Choosing to die--a growing epidemic among the young.

Abstract

WHO estimates that about one million people kill themselves every, year -- a toll comparable to that of malaria. Worse, on present trends, WHO expects the number to climb to about 1.5 million by 2020. Even politicians are starting to accept that suicide is not just a private issue. "Suicide is being talked about," says Dr Michael Phillips, director of the research centre of clinical epidemiology at Beijing's Hui Long Guan Hospital in China. Earlier this year, for example, Chinese vice-premier Li Lanqing chaired a high-profile national meeting on mental health at which suicide was mentioned. The meeting made the front page of the People's Daily. "This would have been unthinkable even five years ago," says Phillips. At varying levels of readiness, other governments, from Sweden to the United States, are now beginning to discuss, plan or implement national prevention strategies, partly as a result of WHO's prodding. About a dozen have strategies in place. Why all the attention now? After all, the rates of reported suicides have been climbing for decades, at least in much of Europe and the Americas, where data go back far enough to reveal trends. Dr Jose Bertolote, who is responsible for WHO's global initiative on suicide prevention, says this trend is reflected in a sample of four large countries studied by WHO -- Brazil, India, Mexico, and the USA -- where increases from 5% to 62% were seen in suicide rates over the past two decades. What is new is the realization that suicide is "un-greying", or becoming more common in younger age groups. Although elderly adults have historically been much more likely than the young to take their own lives, suicide rates in young adults -- especially men -- have been rising steeply in recent years in some European countries, the US, Mexico, the Western Pacific, and elsewhere. In the US, for example, the rate among 15-24-year-olds trebled between the 1950s and the mid-1980s, and although now levelling off has not declined. "In some circles, this would be called an epidemic," says Dr Morton Silverman, a psychiatrist at the University of Chicago, who helped to formulate the national suicide prevention strategy for the US. Because of these upward shifts, and based on the available data, people under the age of 45 now account for more than half of all the "completed", or successful, suicides committed in a year, compared with just 44% of the total in the 1950s, according to WHO. By 2000, suicide had become one of the three leading causes of death in young adults worldwide. Why young people should be so much more likely to kill themselves today than they were in the 1950s is unknown. But psychiatrists have several theories. One is that in countries that have been through rapid economic upheavals the old certainties of jobs, relationships -- even political enemies -- are being swept away faster than the young can cope. Individualistic cultures are leaving people without ideals. "There is a loss of a sense of hope and a loss of a sense of the future," says Silverman. In the past, he argues, most adolescents in industrialized countries believed that if they studied, got a job and earned an income, they could expect a certain standard of living. Most could also expect lasting relationships. Today, says Silverman, "that's all been turned upside down". This trend is not unique to the industrialized world, says Dr Diego De Leo of the Australian Institute for Suicide Research and Prevention at Griffith University, Brisbane. "We [in the developed countries] are globalizing and exporting a lot of our disadvantages," he says. "There will be an increase in suicides in developing countries, with loss of tradition, social cohesion, and spontaneous social support. We are rendering the culture of these countries more individualistic and so making the people more vulnerable to suicide." But older adults are facing just as much uncertainty, so why are young adults and adolescents so vulnerable to it? …