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Perspective

Suicide Prevention Strategies

September 08, 2016| By Dr. Chris Ball | Life | English

More than 800,000 people commit suicide every year, according to the WHO. The vast majority (75%) of those deaths occur in low and middle income countries where suicide is the second leading cause of death among 15-29 year olds.1 Suicide has received more attention in higher income countries following the 2007–2008 economic crisis, which led to a reversal of the downward trends seen in most regions since the 1980s.2 The rise was especially noted for middle-aged men – the U.S. saw a 43% increase between 1999 and 2014 in that age group.3 The U.S. represents a somewhat special case; since the 1990s it has experienced an inexorable rise in the numbers of people killing themselves. Strikingly, in 2012, half of suicide deaths were the result of self-inflicted gunshot wounds.4

The WHO has identified three main suicide prevention strategies that are now well established.5

  • Universal strategies are designed to reach whole populations. This includes "restricting of means", such as limiting over-the-counter medications, fencing in jumping sites, increasing access to healthcare, and reducing harmful alcohol use.
  • Selective strategies target vulnerable groups – those who suffer trauma or abuse, and people who have experienced natural disasters or conflict. This includes groups in which these issues are not typically addressed. A good example is the Australian “Mates in Construction” that provides support services and trains “gatekeepers” to be in close contact with construction workers.6
  • Indicated strategies involve identifying individuals at vulnerable points in their lives (for example, during periods of mental illness or substance abuse) and providing them with community support. Along with the intervention comes training for health workers to help better identify and manage vulnerable individuals. The Applied Suicide Intervention Skills Training program in America, with its strapline, “Driving Suicide to Zero: It is Possible,” invests heavily in suicide prevention training for health care workers and increases community support to vulnerable individuals.7

 

Although these strategies are important to public health and individuals, only universal prevention programs are likely to have an effect on the insured population where economic drivers are seemingly more important.

The evidence for the insured population is complicated. Even with the overall population trend, no increases in the number of suicide claims have been reported, while conflicting views on the suicide rate in insured individuals compared to the general population do not add to the clarity.

In spite of the recent increase in suicide rates, suicide remains a rare event that is difficult to predict either in a clinical setting or during underwriting. If anything, the main impact has been on the financial value of claims rather than the sheer volume.

Even though the majority of those killing themselves experience mental health problems at the time of death, the majority of life claims for suicide do not have a history of mental health problems at application. It is important for individuals who do disclose a history of mental health problems that they are assessed appropriately and not penalized for the perceived rise in risk of suicide within the population.8

 

World Suicide Prevention Day on 10 September is organized by the International Association for Suicide Prevention (IASP). Its purpose is to raise awareness around the globe that suicide can be prevented.

Endnotes
  1. http://www.who.int/mental_health/suicide-prevention/exe_summary_english.pdf?ua=1 (accessed 6/6/2016).
  2. BMJ 2013;347:f5239 doi: 10.1136/bmj.f5239 (Published 17 September 2013).
  3. http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/USA2012.pdf (accessed 6/6/2016).
  4. http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/USA2012.pdf (accessed 6/6/2016).
  5. http://www.who.int/mental_health/suicide-prevention/exe_summary_english.pdf?ua=1 (accessed 6/6/2016).
  6. http://matesinconstruction.org.au/ (accessed 6/6/2016).
  7. http://www.medscape.com/viewarticle/863368 (accessed 6/6/2016).
  8. http://www.genre.com/knowledge/blog/understanding-depression-for-fairer-risk-Assessment-en.html (accessed 6/6/216)

 

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