記得社會學三大奠基者之一的涂爾榦對「自殺」做過專題研究。不論從個人、家庭、或社會的角度來看，我認為這是一個不必要、可預防、以及社會各方面可以更努力來化解的悲劇。

《連線》雜誌上布郎妮女士這篇文章討論：何以全球自殺率下降。

她說：研究發現，英國自殺率下降最重要的原因是家用瓦斯性質的改進 – 家用瓦斯的一氧化碳含量從容易致死降到幾近於零。這個改變導致「開瓦斯自殺」這個方法消失。從而，「自殺方法」大大的受到限制。

該文作者指出：1990 -2016間，中國自殺率降低了60%；原因之一在於中國的經濟快速成長。它導致鄉村人口大量湧入城市；就自殺議題而論，「城市化」的影響有兩個：一是提高個人經濟能力和穩定度；二是減低了一般人取得農藥的機會。在錫蘭和孟加拉，禁止農藥販售後也使得兩國自殺率大幅降低。其它方面的「方法受限」措施同樣得到自殺率降低效果。

作者指出：自殺通常是一時的衝動而不是一個有計畫的行為。如果缺乏一個隨手可得的方法來完成自殺行為，企圖自殺的人多數會打消這個衝動；不再嘗試。

該文後半部分析和報導：造成自殺的各種原因，全球各國自殺問題的現況，以及其它預防自殺的措施等等。我就不一一介紹。


Why Suicide Rates Are Dropping Around the World

Over the past couple of decades, global suicide prevention efforts have reduced deaths by a third—but some countries are falling behind.

Grace Browne, 05/12/23

In post-World War II Britain, national records began to reveal a concerning trend. Deaths by suicide were rising in the war-battered nation, an increase that would continue from the end of the war into the early 1960s. Then, in 1963, that trend mysteriously reversed. The graphs began to teeter downward. Experts puzzled over the reasons behind this drop in the suicide rate. Was it the birth of the Samaritans counseling services in 1953? Was it better psychiatric services offered under the National Health Service? But the reality turned out to be something entirely unexpected.

In the early 20th century, domestic gas that was used to warm British homes and cook people’s dinners was made almost entirely by heating coal, which created a gas mixture imbued with a hefty dose of carbon monoxide. Consequently, ingestion of carbon monoxide poisoning from a gas oven became the most common method of suicide. In the early 1950s, new and cheaper methods of gas production were brought in—with a carbon monoxide content hovering near zero.

Suicides by domestic gas poisoning in the UK began to fall rapidly, bringing down the national suicide rate. Between 1963 and 1970, deaths by suicide fell by a quarter. By 1975, suicides by gas poisoning had pretty much disappeared. The experts were not quite sure what to make of this; could it really be that simple? A 1976 paper on the topic pondered how “the removal of a single agent of self-destruction can have had such far-reaching consequences.”

This question gets to the heart of what’s called “means restriction”—reducing access to methods people use to take their lives. Across the world, means restriction has had a huge impact. Over the past three decades, suicide rates have slowly and steadily dropped; between 2000 and 2016, the global mortality rate from suicide dropped by about 33 percent. So while it may feel like the world is crumbling into a war-torn, authoritarian shit show ravaged by rising temperatures and politicians who stand idly by, we can take solace in knowing that we’ve become better at preventing suicides.

It’s worth noting that all suicide numbers should be taken with a hefty grain of salt. Many countries underreport suicide deaths—due to data lags, as well as reasons related to stigma and religion. In some countries, suicide is still illegal. Nevertheless, it’s worth looking at the downward trend to see what lessons it can impart.

A big chunk of that decrease can be attributed to suicide declines in the two most populous countries in the world. Between 1990 and 2016, suicide rates decreased by 15 percent in India and by over 60 percent in China. A fast-growing Chinese economy resulted in far more people moving from the countryside to more urban areas. This meant that, in addition to more economic stability, they had reduced access to pesticides, a common means of suicide in lower-income countries, especially among young women in rural areas.

Banning or limiting access to dangerous pesticides has had astonishing effects in many other Asian countries too. In 1995, Sri Lanka had the highest suicide rate in the world. The same year, it banned dangerous pesticides, and the national suicide rate has since fallen by 70 percent. In Bangladesh, a similar ban led to a 65 percent reduction. Elsewhere, means restriction methods such as barriers on high structures, gun control laws, and smaller medication packet sizes have been shown to considerably reduce suicide rates.

Means restriction works in part because suicide is often an unplanned act. The time between a suicidal impulse arising and a person acting on that impulse can be as little as five minutes. A person who dies by suicide has traditionally been represented as someone at the end of a long, tortured battle with depression, but this is generally not the case. While having a mental illness is a strong predictor of suicide risk, most people with mental illness will never attempt suicide.

Reducing access to means allows time for the impulse to pass, and the person may never want to try again. One study found that only about 7 percent of people who attempted suicide went on to take their own lives within the following five years.

SUICIDES AREN’T evenly distributed around the world. According to the World Health Organization’s most recent estimates, nearly 80 percent of suicides occur in low- and middle-income countries, where most of the world’s population lives, but high-income countries tend to have higher suicide rates. The general global decline in suicides also hides pockets of the world where rates are climbing—countries like Zimbabwe, Jamaica, South Korea, and Cameroon.

One high-income country is a particular exception to the downward trend: the US. Though rates in the country declined throughout the 1990s, at the turn of the century they began to rise again. Between 2000 and 2018, the suicide rate jumped 35 percent. Suicide is the second-highest cause of death among young Americans aged 10–14 and 20–35 years old. 

You might be shouting: The answer is guns! And you’d be mostly right. In the US, over half of all gun deaths are suicides. In 2021 alone, over 26,000 people died by suicide using a firearm, out of the just over 48,000 recorded suicide deaths in total. Research has found that the states with higher rates of household gun ownership also have significantly higher suicide rates. Limiting gun access remains the “most important actionable public health target for firearm suicide prevention efforts,” according to a 2022 paper looking at the country’s climbing suicide rate.

Suicides linked to guns are “totally preventable,” says Alexis Palfreyman, an honorary research fellow at University College London who researches mental health, suicidology, violence, and sexual and reproductive health and rights. She points to Brazil, which enacted firearms restrictions in 2003, including making it illegal to carry or own an unregistered gun, raising the minimum age for purchase to 25 years old, and instituting background checks for purchase. It led to a 27 percent reduction in firearm suicides. “It’s just such a shame that we don’t seem to think that it’s worth the lives saved to actually do it,” Palfreyman says of the US. 

Other factors may be contributing to rising suicide rates in the US, including structural racism, financial strain (driven by income inequality, personal debt, and unemployment, to name but a few issues), the opioid epidemic, and a societal structure that features significant social isolation. Mental health disorders on the whole are on the rise in the US, which may also help explain the trend. But with firearms involved in over half of suicides, it’s impossible to deny that guns are playing an outsize role.

MEANS RESTRICTION, it’s clear, has been hugely impactful outside of the US. But it won’t get the suicide rate down to zero anywhere. For one, it’s nearly impossible to fully restrict all means. But more importantly, means restriction doesn’t get to the root of the problem—why people feel the urge to take their lives in the first place. This has led to some researchers calling for suicide to be treated as a social justice issue, as opposed to one of a simply psychiatric nature.

In the case of China, better economic stability had a massive impact on bringing the suicide rate down. There’s a strong link between suicide and unemployment, as well as economic crises, including the 2008 global financial crisis. Social safety nets like universal basic income and universal health care could go some way toward bringing suicide rates down, says Gonzalo Martinez-Ales, a psychiatrist-epidemiologist at Harvard University. A 2022 study found that cash transfers targeted at low-income families in Brazil were found to lead to a 56 percent lower suicide rate among those who received them versus those who didn’t. Broad social improvements can have a significant effect on suicide rates.

But beyond means restriction, what are the best bets for specifically targeting suicide rates? One method put forward is risk assessment, the idea that people can be trained to identify individuals most at risk. But Martinez-Ales is skeptical that this would make a real difference, as the time between impulse and action can be so brief. Plus, simply asking people about their suicidal thoughts is not a reliable way of predicting whether they are likely to commit suicide, a 2019 study concluded.

Antidepressant prescriptions, and certain forms of psychotherapy—such as cognitive behavioral therapy and dialectical behavior therapy—have been shown to be effective in treating suicidal ideation and behavior. Other measures that have a good evidence base include school-based education programs and better training for clinicians. But Martinez-Ales wonders just how much impact targeted psychiatric care can have. “That doesn’t mean that I don’t think that providing good care for people who are suicidal is very important,” he says. But the benefits of such interventions are dwarfed by the gains that can be made through means restriction. Ideally, countries should be pursuing all these measures at once.

Aiming solely to reduce the number of people who die by suicide also oversimplifies the larger issue. The number of suicide deaths can obstruct the overall picture of self-directed violence. Men make up the majority of people in the column of deaths, but women and girls dominate every other part of that spectrum, with women more likely to self-harm and to attempt suicide. The reason for this is that men tend to select methods with a higher chance of resulting in death; this is what’s called the gender paradox in suicide. But just because suicidal behavior doesn’t result in death—as is the case for many women—doesn’t mean it can be ignored. “While the deaths might be coming down overall, I think that’s not painting an accurate picture of the fact that a lot of people are in distress,” says Palfreyman. Rates of self-harm are rising rapidly in young women and girls, in particular.

While suicide rates have fallen in many parts of the world over the past decades, for the UN, this isn’t nearly enough. The organization’s Sustainable Development Goals aim to shrink suicide mortality by a third between 2015 and 2030—though hitting that goal may turn out to be wishful thinking. To increase the odds of success, however, lessons from countries that have succeeded in bringing their numbers down will prove invaluable.

Grace Browne is a staff writer at WIRED, where she covers health. Prior to WIRED, her work appeared in New Scientist, BBC Future, Undark, OneZero, and Hakai. She is a graduate of University College Dublin and Imperial College London.

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