Epidemiology and public health aspects of suicide

Every year more than one million people commit suicide, accounting for 1 to 2 per cent of total global mortality. Suicide is a leading cause of premature death, especially among young adults. It is the fifth highest cause of years of life lost in the developed world. In many Westernized countries suicide is a more frequent cause of death than traffic accidents. According to World Health Organization ( WHO) statistics, the annual world-wide incidence of completed suicide was 16 per 100 000 persons in 1995. This means that globally 1 per 6000 persons commits suicide every year.

The long-term trend in suicide mortality has been increasing. The rank order of suicide mortality in the European region in 1990 to 1991 shows 19 countries with suicide rates above the mean for the region: Lithuania, the Russian Federation, Latvia, Estonia, Hungary, Slovenia, Finland, Belarus, Kazakstan, Ukraine, Croatia, Austria, Switzerland, Denmark, Czech Republic, France, Belgium, Republic of Moldova, Slovakia, and Bulgaria. Most of the countries with high suicide mortality are located in Eastern Europe. The lowest suicide rates (below 10 per 100 000) in the WHO's European region are found in the following 15 countries: Azerbaijan, Armenia, Albania, Greece, Georgia, Tajikistan, Uzbekistan, Turkmenistan, Malta, the United Kingdom, Spain, Portugal, Ireland, Italy, and The Netherlands. Outside this region suicide mortality has been exceptionally high (above 40 per 100 000) in Sri Lanka during the civil war, and is also high (above 16 per 100 000) in Japan. Suicide rate is moderate (10—16 per 100 000) in China, Cuba, Canada, Singapore, Australia, New Zealand, Mauritius, the United States, and Uruguay. Everywhere, the male suicide rate is two to four times higher than the female rate; China is the only exception with a very high female suicide rate. (!2)

The suicide rate of elderly people has been higher than in the younger age groups almost universally. In addition, in many Western countries the suicide rate for people aged 65 years and over has been declining for decades. This change is associated with the growth of the general well being and the better social and health services.

Traditionally the incidence of suicide has been low in the younger age group (15-24), but during the past 20 to 30 years the suicide rate has been rising in many Western countries, especially among young males. The suicide rate of the young male adults is nowadays almost at the same level as the rate of middle-aged men. Alcohol misuse has been suggested as one possible causal factor for the increase of suicide rate. Other risk factors of adolescent suicides are school problems, a family history of suicidal behaviour, poor communication, and stressful life events. The most recent adolescent suicide statistics have been encouraging in many countries. In the United States the rate reached a peak in 1987, remained fairly constant for several years, and began to decline in 1996.

A long list of major public health concerns in the field of suicidology has emerged in the Western world in the 1990s:

• suicidal ideation and suicide attempts are surprisingly common in the general population

• the high, and in many countries rapidly rising, rate of suicides among adolescents and young adults

• unemployment as a major risk factor for suicide in Europe

• easy access to lethal suicide methods such as psychotropic or analgesic drugs, guns, and motor vehicles

• high alcohol consumption and increasing substance misuse

• undertreatment of major psychiatric disorders such as depression and schizophrenia

• suicide models projected by the mass media.

These findings indicate that rapid growth and continuous changes in society are simultaneously causing instability and disturbing the development of integration. Some regions and groups of people are inevitably affected negatively by this development, and large numbers of people are thus moving towards a greater risk of suicide.

Scores of special and comprehensive suicide prevention programmes have been launched both locally and nationally during the last 10 years. Everywhere, suicide research has come to be seen as an elementary component of suicide prevention. Only critical research can identify new and specific high-risk groups, and properly evaluate specific interventions and suicide prevention activities in general. (1.3> Suicide prevention is considered in Chapter 4;..15.:4.

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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