Editor: Maurizio Pompili

Suicide: A Global Perspective

eBook: US $49 Special Offer (PDF + Printed Copy): US $143
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Library License: US $196
ISBN: 978-1-60805-427-5 (Print)
ISBN: 978-1-60805-049-9 (Online)
Year of Publication: 2012
DOI: 10.2174/97816080504991120101


In the year 2000, approximately one million people died from suicide: a "global" mortality rate of 16 per 100,000, or one death every 40 seconds.

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 years (both sexes); these figures do not include suicide attempts up to 20 times more frequent than completed suicide. Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in1998, and 2.4% in countries with market and former socialist economies in 2020. Although traditionally suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries. Mental disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide; however, suicide results from many complex sociocultural factors and is more likely to occur particularly during periods of socioeconomic, family and individual crisis situations (e.g., loss of a loved one, employment, honour).

The economic costs associated with completed and attempted suicide are estimated to be in the billions of dollars. One million lives lost each year are more than those lost from wars and murder annually in the world. It is three times the catastrophic loss of life in the tsunami disaster in Asia in 2005. Every day of the year, the number of suicides is equivalent to the number of lives lost in the attack on the World Trade Center Twin Towers on 9/11 in 2001.

Everyone should be aware of the warning signs for suicide: Someone threatening to hurt or kill him/herself, or taking of wanting to hurt or kill him/herself; someone looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; someone talking or writing about death, dying or suicide, when these actions are out of the ordinary for the person. Also, high risk of suicide is generally associated with hopelessness; rage, uncontrolled anger, seeking revenge; acting reckless or engaging in risky activities, seemingly without thinking; feeling trapped – like there’s no way out; increased alcohol or drug use; withdrawing from friends, family and society, anxiety, agitation, unable to sleep or sleeping all the time; dramatic mood changes; no reason for living; no sense of purpose in life.

Table 1.

Understanding and helping the suicidal individual should be a task for all.

Suicide Myths How to Help the Suicidal Person Warning Sights of Suicide Myth:Suicidal people just want to die.Fact:Most of the time, suicidal people are torn between wanting to die and wanting to live. Most suicidal individuals don't want death; they just want to stoop the great psychological or emotional pain they are experiencing
  • -Listen;
  • -Accept the person's feelings as they are;
  • -Do not be afraid to talk about suicide directly
  • -Ask them if they developed a plan of suicide;
  • -Expressing suicidal feelings or bringing up the topic of suicide;
  • -Giving away prized possessions settling affairs, making out a will;
  • -Signs of depression: loss of pleasure, sad mood, alterations in sleeping/eating patterns, feelings of hopelessness;
Myth:People who commit suicide do not warn others.Fact:Eight out of every 10 people who kill themselves give definite clues to their intentions. They leave numerous clues and warnings to others, although clues may be non-verbal of difficult to detect.
  • -Remove lethal means for suicide from person's home
  • -Remind the person that depressed feelings do change with time;
  • -Point out when death is chosen, it is irreversible;
  • -Change of behavior (poor work or school performance)
  • -Risk-taking behaviors -Increased use of alcohol or drugs
  • -Social isolation -Developing a specific plan for suicide
Myth:People who talk about suicide are only trying to get attention. They won't really do it.Fact:Few commit suicide without first letting someone know how they feel. Those who are considering suicide give clues and warnings as a cry for help. Over 70% who do threaten to commit suicide either make an attempt or complete the act.
  • -Express your concern for the person;
  • -Develop a plan for help with the person;
  • -Seek outside emergency intervention at a hospital, mental health clinic or call a suicide prevention center
Myth:Don't mention suicide to someone who's showing signs of depression. It will plant the idea in their minds and they will act on it.Fact:Many depressed people have already considered suicide as an option. Discussing it openly helps the suicidal person sort through the problems and generally provides a sense of relief and understanding.

Suicide is preventable. Most suicidal individuals desperately want to live; they are just unable to see alternatives to their problems. Most suicidal individuals give definite warnings of their suicidal intentions, but others are either unaware of the significance of these warnings or do not know how to respond to them. Talking about suicide does not cause someone to be suicidal; on the contrary the individual feel relief and has the opportunity to experience an empathic contact.

Suicide profoundly affects individuals, families, workplaces, neighbourhoods and societies. The economic costs associated with suicide and self-inflicted injuries are estimated to be in the billions of dollars. Surviving family members not only suffer the trauma of losing a loved one to suicide, and may themselves be at higher risk for suicide and emotional problems.

Mental pain is the basic ingredient of suicide. Edwin Shneidman calls such pain “psychache” [1], meaning an ache in the psyche. Shneidman suggested that the key questions to ask a suicidal person are ‘Where do you hurt?’ and ‘How may I help you?’. If the function of suicide is to put a stop to an unbearable flow of painful consciousness, then it follows that the clinician’s main task is to mollify that pain. Shneidman (1) also pointed out that the main sources of psychological pain, such as shame, guilt, rage, loneliness, hopelessness and so forth, stem from frustrated or thwarted psychological needs. These psychological needs include the need for achievement, for affiliation, for autonomy, for counteraction, for exhibition, for nurturance, for order and for understanding. Shneidman [2], who is considered the father of suicidology, has proposed the following definition of suicide: ‘Currently in the Western world, suicide is a conscious act of self-induced annihilation, best understood as a multidimensional malaise in a needful individual who defines an issue for which the suicide is perceived as the best solution’. Shneidman has also suggested that ‘that suicide is best understood not so much as a movement toward death as it is a movement away from something and that something is always the same: intolerable emotion, unendurable pain, or unacceptable anguish.

Strategies involving restriction of access to common methods of suicide have proved to be effective in reducing suicide rates; however, there is a need to adopt multi-sectoral approaches involving other levels of intervention and activities, such as crisis centers. There is compelling evidence indicating that adequate prevention and treatment of depression, alcohol and substance abuse can reduce suicide rates. School-based interventions involving crisis management, self-esteem enhancement and the development of coping skills and healthy decision making have been demonstrated to reduce the risk of suicide among the youth. Worldwide, the prevention of suicide has not been adequately addressed due to basically a lack of awareness of suicide as a major problem and the taboo in many societies to discuss openly about it. In fact, only a few countries have included prevention of suicide among their priorities.

Reliability of suicide certification and reporting is an issue in great need of improvement. It is clear that suicide prevention requires intervention also from outside the health sector and calls for an innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, e.g., education, labour, police, justice, religion, law, politics, the media.


[1] Shneidman ES. Suicide as psychache. A clinical approach to self-destructive behavior. Nortvale, Aronson, 1993.

[2] Shneidman ES. Definition of suicide. Northvale, Aronson; 1985.


This book is the result of contribution from scholars belonging to different fields that are all dedicated researchers in suicidology. More and more often we are faced with the fact that suicide is not properly prevented despite the enormous knowledge worldwide.

Suicide is the leading cause of death for people worldwide, and one of the three leading causes of death for young people under 25. Every year, approximately one million people die by suicide - one death every two minutes. The World Health Organization estimates that by the year 2020, this annual toll of suicide deaths will have risen to one and a half million, and suicide will represent 2.4% of the global burden of disease. Suicide deaths account for more than half of all violent deaths in the world - more than all deaths from wars and homicides combined.

Every year, many million more people make serious suicide attempts which, while they do not result in death, require medical treatment and mental health care, and reflect severe personal unhappiness or illness. Million more people - the family members and close friends of those who die by suicide — are bereaved and affected by suicide each year, with the impact of this loss often lasting for a lifetime.

Suicide exacts huge psychological and social costs, and the economic costs of suicide to society (lost productivity, health and social care costs) are estimated at many billions of dollars each year.

Because almost a quarter of suicides are of teenagers and young adults aged less than 25 years (250,000 suicides each year), suicide is a leading cause of premature death, accounting for more than 20 million years of healthy life lost.

There are substantial variations in suicide rates among different countries, and, to some extent, these differences reflect cultural differences to suicide. Cultural views and attitudes towards suicide influence both whether people will make suicide attempts and whether suicides will be reported accurately. Suicide rates, as reported to the World Health Organisation, are highest in Eastern European countries including Lithuania, Estonia, Belarus and the Russian Federation. These countries have suicide rates of the order of 45 to 75 per 100000.

Scholars worldwide have puzzled over what makes a person suicidal and what individuals who die by suicide have in their minds. Most often the focus is not on the motives for suicide, nor on the phenomenology of this rare act. It is rather on what is found from small cohorts of suicidal individuals. Each day, dozens of papers on suicide are added to the enormous literature related to this topic.

Models of suicide are less frequently encountered in the literature. It is difficult to produce a sound synthesis of a complex phenomenon, after which many in the scientific community comment that the model omits key features that are not easily identifiable. The lack of models that can actually help in the management of suicide is reflected by the fact that suicide rates have been only mildly changed by the tremendous efforts in this field.

Various models have been reported for suicide such as (1) the scientific view - suicide is caused by factors beyond the individual’s control (the determinist view of suicide), (2) the “Cry for Help” - individuals who die by suicide do not want to die but are seeking help to reduce their distress, (3) suicide as sociogenic - social forces causes suicide (Durkheim’s altruistic, egoistic, anomic and fatalistic suicide). More recently, a stress-diathesis model has been proposed in which the risk for suicidal acts is determined not merely by a psychiatric illness (the stressor) but also by a diathesis. This diathesis may be reflected in a tendency to experience more suicidal ideation and to be more impulsive and, therefore, to be more likely to act on suicidal feelings.

Many clinicians perform careful assessments for suicidal risk in their patients and assume that suitable treatments will resolve this risk. They rarely investigate suicidality in-depth in their patients. The key words here are from the Ancient Greek aphorism "Know yourself" that were inscribed in the pronaos (forecourt) of the Temple of Apollo at Delphi. There are myths and resistances that impair a proper understanding of suicidal people. Many believe that talking about suicide will reinforce the patient’s suicidal ideation, others believe that, when patients talk about suicide, the risk of suicidal behaviour is low. (“Those who talk about it don’t do it.”). Myths and stigmatization should be replaced by a meaningful phenomenology of suicide that involves a true understanding of the suicidal individual’s intimate world.

Increasing globalization, ease of international travel, and refugees and asylum seekers from war and disaster have swelled the number of immigrants worldwide. People who are alienated from their country and culture of origin are vulnerable to various stresses, mental health problems, loneliness and suicidal behaviour. Suicide prevention strategies, tailored to the specific needs of migrant groups, exist in many countries. These programs typically focus on understanding the specific cultural and religious attitudes to mental health and suicide of the migrant group, reasons for migration, and family and social structures. Interventions include educational and social programs designed to identify stresses, teach coping skills, promote use of preventative health practices, improve access to health services and encourage socialising. Suicide prevention programs for migrants may require involvement, championship or leadership from religious or community leaders to be successful.

During the last three decades we have learned a great deal about the causes of this complex behaviour. Suicide has biological, cultural, social and psychological risk factors. People from socially and economically disadvantaged backgrounds are at an increased risk of suicidal behaviour. Childhood adversity and trauma, and various life stresses as an adult influence risks of suicidal behaviour. Serious mental illnesses, most commonly depression, substance abuse, anxiety disorders and schizophrenia, are associated with an increased risk of suicide. Diminished social interaction increases suicide risk, particularly among adults and older adults.

Despite its often complex origins, suicide can be prevented. Communities and societies that are well integrated and cohesive have fewer suicides. Restricting access to methods of suicide (such as firearms or pesticides) reduces suicides. Careful media reporting of suicide prevents further suicides. Educating communities and health and social services professionals to better identify people at risk of suicide, encourages them to seek help, and providing them with adequate, sustained and professional care can reduce suicide amongst people with mental illness. Providing adequate support for people who are bereaved by suicide can reduce their risk of suicide.

Such an appraisal of phenomenology of suicide stresses the need to better understand the suicidal dimension as opposed to the psychiatric dimension and to avoid myths and stigmatization.

This book is an attempt to put together some of the knowledge on suicide and propose proper suicide prevention actions around the world. It presents the rare opportunity to get to know the phenomenon with a broad view of suicide in various continents. Controversial topics are also related to the suicide risk, which makes this volume an update resource for those who want a global perspective.

Maurizio Pompili
Sapienza University of Rome


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