Comment
Suicide and self-harm surveillance across the Western
Pacific: A call for action
~lves,a,* Sharna Mathieu,a and Alexandra Fleischmannb
Kairi Ko
a
Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide
Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
b
World Health Organization, Geneva, Switzerland
An estimated 703,000 people died by suicide in 2019
globally with approximately one-quarter occurring in
the Western Pacific Region (WPR).1 Many more attempt
suicide or endure ideation, and impact further extends
to people bereaved by suicide and/or carers. Tailored,
national suicide prevention strategies should focus on
restricting access to means of suicide, responsible
media communication of suicidal behaviours, boosting
resilience and coping skills among youth, and early
identification and culturally appropriate intervention
with individuals, groups and communities at risk of sui-
cidal behaviours.2 This relies upon establishing and
maintaining surveillance systems to provide accurate
and timely national and local information on suicide
and self-harm.2 However, this is hard to achieve in prac-
tice and requires substantial departmental collabora-
tion, prioritisation, and funding.2,3 Furthermore, the
WPR is a particularly diverse region, with vast differen-
ces in the size of land mass, populations, and econo-
mies of countries, as well as sociodemographic
characteristics and cultural-linguistic backgrounds.
Consequently, the quality of suicide surveillance sys-
tems vary greatly across the region,3 and even more so
when considering reliable high quality surveillance sys-
tems of self-harm.4 Enhancing the quality of existing
surveillance systems and establishing new systems
(especially for self-harm) is essential for suicide preven-
tion in the region and will increase understanding of
local risk and protective factors and facilitate the evalua-
tion of suicide prevention activities.
Figure 1 presents age-standardised suicide rates
based on the World Health Organization (WHO) esti-
mates by gender for the WPR.5 Kiribati, Micronesia,
Mongolia, Republic of Korea, Solomon Islands, and
Vanuatu have rates far exceeding the global average age-
standardised rate of 9.0 per 100,000 (2019).1,5 Never-
theless, Joinpoint regression analyses showed a
DOI of original article: http://dx.doi.org/10.1016/j.
lanwpc.2021.100283.
*Correspondence: Kairi K~ olves, Level 1, Building M24 Psychol-
ogy, 176 Messines Ridge Road, Mt Gravatt Campus, Griffith
University, QLD, Australia, 4222.
E-mail address: k.kolves@griffith.edu.au (K. K~olves).
© 2022 World Health Organization, Licensee Elsevier Ltd. This
is an open access article under the CC BY-NC-ND IGO license
www.thelancet.com Vol 19 Month February, 2022
significant decline of age-standardised suicide rates for The Lancet Regional
Health - Western Pacific
women across most countries (2000-2019). Similarly
2022;19: 100367
declines were observed for men in several countries;
Published online 1 Janu-
however, Papua New Guinea, Philippines and Viet ary 2022
Nam showed a significant increase during the whole https://doi.org/10.1016/j.
observed period (2000-2019) and an in increase was lanwpc.2021.100367
observed in Australia since 2003, in Micronesia since
2009, in Malaysia since 2013 and in Brunei Darussalam
since 2014. There were notable variations by sex (from
1.8 in China to 13.4 in Solomon Islands in 2019), which
are in line with previous research and may be explained
by differences in gender and cultural norms.6 However,
only high-income countries within the WPR have mor-
tality registration systems covering the entire country
and providing ‘high quality’ suicide statistics by the
WHO.1 Whereas, in lower income countries these sys-
tems are either non-existent or of poor quality and
modelling techniques are utilised for calculating the
estimates.1 Current best practice guidelines for imple-
menting suicide prevention activities at the national
level account for these contextual differences and sug-
gest a scaled approach to establishing or enhancing sur-
veillance activities.2
Surveillance of suicide attempts and self-harm is
more challenging4 and currently there is one dedicated
self-harm monitoring system on the emergency depart-
ment (ED) level in the WPR (in Australia7). Further
national hospital-based registers in the WPR can be
found in Japan,8 the Republic of Korea,9 and
Australia.10,11 Periodical cross-sectional surveys may
provide additional information about self-reported sui-
cide attempt/self-harm prevalence as well as suicidal
ideation in the community.12 Additional surveillance of
mental health problems and suicidality can be also gath-
ered from helpline services.13 Further practical advice is
comprehensively detailed in the WHO manual for
establishing a self-harm surveillance system, and coun-
tries across the region without such (particularly low-
and middle- income countries) are encouraged to tailor
these to their specific circumstances.3
Despite their limitations, existing surveillance sys-
tems provide essential information regarding the direc-
tions of future suicide prevention for the region. A
timely example of the use of real-time surveillance infor-
mation has been to rapidly assess whether changes in
suicide rates occurred during the initial period of the
1
 Comment

Figure 1. Age-standardised suicide rates by gender in Western Pacific Region.

ongoing Covid-19 pandemic.14 Regarding the WPR spe-
cifically, current information can be used to highlight
certain risk groups, main means of suicide, and risk cor-
relates to inform tailored suicide prevention strategies.
For example, in a recent review the high burden of sui-
cide in youth and cultural/ethnic minority groups
across the Pacific Islands, and the importance of
restricting access to highly hazardous pesticides in rural
areas.15 Furthermore, the absence and/or poor quality of
surveillance across some areas of the region reveals how
crucial it is that lower income countries are supported
and encouraged in establishing, maintaining, and refin-
ing their systems (especially for self-harm). There is a
need for enhancing and/or developing suicide and self-
harm surveillance systems across the WPR. A regional
sentinel surveillance system on suicide and self-harm in

2 www.thelancet.com Vol 19 Month February, 2022


the WPR could be an important step forward in increas-
ing the availability and quality of data.
Declaration of interests
’Strengthening evidence-based and data-informed sui-
cide prevention in the Western Pacific Region’ project is
supported by WHO Western Pacific Regional Office.
Author contribution
KK: conceptualisation, data curation, formal analysis,
methodology, project administration, and writing− review
& editing; SM: conceptualisation, writing − original draft;
AF: conceptualisation, writing− review & editing.
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