Abstract
Suicide, especially among young people, appears to be increasing in prevalence in diverse countries and cultures. The reasons for this worrying trend remain obscure. Here we present commentaries on suicidal trends in three countries.
First, Masahito Fushimi and colleagues from Japan draw our attention to the dramatic increase in the number of suicides, especially in Akita Prefecture, where the rate is double the national average. It is extraordinary to read that not only was the highest suicide rate among those of middle age, but the cause of death was usually by hanging, a mode of suicide that is rather unusual outside certain penal institutions in the UK. Economic worries are thought to be an important aetiological influence; they have been exacerbated by the 15 years in which Japan has experienced debt and deflation-ridden economic stagnation. There is also a worrying trend for younger people to engage in suicide pacts made via the internet, a vogue that is now worrying countries in the West as well.
Brazil is a diverse and vibrant country with very different cultures and huge discrepancies in wealth, both within and between regions. The suicide rate is apparently astonishingly low by international comparison, although the country’s religious culture may mean that the reported rate is an underestimate. Even so, there has been an increasing risk of suicide over the last two decades, especially among young people. Carolina de Mello-Santos and colleagues discuss this trend, which, in terms of preferred method, is linked especially to the wide availability of firearms (although poisoning and hanging are also common). Increasingly, young single males with low educational attainments and poor economic prospects are the victims.
Finally, Dr N. K. Ndosi provides a fascinating account of suicides in Africa, from the perspective of Tanzania. In Africa, we are told, there are very strong societal prohibitions against suicide, which brings opprobrium on the family of the victim. Despite these attitudes, there is a trend to increasing suicidal behaviour in sub-Saharan Africa, especially among the young, which could be related to increasing urbanisation and the breaking down of traditional cultural structures which militated against the behaviour in former times. We find not only aetiological factors that are culturally relatively specific, such as the oppression of women in patriarchal societies, but also the creeping in of those that were formerly concerns within deprived inner cities in the West, such as heroin addiction. The role to be played by psychiatrists in the primary and secondary prevention of suicide in the diverse cultures discussed in these articles is discussed by all contributors.
It is extraordinary to read that not only was the highest suicide rate among those of middle age, but the cause of death was usually by hanging, a mode of suicide that is rather unusual outside certain penal institutions in the UK.