Suicide and Suicide Prevention in Asia

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60% of the world's suicides take place in the Southeastern and Western Pacific regions of Asia. China has 21% of the world's population and between 30 and 40% of the world's suicides. Suicide Prevention International (SPI) has completed a survey of the problem and the measures being taken to address it: Suicide and Suicide Prevention in Asia has just been published by the World Health Organization.

Suicide in China dramatizes the dimensions of the problem. It is the fifth major cause of death in the country, and the leading cause of death for young people 15-34 years of age. At least three quarters of the suicides are in rural China where the suicide rates are at least three times the urban rates. The suicide rate for women is higher than that for men, and has left large numbers of young children motherless. A major contributing factor is the shortage of doctors and other health care providers. The rural areas of India have similar problems.

Obtaining adequate figures on suicide rates in Asia is a problem since in many countries doctors are generally not required to sign death certificates; Japan is the notable exception. In Vietnam, a family member reports the cause of death to a local health official ("his heart stopped beating" or "she stopped breathing." The only officially verified causes of death are those of the small minority of patients who die in hospitals. Since enormous stigma attaches to suicide in countries like Pakistan and India and where both suicide and attempted suicide are against the law (a woman's chances of being married are greatly diminished if it is known there was a suicide in her family) this makes determining suicide rates difficult and discourages individuals who have made suicide attempts from seeking help.

A few countries - Australia, New Zealand, Japan, and Sri Lanka - have national strategies to prevent suicide; others -Malaysia, the Republic of Korea, and Thailand - are in the process of doing so. All rely to varying degrees on non-governmental agencies to develop and implement prevention strategies. They institute measures ranging from creating public awareness of depression as treatable and suicide as preventable and improving portrayal of suicide in the media to reducing access to lethal means of self-harm and improving treatment of depression and other disorders that convey suicide risk.

The major weakness of many of the prevention initiatives in the Asian countries is their failure to build in evaluation procedures that would enable them to tell if the initiatives are effective. In addition, a major contributing factor to the difficulty of even developing prevention strategies is the shortage of doctors and other health care providers.

What Can Be Done
Suicide and Suicide Prevention in Asia not only reviews the extent of the problem of suicide in Asian countries, but also discusses the varying cultural contexts in which suicide occurs, what suicide prevention initiatives are being undertaken to address them, evaluates the evidence for their effectiveness and, when indicated, makes suggestions for building in evaluative measures that could help make it possible to determine how effective they are.

SPI is working with Asian investigators to develop, implement, and fund two major suicide initiatives in rural China and one in Vietnam. All three reflect responses to the unique configuration of the suicide problem within these countries.

Developing a Mental Health Service Network in Rural China
Psychiatrists from a county mental hospital are training personnel in the villages and towns in a large province (Hunan) to recognize and refer individuals with depression, and/or risk for suicide to the hospital for treatment and subsequently to provide community mental health care for these patients. We expect a significant reduction in suicide and attempted suicide. The ultimate goal is to establish a cost effective model for providing care for these patients that could be adopted by the Chinese government and replicated throughout rural China.

Social-educational Interventions for Rural Suicide Attempters in China
The project strengthens the social support network available to patients seen in hospital emergency rooms following medically serious suicide attempts. It aims at reducing repeated suicidal behavior by helping these suicide attempters find alternative ways of dealing with interpersonal conflicts and other stresses.

Suicide Prevention in Vietnam
The project is ascertaining the frequency of suicide in Vietnam by a sampling method in geographically representative provinces throughout the country. Personnel in the community health centers will be trained to do verbal autopsies. They will visit every family after a death and interview them to determine if the cause of death is a suicide. The clinical leader of the project will come at regular intervals to retest staff and oversee the process. At the end of a year the data for all the districts will be analyzed so that we will have a good estimate of what the actual suicide rate is in the country - information that provides the necessary baseline for evaluating the success of any suicide prevention initiative.

The Suicide and Suicide Prevention in Asia study was led by Dr. Herbert Hendin in association with Asian suicide prevention experts from 13 countries and several consulting experts from Europe and the United States. Editors of the manuscript in addition to Dr. Hendin were Michael Phillips, Lakshmi Vijayakumar, Jane Pirkis, Hong Wang, Paul Yip, Danuta Wasserman, Jose Bertolote, and Alexandra Fleischmann.


Click here to see the Suicide and Suicide in Asia monograph >>


Click here to visit WHO's Suicide Prevention website >>