3 October 2005

Suicide rates are increasing in developing countries

A new article reveals suicide rates are on the increase in developing countries and argues for the establishment of regional centres for suicide monitoring and surveillance.

Writing in the October edition of the Journal of the Royal Society of Medicine, Professor Murad Khan¹ outlines the global trends in suicide, examines existing statistics and highlights the need for greater research in suicide prevention in developing countries.

"The World Health Organization estimates that one million people kill themselves each year," writes Professor Khan.

"Despite advancements in the treatment and recognition of depression, suicide rates have steadily increased over the last 50 years."

The incidence of suicide is usually reported as a rate per 100 000 - greater than

30/100 000 is considered a high rate, e.g. Sri Lanka and Lithuania, 10-29/100 000 is a middle rate, e.g. China and India and less than 10/100 000 is a low rate, e.g. Egypt and Jordan.

!Suicide rates, however, do not reflect the true extent of the problem,! argues Professor Khan.

!For example, China's incidence of suicide is about 25/100 000 but it has the highest number of people (287 000) who kill themselves every year.

"Similarly, India has a rate of 10-11/100 000 but is second only to China in the actual number of people (110 000) who kill themselves. Put another way, the total numbers of suicide in the top ranking European nations – Lithuania, Latvia, Estonia and the Russian Federation – is less than the total number of suicides in India.

"Pakistan, which has seen a dramatic increase in suicide incidences in the last few years, neither collects national suicide statistics nor reports them to WHO – making the compilation of global suicide statistics difficult and the planning of prevention programmes almost impossible," he said.

Although suicide in no longer a criminal offence in developed nations, it continues to be in developing countries, especially in Islamic nations. Professor Khan argues the influence of religious and social factors on the diagnosis and registering of suicides coupled with the stigma of mental disease leads to under-reporting, which may be as high as 30 - 100%.

"Many developing countries are struggling with poverty and high population growth. Communicable diseases take precedence over others and mental health has a very low priority," said Professor Khan.

"Coupled with poverty, many of these nations are governed by regimes that provide only a fraction of what is needed to health and social sectors.

"For example, in Pakistan, only 0.7% of GDP is allocated to health compared to 4.6% for defence. Most South American countries devote less than 2% of the total health budgets to mental health."

Professor Khan's article highlights the lack of research on suicide from developing countries.

"Very little is known about suicides in the Middle East, Africa and South America," he says.

"Without information, prevention programmes cannot be developed. One way forward is the establishment of regional centres for suicide monitoring and surveillance, given the commonalities in culture, social and economic conditions in different regions."

"Sharing and exchanging information and research findings amongst nations regionally could be mutually beneficial. Data collection needs to be developed at district, provincial and national levels and it should be made mandatory for all developing nations to report their mortality data to WHO."

"Suicide prevention in developing countries poses a unique and formidable challenge and better information would go a long way to improving the diagnosis of suicidal deaths and ultimately their prevention," Professor Khan said.

'Suicide prevention and developing countries' by Murad M Khan is published in the October 2005 issue (Volume 98) of the Journal of the Royal Society of Medicine.

JRSM is the flagship journal of the Royal Society of Medicine. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.

¹ Aga Khan University, Karachi, Pakistan

[ends]