Suicide toll highlights mental health challenges

Jolyon Attwooll

21/06/2021 5:05:48 PM

A new World Health Organization report lays bare the global toll due to suicide each year – and the challenges facing health professionals.

Young man struggling with depression.
In Australia, suicides accounted for around nine deaths a day in 2019.

One in every 100 deaths worldwide is attributed to suicide, the most recent World Health Organization (WHO) statistics suggest.
Detailing the latest data from around the world, the report highlights the global challenges facing communities and health practitioners.
Australia is not exempt from the burden of suicide, with the Australian Bureau of Statistics (ABS) recording 3318 suicides in 2019, of which 75% (2502) were men.
Suicides accounted for around nine deaths a day that year – a rate of 19.8 suicide deaths per 100,000 people among males, and 6.3 among women.
According to the WHO report, the overall suicide rate in Australia is higher than many other nations with a comparable high-income standard of living, including New Zealand and the United Kingdom. However, the rate in the United States was notably higher with 53,099 recorded suicides in 2019 (22.4 per 100,000).
Overall, deaths due to intentional self-harm represented 1.95% of the 169,301 registered in Australia – more than the global rate highlighted by the WHO.
The ABS also notes the rate of suicide among males is now tracking higher than it did a decade ago when it stood at 17.5 per 100,000. Suicide is currently the 10th leading cause of death in the country among men.
Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine, believes there is still some way to go in encouraging men to look for support for their mental health.
‘Men do present to general practice less often than women, particularly for mental health problems, although that has improved over the last few years with greater awareness,’ she told newsGP.

‘The more that men feel enabled to seek help by normalising help, the better that will be. We still have a culture where men have been socialised not to seek help.
‘These are generalisations, and it is changing, but it is still quite a strong behaviour pattern.’
A similar upwards trend has also been evident among women, with the rate rising from five to 6.3 per 100,000 people, placing suicide as the 22nd most prevalent cause of death.
In Australia overall, the average age of death due to suicide was 43.9 years of age for men and 44 for women.
Among Aboriginal and Torres Strait Islander people, the level is even higher, with suicide cited as the fifth-highest cause of death overall – and the second leading cause among men. It is also happening at a younger age on average among Aboriginal and Torres Strait Islander people, with the median age at the time of death 29.8 years.
States and territories show significant variations, with the highest suicide rates in the Northern Territory and Tasmania. Victoria and New South Wales track below the national average.
The Australian Institute of Health and Welfare (AIHW) has contextualised the toll from suicide, saying it was two-and-a-half times the national road toll in 2018, and that it was the leading cause of death among people aged 15–44 from 2016–2018.
That was qualified as follows: ‘To some extent, this is due to the sound physical health of people in these age groups, with chronic diseases only beginning to feature more prominently among people aged over 45.’
The WHO report relates to 2019 and does not cover the period impacted by COVID-19, but early indications suggest the suicide rate in Australia has not risen as was feared in the early days of the pandemic.
In Victoria, the state which has felt the greatest social and economic impact of the pandemic, the total number of deaths by suicide fell slightly in 2020 compared to the previous year, data published by the Victorian Coroners Court shows.
Dr Andronis believes early government interventions may have helped, as well as the way people responded. 
‘The homeless were housed – that would have led to less suicides, as [homelessness] is a risk factor for suicide,’ she said. ‘We know that the [Federal] Government’s JobSeeker and JobKeeper payments would have made a big difference to people as financial and job insecurity are also very important risk factors.
‘Finally, there were a lot of people who rallied together with their own family, who did manage to repair things – I saw quite a lot of that in my own practice.’
However, Dr Andronis remains concerned that the full effects of the pandemic have not played out, and says there has been a noticeable spike in mental health issues among patients.
 ‘COVID and all the uncertainty that has come with it is very, very stressful. The incidence of mental health problems has significantly increased over the last year-and-a-half,’ she said. 
‘People feel disconnected, especially in Melbourne with the fourth lockdown. We’re seeing that reflected in the patients we are seeing.
‘There’s a sense of helplessness – and autonomy and independence are very important aspects of good mental health.’
The WHO article outlines its aim to reduce the global rate of suicides by a third by the end of this decade, basing its strategy around four different strands.
These include limiting access to the means of suicide, educating the media around responsible reporting, fostering socio-emotional life-skills in adolescents and facilitating the early identification and management of anyone affected by suicidal thoughts.
For Dr Andronis, a key role for GPs lies in opening up channels of communication. ‘Having a conversation with our patients about the social determinants of health, including mental health, is something I am very keen to advocate for.
‘That’s where you open the door to conversations that will reveal distress and offer the opportunity to do something.
‘Those social determinants such as homelessness, financial stress, job stress, loss of connections with family and society in general – they are under-recognised.
‘Asking those social questions, that’s the most important thing GPs can do to improve mental health outcomes, particularly for suicide risks, and especially for men.’

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