The theme of this year’s World Health Day is ‘Depression – let’s talk’. Led by the WHO, this year’s campaign aims to mobilise awareness and discussion about the mood disorder which, according to the WHO, is the leading cause of ill health and disability globally. There are now over 300 million people living with depression, many of which lack support and medical treatment and are prone to mental health stigma.
To commemorate World Health Day, Clinical Psychologist and international expert on suicide, Prof Lourens Schlebusch, discusses the worrying increase in adolescent depression and suicide attempts and what’s needed to combat the issue.
Worldwide, approximately one death by suicide occurs every 40 seconds and one attempt is made every one to three seconds. By 2020, these predictions are expected to increase worldwide to one death every 20 seconds and one suicidal attempt made every one to two seconds. Such figures indicate that, on average, more people globally die annually from suicide than they do during war.
Suicidal tendencies don’t always increase with age
Traditionally, suicide rates have shown a positive relationship with age, in that they tended to increase in older people – some six to eight times higher than in younger people. However, recent statistics show that, on a global spectrum, more younger people die from suicide than older people. The global incidence of suicide in under 15-year-olds has, in fact, more than doubled since 1960 in both males and females.
Suicidal behaviour in the young can range from lethal attempts with high intent to die (fatal suicidal behaviour) to non-lethal attempts (nonfatal suicidal behaviour) with low or no intent to die. In South Africa, about 9.5% of non-natural deaths in young people are because of suicides and 10 to 20 times more non-fatal suicidal behaviours occur per year.
In many cases of suicide, threats or non-fatal suicidal behaviour, parents and other adults do not always take the behaviour seriously for various reasons. They often consider it as mere gestures or threats to manipulate, or because they want to avoid publicity and social embarrassment. This can only make the situation worse and increase the number of fatal suicidal behaviours.
In South Africa suicidal behaviour in the younger generations has become exponential, constituting a major public health problem. And while other countries have developed and implemented national preventative programmes, strategies and priorities, in South Africa such initiatives are still very much needed. Given the research findings, the severity of the problem in young people in South Africa should not be underestimated.
The need for successful interventions
The high suicidal prevalence rates have considerable implications for mental health care facilities in the country. Early recognition of risk factors is important for the prevention of suicidal behaviour and the need to develop appropriate, cost-effective interventions. Regional suicide preventative programmes and service agencies are in place in some instances, but a national suicide preventative programme, which has already been recommended, is yet to be implemented.
To prevent suicidal behavior and promote mental health, a national programme for suicide prevention should provide a strategic framework for action at all levels, i.e. national, provincial, regional and local. The goals should include:
- Reducing suicide deaths and non-fatal suicidal behaviour
- Reducing risk factors and promoting protective factors
- Promoting early detection of new trends and a reversal of emerging problem areas
- Promoting public awareness of suicidal behaviour, its causes and possibilities for prevention
- Increasing support to individuals, families and communities affected by suicidal behaviour
It is critical to have a thorough understanding of the risk factors and causes of suicidal behaviour in order to deal with them. A primary strategy for suicide prevention is the recognition and effective treatment with both pharmacological and psychological methods of depression and other underlying psychopathology that often go undetected in young people and contribute to suicidal behaviour.
It is also essential that school children and students be trained to identify and manage conflict situations and crises that could result in suicidal behaviour. Early recognition of risk factors are important for prevention of suicidal behaviour, as is the need to develop appropriate, cost-effective therapeutic interventions and research, as well as policy priorities.
Prof Schlebusch is an international expert on suicide having authored two books ‘Mind Shift: Stress Management and your health’ and ‘Suicidal behaviour in South Africa’. He is currently an Emeritus Professor of Behavioural Medicine at the Nelson R Mandela School of Medicine, University of KwaZulu-Natal and in private practice at Life Entabeni Hospital, Durban.