Steady rise in suicides will only drop if social ills are tackled
Suicide rates continue to rise across both the developed and the developing worlds. This is despite many countries implementing suicide prevention programmes in line with the World Health Organisation’s guidelines.
Suicide rates have increased by 60% over the past 45 years. Globally there are 16 suicides for every 100 000 people. And for every suicide that takes place, there are about 20 attempted suicides.
According to the World Health Organisation there are 800 000 suicides a year globally. This is expected to rise to 1.53 million by 2020. About 75% of the world’s suicides take place in low and middle income countries.
The research also shows that men typically have a higher risk than women for completing suicide but more women attempt suicide than men.
Our research shows that in South Africa young men are more likely to than ever before to engage in suicidal behaviour because they cannot live up to the expectations placed on them as well as how society views men.
Despite decades of research, preventing suicides remain a problem. The main challenge is that suicide prevention programmes are typically bio-medical and focus primarily on identifying people at risk and promoting access to psychiatric care.
These approaches are often grounded in the assumption that suicidal behaviour is a symptom of psychopathology (mental disorders) and that people who want to die need psychiatric care.
But medicalising suicide ignores the socio-cultural context in which suicides occur. Our research has shown that suicidal behaviour has a social, economic and cultural context. And unless these factors are considered alongside psychiatric care, steadily increasing suicide rates will not be curbed.
A growing body of research is helping policymakers understand that suicidal behaviour – like any other form of human behaviour – has a social, economic and cultural context. These situational factors are as much potential precipitants of suicidal desires as are bio-medical and psychiatric factors.
Pressures on men
The perception, according to our research, is that men have to behave in a certain way: they have to have power, be achievers and be in control. And those who cannot either risk being an “outsider” who is stigmatised or opt for suicide as a viable way out.
Interviewed participants saw suicide as a legitimate way for men to deal with conflicted feelings of shame, loss, or vulnerability particularly when these feelings were elicited by the experience of not living up to societal expectations.
In South Africa suicide accounts for 9.6% of all unnatural deaths. There is about one suicide every hour. Data suggests that 80% of suicides in South Africa are males and that suicide rates are highest among those between the ages of 15 and 29.
Our interviewees indicated that clear and rigid social norms dictated and regulated the behaviour of young men in South Africa. They were acutely aware of the perceived gender norms and what the societal expectations were around these. Failure to conform to these norms precipitated feelings of shame and guilt, social exclusion, impotence and isolation.
As a result, suicide was a “logical solution”, allowing these young men to re-empower themselves and escape difficult feelings associated with being isolated or shunned by society.
Although they conformed to the dominant ideals of masculinity which make it difficult to access support or express fear, pain, and vulnerability, not conforming liberated them. It meant they were allowed to express emotions and access support.
But they were aware that a stance like this would make them socially disconnected, and put them at risk of being stigmatised.
Our research suggest that these socio-cultural ideas about manhood may prevent young men from accessing care, communicating their distress or forming protective authentic relationships.
Socio-cultural factors are not the only factors that contribute to suicide. Ongoing research has highlighted the role of economic factors such as poverty, unemployment and hunger in the aetiology of suicide. When people experience economic adversity it can lead to feelings of entrapment, hopelessness and helplessness. This, in turn, gives rise to suicidal thoughts and feelings.
The epidemic of peasant farmer suicides in India following crop failures is an example of this.
A new approach
There is no substitute for good psychiatric care for people who exhibit symptoms of psychopathology like mood disturbances and psychosis. Accessible, affordable and effective psychiatric care is essential for suicide prevention in these cases.
But to make serious advances in suicide prevention, holistic interventions must be developed that move beyond bio-medical and psychiatric explanations of suicidal phenomena.
Such approaches might include systemic interventions to address the economic and socio-cultural factors that contribute to suicide. It would also provide effective integrated person-centered care, which includes psycho-social services at a primary health care level and address gender norms and attitudes towards suicide and help seeking.
Jason Bantjes receives funding from the South African National Research Foundation and the South Africa Medical Research Counciil.