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An uncomfortable truth | The World Weekly

In 2012, 804,000 people were reported to have killed themselves around the world. According to the World Health Organisation, that is one suicide every 40 seconds - an increase of 60% over the past 45 years.

Suicide has become a global phenomenon from which no demographic is immune, spanning geographical divides and socio-economic status. While men and women over 70 are the most likely to commit suicide in almost every region, there is a growing concern about the prevalence of suicide among young people.

“Youth suicide is a major public health issue that must be immediately and vigorously addressed,” Dr. Lisa Boesky, an expert on suicide and mental health in teenagers, tells The World Weekly. Indeed, suicide sits only behind road accidents as the leading cause of mortality for 15-29 year olds globally.

The methods vary from region to region. In India and across agricultural nations in Asia, consuming poison - pesticides in particular - is the most prevalent. In the USA, where access to firearms is readily available, 60% of suicide victims shoot themselves. In Britain, the Balkans and eastern European countries, drowning, jumping from heights, wrist cutting and hanging are the most common.

As stark as these figures are, this is likely far from the full picture. “There is stigma about suicide everywhere,” says Dr. Alexandra Fleischmann, a suicide prevention expert at the World Health Organisation. “Therefore there is underreporting; families do not want the stigma of a suicide attached to a death.”

While there are observable trends in countries with high suicide rates - poor access to healthcare, economic stagnation, conflict, alcohol abuse, high social pressures and social stigma - no single explanation exists for rising global suicide rates. Only deeply personal and nuanced experiences, at both an individual and national level, tell the whole story as a look around the world demonstrates.

The country with the highest suicide rate in the world

“What would drive a 13-year-old boy to commit suicide?” asks Supriya Singh, founder of The Guyana Foundation, when recounting the story of a young boy who hanged himself earlier that year. He rarely saw his mother or father, who were struggling to earn a living on the other side of the country. This story is increasingly common in Guyana, where 44.2 people in every 100,000 kill themselves, making it the suicide capital of the world.

Why does Guyana have this tragic label? Ms. Singh believes that people are “scarred” by social, political and economic struggles since gaining independence from Britain in the 1960s. “Years of turbulent politics, poor economic development, high unemployment, ethnic division and child abuse have all contributed,” she tells TWW.

As is common in high-suicide nations, mental health provision remains a major problem. The capital Georgetown is home to the country’s five registered psychiatrists, who serve Guyana’s population of 800,000 people, many of whom are left isolated by poor infrastructure and challenging geography. As a largely agricultural economy, the ingestion of pesticides is the most frequently used method of suicide.

Mental health issues are stigmatised and alcohol is used as a coping mechanism. Nonetheless, they are finally being recognised. On March 26, the Guyanese Mental Health Unit announced the launch of an anti-depression campaign, optimistically stating that it aims to have national suicide rates declining by 2018.

The case of Guyana shatters the misconception of mental health problems as a Western phenomenon and highlights rising suicide rates in low and middle-income countries. So while Guyana’s suicide rate is novel, its toxic combination of socio-economic troubles and poor mental health provision is not.

Stagnant economies and alcohol consumption in the former socialist republics

Lithuanians will proudly tell you they were the first nation to declare independence from the Soviet Union in March 1990. But in more recent history the country claims a less desirable legacy.

On September 2015, roughly 800 activists - one for every person who takes their own life each year - laid down on the cold, granite floor of a square in the heart Vilnius, the capital. That translates to 31 suicides per 100,000 people, putting Lithuania fourth in the global suicide tables and top among European countries.

800 activists lay down in the centre of Vilnius, Lithuania, to raise awareness of suicide in the country

This trend can be seen across many former socialist states. Of the WHO’s 25 most suicide-prone countries, eight are from the former Soviet Union and Warsaw Pact: Lithuania, Kazakhstan, Turkmenistan, Russia, Hungary, Belarus, Ukraine and Poland.

Beyond their shared history, these countries share high levels of alcohol consumption. This is not a new concern: in the turbulent final years of the USSR, the Communist Party introduced partial prohibition between 1985-87 to reduce the burden of alcohol-related health problems.

The correlation between alcohol consumption and suicide is no coincidence, says Dr. Fleischmann. She tells TWW that one fifth of suicidal deaths globally are linked with excessive drinking, though addiction is often a symptom of mental health issues rather than the cause. The idea that alcohol mitigates the effects of harsh, dark winters in eastern Europe remains an appealingly simple one, but fails to grasp the bigger picture.

Larisa Sotieva, a senior advisor to peace-building organisation International Alert, believes that the rapid transformation of post-communist societies has left many people in a state of existential crisis. “During the Soviet era, everybody believed we are the most powerful nation in the world,” she says. “There used to be predictability and stability. But after Perestroika nothing was stable or predictable. Reintegration into the world was very harsh on the average person.”

Economic turmoil in the 1990s and stagnation in many places since then has exacerbated this problem and left many people nostalgic “for the time when you or your parents didn’t have to think about earning money”, Ms. Sotieva adds.

Underreporting in the Middle East

The unremarkable town of Sidi Bouzid in central Tunisia changed the course of world history on December 10, 2010, when Mohammed Bouazizi, a 26-year-old Tunisian fruit vendor, cried out "How do you expect me to make a living?" He then struck a match and placed it on his gasoline-soaked body.

Mr. Bouazizi’s self-immolation was a deeply personal act. But it was indicative of desperation felt by many men and women across the region and ultimately catalysed the Arab Spring.

But statistics fail to reflect this. According to WHO’s 2012 statistics, of the country’s with the top 12 lowest suicide rates, 11 were nations located in the Middle East and North Africa (MENA).

Most striking is Iraq, a country that has remained in a perpetual state of conflict for 14 years - with the psychological and physical trauma that inevitably inflicts upon a population - ranking 9th lowest in suicide rates globally. This is despite sitting 117 out of 155 on the UN’s World Happiness Report, and having only 100 psychiatrists to support a population of 33 million people.

Patients stand near windows inside the al-Rashad mental health facility in Baghdad in March 2006

This is not unique in the region. After four decades of human rights abuses under Muammar Gaddafi, and the onset of a bloody civil war since 2011, the Danish Institute against Torture described Libya as a mental health ‘ticking time bomb’. Yet it supposedly boasts the tenth lowest suicide rate in the world. 

These disparities suggest that suicide statistics in MENA could be untrustworthy. Ziad Kronfol, a professor of psychiatry at Weill Cornell Medicine in Qatar, says taboo remains a major obstacle to accurate records. But he thinks the region’s volatility remains the single biggest impediment.

“It’s extremely difficult to conduct research and collect data in conflict zones,” he says. Mental health issues in this region, among the most severe in the world, are likely to remain undetected and untreated.

Japan and Korea’s overworked and overstressed millions

But political volatility, conflict and poverty are not the only explanation for high suicide rates, as South Korea and Japan, two wealthy nations in the Organisation for Economic Co-operation and Development (OECD), illustrate. Despite their economic success, they rank second and 17th respectively.

In Japan, suicide is the main cause of death for men aged 20-44. “Overwork is definitely a factor,” says Dr. Junko Kitanaka, a medical anthropologist at Keio University. According to the OECD, roughly 22% of Japanese work 50 hours or more a week, compared with 11% in the US. ‘Karoshi’, or death by overwork, is now a legally recognised cause of death.

‘Hikikomori’, a word used to describe adolescents who withdraw from social life, are a symptom of this societal pressure. Tamaki Sait?, the psychologist who coined the phrase, estimates that there are one million hikikomori, with another 1.55 million people on the verge of joining them.

A ‘hikikomori’ sits in his bedroom in Japan

According to Dr. Yuko Watabe, a clinical psychologist at the Temple University, Japan Campus, both family culture and overwork contribute to hikikomori- an almost uniquely Japanese phenomenon.

The situation is worse in South Korea, where suicide is the number one cause of death for people aged 10-39. South Koreans work some of the longest hours in the world - more than 50% longer than Germans. ‘Gwarosa’, the equivalent of karoshi, is also a major public health concern.

Efforts to curb excessive work hours are underway in both nations, showing a positive effect in Japan in particular, where 2016 produced its lowest suicide rate for 22 years. Still, the picture is far from positive: 21,764 took their own lives.

No simple solution

“Suicide is very complex mix of social and biological factors,” says Dr. Kronfol. “Even for experts it is not always easy to predict, so while there are trends, there is no one formula for resolving this.”

Although broad overarching themes exist, the combination of factors that drive people to suicide remain nuanced and are impossible to separate from the personal and national context in which they occur.

While the overall suicide rate in OECD countries has decreased since 1985, it is rising in many parts of the developing world. But as taboos persist, and mechanisms for gathering statistics remain poor in many regions, the sorry fact is that the full extent of this modern-day plague is yet to be uncovered.

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