Suicide Prevention Strategies Should Also Tackle Social Issues: Study Finds

National strategies to prevent suicide should address social issues to stop people from reaching crisis points, argue authors of a new series in The Lancet Public Health journal. They stress that while clinical services for those in crisis are essential, addressing social risk factors is equally important.

The international team, including members from the Public Health Foundation of India, New Delhi, calls for a shift in how suicide is viewed. They suggest moving away from seeing it solely as a mental health issue and recognising the impact of factors like poverty, domestic violence, addictions, and isolation.

Focus on Social Determinants

This perspective is particularly relevant for India, which launched its National Suicide Prevention Strategy in November 2022. The strategy primarily focuses on mental health solutions, despite police data showing that gender, employment, and stressful life events also play significant roles.

The strategy aims to reduce suicide deaths by 10 per cent by 2030. Objectives include establishing effective surveillance systems for suicide and integrating mental well-being curricula across educational institutions.

Published on World Suicide Prevention Day, the series outlines six aspects of a public health approach to preventing suicide. One model examines social determinants to understand how suicides might occur.

Economic Factors and Suicide Rates

With over 170,000 lives lost annually to suicide in India, addressing socio-economic pressures alongside mental health is crucial. A public health approach that fosters collaboration among various sectors can create a supportive environment prioritising early intervention and reducing stigma.

Series author Rakhi Dandona, Professor of Public Health at the Public Health Foundation of India, stated, "By taking a public health approach and fostering collaboration among various sectors, we can create a more supportive environment that prioritises early intervention, reduces stigma, and ultimately saves lives."

The authors also highlight the need for national policies to cushion economic downturns' effects. This includes maintaining minimum wage levels and understanding how exposure to suicide—through media or real life—can increase suicide risk.

Transmission of Suicide

One paper in the series links poor economic status with suicide in low- and middle-income countries (LMICs). In India, higher male suicide rates are seen in states with higher unemployment levels. Unemployment is also a significant risk factor among women.

The authors note that a model accounting for marginal land holdings among farmers, indebted farmers, and land used for non-food crops could explain 75 per cent of changes in state-level suicide rates.

Another paper discusses the transmissibility of suicide. Exposure to suicide-related information or another person's death by suicide can draw attention to specific methods. The authors call for restricting cognitive availability of means through careful media representation.

Media's Role in Suicide Prevention

"In simple terms," Dandona explained, "media needs to consider if reporting is necessary, how it should be reported without increasing risk for others, and ensure accurate reporting along with promoting help-seeking." Guidelines are available for responsible reporting.

The fifth paper describes interventions targeting four major risk factors: alcohol use, gambling, domestic violence and abuse, and suicide bereavement. At an individual level, signs such as language used during conversations can indicate these risk factors.

Recognising Warning Signs

Dandona emphasised the importance of listening to people’s language of despair. "It is important to listen to what people have to say," she said. "Anecdotal evidence suggests that statements highlighting suicidal thoughts are often missed or not taken seriously."

For these conversations to happen effectively, people need a supportive environment where they feel safe sharing their experiences and being taken seriously.

Suicide is the third-leading cause of death among those aged 15-29 years globally and claims over 7.2 lakh lives annually according to the World Health Organization. About three-fourths of suicides occur in low- and middle-income countries.