Suicide is a significant but often neglected public health issue surrounded by stigma, myths, and taboos. Every case of suicide is a tragedy that severely impacts not only individuals but also families and communities. Each year, more than 703,000 people take their own life after many suicide attempts, corresponding to one death every 40 seconds. Since the WHO declared COVID-19 a pandemic in March 2020, more individuals experience loss, suffering, and stress. Focusing on suicide prevention becomes especially important to build social connections, raise awareness, and provide hope. Reaching out to loved ones for their mental health and wellbeing could be life-saving.
The third regional report on suicide mortality published in March 2021, indicated this problem continues to be a public health priority in the Region of the Americas. Suicides are preventable with timely, evidence-based, and often low-cost interventions. In June 2021, the WHO launched LIVE LIFE, an implementation guide consisting of four key interventions, to prevent suicide around the globe. A multisectoral approach is critical to engage the society and stakeholders for a collaborative effort.
- In the Region of the Americas, 98,000 suicide deaths per year were reported on average from 2015 to 2019, with the suicide rate in North America and the non-Hispanic Caribbean higher than the regional rate.
- About 79% of suicides in the Region occur in males. The age-adjusted suicide rate among males is more than three times higher than in females.
- Suicide is the third-highest leading cause of death among young people aged 20 to 24 in the Americas. People aged 45-59 have the highest suicide rate in the Region, followed by those aged 70 and older.
- Suicide is the fifth-highest cause of DALYs in the Americas, with an almost nine-fold range considering the percentage of total burden, from 0.4% in Antigua and Barbuda to 3.6% in Suriname.
- In 2019, the age-adjusted YLL for both sexes is the highest in Guyana, equalling more than 3200 years per 100,000 population, followed by 1772 years in Suriname and 1462 in Uruguay.
- Suffocation, firearms, poisoning with drugs and alcohol, and poisoning with pesticides and chemicals are the four most frequently used methods for suicide, accounting for 91% of all suicides in the Region.
Tackling the complexity of suicidal behaviors starts with identifying risk and protective factors. Key risk factors range from health systems and society to community, relationship, and individual levels. These include barriers to accessing health care, disaster, war and conflict, previous suicide attempts, etc. Such factors often act cumulatively to increase one’s vulnerability to suicidal behavior. While the link between suicide and mental disorders is well established, many suicides could also happen impulsively in moments of crisis, such as financial loss. Some protective factors include strong personal relationships, religious or spiritual beliefs, and positive coping strategies and wellbeing practices.
Mitigating risk factors to reduce the means of suicide or enhancing protective factors to build resilience can effectively reduce suicide rates. For example, impulsive suicide can be prevented by restricting access to lethal means. Yet, suicide prevention has not been adequately addressed in many countries due to a lack of awareness of suicide as a significant public health concern, which prevents people from seeking help. Under-reporting and misclassification are more significant problems in suicides than in other causes of death due to its sensitivity and illegality in some countries. The challenge is real, and actions must be taken.
PAHO strives to work with all stakeholders in preventing suicides in the Americas. The UN Sustainable Development Goals (SDG), Target 3.4, aims to reduce one-third of premature mortality by 2030. In alignment with the target, the current PAHO Strategic Plan 2020-2025 included suicide as an indicator for evaluating the Region of the Americas.
Every five years, the Mental Health and Substance Use Unit of the Pan American Health Organization (PAHO/WHO), in conjunction with WHO Collaboration Center at Brown University Center, produces a regional report on suicide mortality in the Americas. PAHO has published three reports in this series, each evaluated the period of 2000-2004, 2005-2009, 2010-2014, and is currently working on the fourth publication analyzing the period 2015-2019. These reports overview suicide mortality in the Americas, categorized by subregions and countries, age, gender, and suicide methods. More frequently reported data would be needed from countries to publish the reports timelier for decision-making.
The Mental Health ATLAS is a project of the WHO that tracks countries’ progress in achieving objectives of the Mental Health Action Plan 2013-2030, which supports countries in their effort to meet the SDG Target 3.4. The series of the ATLAS reports since 2000 marks PAHO’s substantial work in planning and collation of data to reduce 10% of suicide rate in the Region. Specifically, the ATLAS survey Question 11, Mental health promotion and prevention, examines the presence of a national suicide prevention strategy, associated programs, and training, which could strengthen the information system on promoting mental health.
In 2016, PAHO published a report on “Prevention of Suicidal Behavior.” This publication was conceived as a practical tool that provides essential information to better understand suicidal behaviors and the main strategies to combat them, from the registry to the evaluation of interventions, considering the approaches already underway in the Region.
The PAHO technical unit provides technical support to countries for developing National Suicide Prevention Strategies. These strategies are essential for elevating suicide prevention on the national agenda. The NMH data portal is also available on the PAHO webpage to map out the burden of suicide in the Region.
As part of capacity building for suicide prevention, PAHO observes World Suicide Prevention Day. The theme from 2021-2023 is “Creating hope through action.” Every year, PAHO prepares series of communication products targeting organizations and personnel from the health sector, social services, and education to drive behavioral changes in suicide prevention.
The unit has also developed educational materials on suicide prevention for professionals. The interactive virtual course, Prevent Self-harm/suicide: Empowering Primary Health Care Providers, offers comprehensive training on self-harm/suicide and is available on the PAHO Virtual Campus for Public Health. Using the WHO mhGAP-IG’s section on self-harm/suicide, PAHO supports countries to train primary health care providers and humanitarian workers, in non-specialized health care settings, on suicide prevention through assessment, management, and follow-up. PAHO additionally provides training and webinars to journalists on responsible reporting of suicides, guiding them to communicate about suicide to the public in ways that reduce stigma, promote care-seeking, and express hope.
