Management of mental disorders plays a key role in the prevention of suicide and is an area that needs to be given critical attention in future action.
The study which was published online by Cambridge University Press, revisits the available evidence on suicide cases and diagnosis and highlights critical issues for further research and action.
Suicide – a serious public health problem
In the year 2000, around 814 000 persons died by suicide, according to World Health Organisation (WHO) figures. Suicide rates climbed by 60% in some nations over the last 45 years, and it is now one of the three main causes of death among individuals aged 15-34 worldwide.
These statistics clearly show that suicide is a major public health issue. The link between suicide and mental problems has been well-researched and documented, leaving the critical function of mental disorder management in suicide prevention undisputed.
Mental Disorders in Cases of Suicide
In comparison to the more than 814 000 suicide deaths globally each year, the number of published cases explicitly addressing the psychiatric diagnoses of those who died by suicide has been rather limited. Most notably, 82.2% of all cases investigated originated in Europe (especially the United Kingdom and Scandinavian countries) and North America. Only 1.3% (216 instances) came from developing countries (India and Taiwan).
This creates a considerable bias towards Northern European countries, calling any generalization or advice based on those statistics to other cultural settings into question. If one still insisted on analysing all 8205 cases of suicide among the general population, ignoring the research’s limitations, one would discover that, predictably, a mental diagnosis was made in the majority (almost 95%) of those analysed.
Depression accounted for 35.8 % of all suicide diagnoses
Second, contrary to popular belief, mood disorders (i.e., depression) were most frequently related to suicide. According to the combined data from available general population studies, depression accounted for 35.8% of all diagnoses. However, out of the 8205 patients, 53.7% were diagnosed with depression.
This is consistent with the findings of Lönnqvist who reported depression diagnoses in the range of 29-88% in psychological autopsy studies (12 studies, n=1945 patients).
Mood disorders and severe psychiatric disorders frequently found in suicide diagnosis
Third, it is worth emphasizing that the comorbidity of mood disorders with substance-related diseases (in reality, depression, and alcoholism) was most frequently discovered in general population studies with multiple diagnoses (n=6370 cases).
This intersection of depression and alcohol certainly warrants more attention. Severe disorders (e.g., schizophrenia, organic mental disorders) accounted for 45.3% of all diagnoses in psychiatric hospitals, while less severe or disabling disorders (substance-related, anxiety/somatoform, and adjustment disorders) accounted for 32.1% of all diagnoses in the general population.
Treatment effectiveness of disorders on suicide prevention
Assuming we had enough knowledge regarding the link between suicide and mental diseases, we could take a step further and challenge the treatment effectiveness of the disorders in question.
If we apply the average depression treatment effectiveness of 52% in the World Health Report 2001 – which reflects real, concrete constraints rather than an idealistic but unattainable 100% – and assume that 50% of people with depression were correctly identified and treated.
This would cut global suicide rates from 15.1 per 100,000 to 13.9 per 100,000. Applying the same logic to alcohol-related disorders and schizophrenia and combining the corresponding calculations for these three disorders most associated with suicide, we could ideally expect a combined reduction of suicide rates of around 20.5%: from 15.1 per 100,000 to 12 per 100,000. When applied to the number of suicides in the year 2000, this would represent more than 165 000 lives saved; yet there is still much work to be done.
Reconsider suicide prevention focusing on the management of specific diseases
Based on what we know today, primarily from Western-oriented countries’ experiences, we may need to reassess suicide prevention programs that focus solely or primarily on the care of specific conditions (e.g., depression). A good suicide prevention strategy should incorporate comorbidity and include treatment for at least schizophrenia, depression, and alcohol-related disorders as significant components.
To that purpose, raising public knowledge regarding the treatment of psychiatric diseases linked to suicide, as well as integrating management and improving treatment effectiveness, are critical. Given the chronic character of mood disorders, substance-related illnesses, and schizophrenia, the WHO’s recently suggested method for chronic disease management appears particularly promising in this regard.
The main point here is that one-dimensional solutions to complicated situations are ineffective. As a result, successful treatment for chronic illnesses necessitates a shift in healthcare delivery away from episodic care in reaction to acute illness and towards a comprehensive system of care geared to fulfilling patients’ long-term requirements.
Suicide prevention to consider the physical environment
Suicide prevention should also involve the (physical) environment (e.g., controlling the availability of suicide tools and appropriate media reporting). Finally, information concerning specific psychosocial risk factors, suicide risk scenarios, and suicidal people’s experiences of stress because of unpleasant life events should be expanded across cultures.
Help is here:
Toll-Free Mental Health Rehabilitation Helpline Kiran (1800-599-0019)
Name of the Organisation: Vandrevala Foundation
Vandrevala Foundation is a non-profit that partners with organizations to help communities thrive by providing education and healthcare. Vandrevala Foundation launched a mental health helpline in India in 2009 to offer free psychological counselling and crisis mediation to anyone who is experiencing distress due to depression, trauma, mood disorders, chronic illness, and relationship conflict.
Contact: Email: firstname.lastname@example.org
Telephone: +91 9999 666 555
Name of the Organisation: Aasra
AASRA volunteers conduct workshops on different levels with high-risk target groups eg school, college students, highly-stressed employees of call centres, financial institutions, multinationals etc. AASRA volunteers have Outreach programs to reach out to the multitudes who may choose to end their lives because of chronic suffering or terminal illness.
Contact: email: email@example.com