under-represented. Studies on pre-suicide-attempt intervention are also insufficient in generating a simple and generalizable prevention methodology. Moreover, the likelihood of creating a one-size-fits-all approach is minimal. This might be why we know less than we’d like to.
There are studies that show that email, phone and in-person communication following an attempt can make a positive difference, but these studies have relatively low numbers of participants and clearly need follow-up. We also have studies that show we can increase the understanding of suicide and its risk factors in high schools and colleges, but it isn’t clear whether this understanding leads to decreased suicide rates. We do know that treatment as usual — that is, telling someone to go to an appointment with a yet-to-be-met clinician following his or her discharge from an emergency room or hospital — falls short of other more personal interventions.
All of this points to a common flaw in the understanding of suicide.
Suicide isn’t a formal disease. We don’t treat suicide itself. We treat the causes of suicide.