Overview of Suicide

Nicholas Pang
Universiti Malaysia Sabah
Key facts about suicide and self harm
• 800,000 deaths per year worldwide (1 every 40 seconds)
• 1.5% of people die by suicide
• Second leading cause of death among young people (age 15-29)
• For every person that dies of suicide, 20 people attempt suicide
• Many of these deaths are preventable
• Suicide is reducing worldwide, perhaps due to treatment of mental
disorders

World Health Organization (WHO). Preventing suicide. 2004.

Suicide and self harm in Malaysia?
• Suicide rate approximately 6-11/100000 people every year
(worldwide average 10/100000)
• Higher in men, young people and Indian ethnic group.
• Most common methods – jumping from heights, hanging, drowning,
poisoning
• Difficult to know if rate is increasing or decreasing- problems in reporting
suicide- many suicides are not reported as suicide.
• Self harm rate is approximately 0.5% per month.
• Suicidal ideas very common – 6-8% of population
Armitage CJ, Panagioti M, Abdul Rahim W, Rowe R, O’Connor RC. Completed suicides and self-harm in Malaysia: A systematic review. Gen.
Hosp. Psychiatry [Internet]. Elsevier Inc.; 2015;37:153–65.
Maniam T. Suicide and Undetermined Violent Deaths in Malaysia, 1966-1990: Evidence for the Misclassification of Suicide Statistics. Asia-
Pacific J. Public Heal. [Internet]. 1995;8:181–5.
• For example a 15 year old girl ends her life by jumping off her apartment
block:

Why???
Why??? She has depression
Depression not
recognized by She is bullied at
school, doctor or school
parents

Feels like a failure

She believes it is No bullying
because she is not
wrong to discuss prevention policy at
in the top set at
her distress school
school

Parents are working Never been taught

Afraid to approach
long hours and are stress management
school counsellor
always stressed skills

Family not Read about a Lives in high rise

connected to the celebrity suicide in building with no
community the newspaper barriers
Why???
• Normally no single cause in any suicide.
• We can never simplify causes of suicide- it is nearly always complex
• If we want to reduce suicide we need to look at many factors
Reasons for suicide.
• Mental disorder
• 80% of suicides associated with mental disorder
• Especially major depressive disorder and alcohol use disorder
• Relationships and connections
• Relationship conflict and loss – friends, marriage, family
• Abuse at school, work, home
• Social isolation and exclusion
• Stigma of suicide, self harm, help seeking
• Social and economic factors
• Low educational achievement
• Low occupational status Li, Z., Page, A., Martin, G., & Taylor, R. (2011). Attributable risk of psychiatric and socio-
• Unemployment economic factors for suicide from individual-level, population-based studies: A
systematic review. Social Science and Medicine, 72(4), 608–616.
• Discrimination Armitage CJ, Panagioti M, Abdul Rahim W, Rowe R, O’Connor RC. Completed suicides
and self-harm in Malaysia: A systematic review. Gen. Hosp. Psychiatry [Internet].
Elsevier Inc.; 2015;37:153–65.
How do we prevent suicide?
1. Restricting access to means of suicide (eg pesticides, firearms,
barriers on high places)
2. Treating mental disorders
3. Reducing harmful use of alcohol
4. Supporting people at risk
5. Training and education
6. Responsible press reporting
7. Tackling community and relationship risk factors.
1. Restricting access to means
• Allows people to buy time
• Structural barriers at ‘suicide hotspots’
• Reduces suicides at the hotspot by 89%
• Reduction overall in the cities studied by 28%
• Gun ownership in the US- states with lower gun ownership have lower
rates of suicide.
• Reduce pesticide access – eg suicide rate in Sri Lanka nearly halved
after some of the pesticides were banned

World Health Organization (WHO). Preventing suicide.

Pirkis, J., Spittal, M. J., Cox, G., Robinson, J., Cheung, Y. T. D., &
Studdert, D. (2013). The effectiveness of structural
interventions at suicide hotspots: A meta-analysis.
International Journal of Epidemiology, 42(2), 541–548.
Suicidal ideas and access to means
Suicidality High risk
10
time
9

0
9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 20.00 21.00 22.00 23.00 24.00
Suicidal ideas and access to means
Suicidality
10

0
9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00
2. Treating mental disorders
• Mental disorders are very common (10-15% of population), but most are not
treated in Malaysia
• >90% of people with common mental disorders are not treated
• Mental disorder is present in around 80% of people that die by suicide.
• We need to improve access to high quality non-stigmatising mental health care.
• World health organisation advises mental health care should be available in
primary care for common mental disorders.
• We need to improve resources for mental health care – currently services are
underdeveloped.
• Services need to work collaboratively- eg healthcare needs to work with
education, welfare, police etc.
3. Reducing harmful use of alcohol
• One fifth of all suicides in the world can be attributed to alcohol and
other substances
• Policies which address harmful use of alcohol are likely to reduce
suicide and self harm
• Raising awareness and education
• Community empowerment
• Improving taxation policy to reduce harm
• Quality treatment services for people with alcohol and substance use
disorders

World Health Organization. (2014). Preventing suicide.

4. Supporting people at risk
• Telephone support lines.
• Befrienders
• Health services that can respond to crisis
• Destigmatising suicide, self harm and help seeking
• Decriminalising suicide – does not prevent suicide deaths, only prevents
people from seeking help
• People who have self harmed afraid to go to hospital
• Talking about distress seen as ‘attention seeking’
• Supporting families where someone has died of suicide
• They are also at risk
5. Training and education
• School programs
• Skills training programme – eg team skills, distress management skills
• Awareness about mental disorders
• Peer training programmes- eg ‘sources of strength’ programme in US, uses
trained peer leaders, who can link troubled adolescents with adults that can
help. Increases connectivity
• ‘Gatekeeper’ training
• Training people on the front line – eg community and religious leaders,
teachers, police officers, healthcare staff
• Programs to increase awareness and reduce stigma
6. Responsible Reporting of Suicide
• Vulnerable members of society may copy suicides that they read
about in the newspaper
• Across the world, celebrity suicide leads to increases in rates of
suicide

Careful reporting could lead to people seeking help and can save lives.
• Normalise help seeking and discussing distress
Media reporting
• Don’t glamorise or dramatise
• Don’t include details of methods
• Don’t oversimplify or brush over complexity
• Don’t speculate about ‘trigger’
• Don’t mention websites that glamorise suicides
• Consider the effect on the family left behind – they are at high risk for
suicide as well
• Mention where to seek help for people with suicidal thoughts

Samaritans. (2013). Media Guidelines for Reporting Suicide.

7. Tackling community and relationship risk
factors.
• Economy- strong economy reduces the risk
• Suicide rate increased after economic crisis 2008
• Unemployment or underemployment is a risk factor
• Need to consider ways to make society more connected
• Supporting relationships
• Strengthening families
• Time for parenting
• Changes in employment practices
• Reducing dislocation – disconnection of communities and families
• Encouraging groups, clubs, societies that bring people together.
• Improving quality of life of whole community
7. Tackling community and relationship risk
factors.
• Tackling isolation and lack of social support
• Reducing social exclusion and discrimination
• Minority groups have a higher risk of suicide.
• Tackling abuse
• Bullying
• Abuse in the home
• Abuse in the workplace
• Tackling inequality
• Wealth gap and power gap
Conclusions
• Many deaths could be prevented
• Needs many people working together to do this