By Shonel Perera
The World Health Organisation (WHO) estimates that approximately 800,000 people die each year due to suicide, with the majority of deaths occurring in low-income and middle-income countries and there are more who attempt suicide. Suicide accounted for 1.4% of all deaths worldwide, making it the 17th leading cause of death in 2015. While this makes grim news, WHO also says that effective and evidence-based interventions can be implemented at population, sub-population and individual levels to prevent suicide and suicide attempts.
In the recent years, mainstream and social media coverage around suicide has created an impression that Sri Lanka’s suicide rate is growing rapidly. Sections of the media have begun calling Sri Lanka the ‘suicide capital’ of the world as well while others are quick to blame new technologies such as social media as the ‘cause’ for some recent youth suicides, without any research to back such claims.
There is no doubt that suicides are a major issue inthe Sri Lankan society. It warrants a response at policy, institutional and community level. But first, we need to better understand the magnitude of the problem and the factors involved.
Depression symptoms can vary from mild to severe and can include:
Feeling sad or having a depressed mood
Loss of interest or pleasure in activities once enjoyed
Changes in appetite — weight loss or gain unrelated to dieting
Trouble sleeping or sleeping too much
Loss of energy or increased fatigue
Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
Feeling worthless or guilty
Difficulty thinking, concentrating or making decisions
Thoughts of death or suicide.
Sadly, the general public’s view on this issue is dominated by media hype, activist rhetoric and misconceptions instead of data-driven analysis. In September 2014, WHO’s first global report on suicide wrongly identified Sri Lanka has having the fourth highest suicide rate in the world (28.8 deaths per 100,000 according to them). That rate was modelled using data that was eight years out of date, which was the last national data submission made in 2006.
A PhD researcher at the University of Bristol, UK, who had studied this topic in-depth, questioned WHO’s analysis. She then went in search of actual records, and studied suicide data from Sri Lanka Police Department’s statisticsdivision. It was then found that there had been 2,644 fewer suicides in 2012 than which had been estimated by WHO using the 2006 data. When she used the more recent data, it reduced the annual suicide estimate by a quarter, and the country’s suicide rate came down to 17.1 per 100,000. That fresh analysis, which she published in several medical journals, repositioned the island nation at 22nd in global rankings for suicides back then. However, regrettably, we are on top at present.
Suicides are the tragic outcome of complex human, socio-economic and societal factors. Determining what causes a specific health outcome is very difficult because it is quite rare to be able to identify a single factor or a single reason for suicide. Usually there is no single cause, but a collective of factors which increases an individual’s vulnerability to suicide. There are, however, some clearly recognised factors that increase an individual’s risk of suicide — for example debt, losing a job, a relationship breakdown, bullying, and substance abuse. These factors may interact with pre-existing vulnerabilities such as mental health issues to increase the risk of suicide.
In studying suicidal thoughts and behaviours,Researchersfocus on two approaches in analysing, Firstly, a multivariate analysis, which is analysis that takes account of other factors to enable them to look at the specific impact of a risk factor they are investigating. Secondly, time series approaches, which is looking at the rate of suicide over time and how it changes in response to environmental or social shocks, like economic recessions, pesticide bans or certain restrictions by government, etc.
If individual suicide deaths are to be investigated, then the tool most commonly used is a psychological autopsy. Using this method, researchers would collect information on the deceased via interviews with family members, friends and other relevant individuals. Where available, detailed information will also be collected from health records. It is a comprehensive method to try to detail the factors which would have contributed to the suicide death. This method, however, relies on third party reports of why the deceased decided to kill themselves and therefore might or can be biased, especially in Sri Lanka as there are no supporting medical records.Suicide researchers in Sri Lanka often use the Department of Police data, as it is collected nationally and many deaths by suicide occur in the community rather than in hospitals (the exception is deaths by self-poisoning, but these now comprise less than 30% of all suicide deaths).
The question on whether there are systematic and on-going attempts to monitor and understand the various factors that contribute to suicides remains in Sri Lanka.Several studies have investigating trends and factors influencing trends in suicide over the last few decades. There are several groups in Sri Lanka and in other Universities around the world who have been investigating this. The research in this area has involved scholars from several different disciplines, which highlights the fact that suicide behaviour is difficult to investigate given its complexity.
Sri Lanka has experienced major changes in its suicide rates since the 1970s, and by 1995 it had one of the highest rates in the world. Today it has the highest with almost 8 deaths per day. However researchers say that it is difficult to get exact and accurate statistical analysis as low and middle income countries do not always have to most accurate records and statistics.However, Sri Lanka has made major advances in reducing its suicide rate from the peak in the mid 1990s when there were over 8514 reported suicide deaths.
This has now come down significantly as there were 3,025 suicide deaths reported in 2016. Compared to neighbouring South Asian countries, where there has been little change in suicide rates, Sri Lanka has managed to reduce its crude suicide rate by 70% during the last two decades. Good but not great as suicide is still a problem. A problem is no longer a problem only when it is eradicated.
Research indicates that the major contributor to the reduction in suicide in Sri Lanka appears to have been the removal/bans on the sale and import of the most toxic pesticides in the country. This removal has resulted in dramatic declines in the number of people dying by suicide.
While the number of people dying by suicide has dramatically reduced in Sri Lanka, there are still large numbers of people making suicide attempts, indicating that there is a level of distress being experienced by the population which needs to be addressed. In addition, Sri Lanka still has a high suicide rate in young people (twice that of high income countries). Given that many factors contribute to suicidal behaviour, a multisector approach is needed to counter this trend. This approach, however, needs to properly co-ordinated. Some of my own work has highlighted the need for developing life skills (relationship and budgeting), reducing alcohol misuse, as well as the state and society providing improved mental health services and better awareness.
Within policy makers and public health professional there is a general awareness in their circles that the suicide rate in Sri Lanka has changed over time. However, the articles in the Lankan media about suicide use information and analysis that are somewhat outdated. This is partly due to journalists and even mental health activists not always having the latest data available to them.
It is important to keep in mind is that suicide is a complex behaviour, and we should avoid oversimplifying what causes someone to take their life. There will be many who experience an exposure, for example the drought, who do not take their lives. As previously mentioned, causality is very hard to ascertain, and requires the right data and methods to investigate it.
A better link with active researchers in the field of suicide would be of benefit to the organisations but also to them as researchers. They are always looking for ways to engage with organisations to make sure that accurate data are used when reporting about suicide and in the ways that suicide is discussed. But it is also important to note that there is strong evidence that media reporting of suicides can, sometimes, adversely impact on suicide rates and so any discourse must be handled carefully.
The WHO suicide prevention report is an important document and has been useful for many who want to get an overview of suicide globally. The report utilised data that was submitted to them by country offices to calculate the suicide rate in 2012. If the data were out of date then WHO projected the number of deaths they would expect to see, based on previously submitted data. Sri Lanka had not submitted the most up to date statistics on suicide to WHO and this resulted in an incorrect estimation.The WHO report did caution users of the report, that the data may not be accurate.
What are your impressions of how the Lankan media reports on suicides – both on specific incidents, as well as in discussing overall trends?
The way in which suicide is portrayed in Sri Lanka is distressing. The media have a major role to play in suicide prevention. Evidence has shown that certain types of media depictions of suicide can lead to imitative behaviour and result in increases in the number of suicides. Vulnerable people such as young people, those experiencing various difficulties and living in dire conditions may be more likely to over-identify with the suicide victim.In fact, WHO and the International Association for Suicide Prevention (IASP) have released a new version in October 2017 on the guidelines to follow and how to handle suicides in countries. So ethical guidance is available to anyone looking for it.
Many media outlets around the worldrecognise the importance of sensitive suicide reporting. The Sri Lankan media could adopt a similar strategy when reporting on suicide deaths by ensuring that they adhere to a set of basic guidelines so as to not have the public perceive this act in a persuasive manner or offend anyone.
The country still has a long way to go with regard to suicide and suicide prevention and help. However, if any individual faces suicidal thoughts or feelings or knows anyone with the same mindset they can contact Sumithrayo – 0112696666.
Sumithrayo, a Government approved charity was founded by the Late Mrs. Joan De Mel in 1974. From its humble beginnings at Deans Road, Colombo 10, on premises loaned by the Ceylon Social Services League, Sumithrayo is now housed at no 60B Horton Place, Colombo 07, which was gifted by it’s beloved founder – Joan de Mel. The organization was incorporated by an Act of Parliament No.10 of 1986.
Information courtesy: DailyNews, SundayObserver