Suicide and Culture

Suicide is defined as “the act of intentionally ending one’s own life.” (Nock et.al, 2008, p.134).  Global estimates suggest that suicide continues to be a leading cause of death.  The World Health Organization (WHO) in 2012 estimates that each year approximately one million people die from suicide, which represents a global mortality rate of 16 people per 100,000 or one death every 40 seconds. It is predicted that by 2020 the rate of death will increase to one every 20 seconds.

 

The general trend of suicide is provided by a WHO report in 2012 and Nock et al. (2008):

l   In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 (male and female). Suicide attempts are up to 20 times more frequent than completed suicides.

l   There is a cross-national consistency in the early age of onset of suicide ideation and the rapid transition from suicidal thoughts to suicidal behavior.  Suicides globally by age are as follows: 55% are aged between 15 to 44 years and 45% are aged 45 years and over.  Youth suicide is increasing at the greatest rate.  This trend is confirmed in Hong Kong.  In Time Out Hong Kong 7 Dec 2011, it was reported that the suicide rate among teenagers aged 19 and under increased by 58%, while suicide rate among adults steadily decreased.

l   Mental health disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide.  This view is shared by Tondo and Baldessarini (2011) that 90% of suicides in the US occur in persons with a clinically diagnosable psychiatric disorder, particularly patients with bipolar depression disorder.

Moreover, there is significant cross-national variability reported in suicide and suicidal behavior.  The implication is that it is important to address specific underlying issues unique for each country.  The WHO and other researches find that:

l   In Europe, particularly Eastern Europe, the highest suicide rates are reported for both men and women.

l   The Eastern Mediterranean Region and Central Asia republics have the lowest suicide rates.

l   India, China and Japan account for more than 40% of all world suicides.  In 2006, Beautrias estimated that within Asia national suicides rates vary widely, from as low as 2 per 100,000 per year (in countries like the Philippines and Pakistan) to rates of more than 20 per 100,000 in Japan, rural China and Sri Lanka.

What are some factors that explain national differences in suicide?

Socio-demographic and economic variables – Lower suicide rates were found for nations with less economic development and where Islam was the dominant religion.

Physiological differences – The higher the proportion of people in the nation with Type O blood, the lower the suicide rates.

Societal differences – Suicide in modern societies seems to increase as social integration and regulation decrease.  There is one suicidal theory proposed by Naroll that suicide occurred in those who were socially disoriented.  “Thwarting disorientation contexts are those in which the individual’s social ties are broken or weaken and those in which another person thwarts the individual and prevents him or her from achieving desired and expected satisfactions or in which they experience frustration.” (Lester, 2008, p.62).  Naroll’s view seems to provide a good explanation to the high suicide rates in Hong Kong.  The lack of parents and teachers’ recognition in academic performance is one commonly reported reasons for teenage and college students’ suicides.  Vengeful suicide is another common reason whereby the teenagers want to get back at those who they believe have caused them misery, such as feelings of isolated and alone from parents’ divorce.

Besides the above factors that explain the national differences, some risk factors that cause suicide are:

Psychiatric factors – Mood, impulse-control, alcohol/substance use, psychotic and personality disorders convey the highest risk for suicide and suicidal behavior.

Psychological factors – Factors such as hopelessness, anhedonia, impulsiveness and high emotional reactivity will increase a person’s psychological stress level, thus increasing suicidal risks.

Biological factors – family, twin and adoption studies provide evidence for a heritable risk of suicide and suicidal behavior.  Much of the family history of suicidal behavior may be explained by the risk associated with mental disorders.

Stressful life events – Such events interact with the above factors to increase suicidal risks.  Examples of stressful life events are family and romantic conflicts and the presence of legal and disciplinary problems.  In the case of Hong Kong, a common risk factor for youths and young adults suicide are due to family conflicts with respect to their academic achievements which may lead to disciplinary consequences.

In the next blog post, I will look into the specific issues prevailing to suicides in Asia.

Reference list:

Beautrais, A.L. (2006). Suicide in Asia.  Crisis, 27(2), 55-57. Doi: 10.1027/0227-5910.27.2.55

Befrienders Worldwide. (2012). Suicide statistics.  Retrieved from http://www.befrienders.org/info/index.asp?PageURL=statistics.php

Lester, D. (2008). Suicide and culture. World Cultural Psychiatry Research Review, 3(2), 51-68.

Nock, M.K., Borges, G., Bromet, E.J., Cha, C.B., Kessler, R.C. & Lee, S. (2008). Suicide and suicidal behavior.  Epidemiologic Reviews, 30, 133-154. Doi: 10.1093/epirev/mxn002

Tondo, L. & Baldessarini, R.J. (2011, February 10). Can suicide be prevented? The Psychiatric Times.  Retrieved from http://www.psychiatrictimes.com

Zhao, S. (2011, December 7).  The shocking rise of child suicide. The Time Out Hong Kong.  Retrieved from http://www.timeout.com.hk