Suicide Research and Prevention in Developing Countries in Asia and the Pacific
Milner, Allison, De Leo, Diego, Bulletin of the World Health Organization
Low-income countries in Asia and the Pacific have the highest burden of suicide in the world. These countries are among the poorest globally, and face many social and political challenges.
Suicide trends in these countries differ from those recorded in Europe and North America. For example, compared to high-income countries where suicide among males is predominant, China, India and Pacific island countries report a proportionately higher number of female suicides. There are also noticeable differences in the age distribution of suicide, with young people at greater risk in India and the Pacific islands and elderly people of growing concern in Asia. As in high-income countries, hanging is among the most common suicide methods; however, a large number of suicide deaths throughout Asia and the Pacific also occur through ingestion of toxic substances, such as agricultural pesticides, and inhalation of burning charcoal filmes. These distinctions between risk groups and suicide methods not only indicate the urgent need for suicide research and intervention, but also raise the question of whether the strategies designed for populations in high-income countries are appropriate for developing countries and culturally diverse settings.
Many low-income countries in this part of the world face challenges such as poverty, poor education, rapid industrialization and limited health services. These countries have a high burden of deaths due to both infectious and noncommunicable diseases. As a consequence, there is very limited availability of resources or professionals needed for suicide research and prevention (e.g. doctors, nurses and mental health specialists). Fragmented data on suicide mean that it is often difficult to have a clear understanding of the size of the problem and to identify specific groups "at risk"
Aside from these practical barriers, reporting of suicidal behaviours may be affected by the complex and often conflicting cultural attitudes towards suicide. Suicide is openly condemned in Muslim countries of the region, a fact related to its explicit prohibition in the Koran. (1) Many Asian cultures hold contradictory attitudes towards suicidal behaviour, where it may be condemned in some circumstances and accepted in others. (2) Women, in particular, are affected by these ambiguous cultural attitudes. Arranged marriages, dowry vindications and unequal rights are some of the most common themes involved in suicidal behaviours of women in India and Muslim countries. (3,4) Family conflict and powerlessness, combined with the easy availability of pesticides, are at the basis of the particularly high rates of suicide in rural Chinese women, (5) and constitute a serious public health concern. The fact that suicide is still considered a criminal offence in several countries (e.g. Tonga) may further impact on the willingness of people to seek treatment for suicide, or to report suicide cases to hospitals or the police. Suicide prevention initiatives need to be specifically developed for each area or country and should consider both contextual limitations (e.g. limited funding and human capital, negative cultural attitudes) and strengths (e.g. motivation to reduce suicide, effective community engagement and support).
In establishing a suicide prevention agenda, researchers and health professionals need to draw attention to the issue at the highest governmental level (e.g. ministry of health). It is also crucial to obtain support (both financial and in human resources) from major stakeholders such as government officials and policymakers, coroners, health professionals, community organizations and police departments.
Suicide mortality data is reported regularly to WHO by only India, Sri Lanka and Thailand (WHO South-East Asia Region) and only Australia, China, Hong Kong Special Administrative Region of China, Japan, New Zealand, the Philippines, the Republic of Korea and Singapore (WHO Western Pacific Region). …