ABSTRACT
Introduction Suicide, referred to as a preventable public health crisis, is responsible for between 850,0001,0000,00 deaths worldwide annually (Hawton & van Heeringen, 2009; WHO, 2014). These rates are likely an underestimation due to religious taboos about suicide, cultures that consider suicide illegal or a criminal offense, variability across countries as to who conducts the examination, how the death is classified and potential assigning of the death to the category of mortality due to injury rather than suicide (Fisher, Herman, de Mello, & Chandra, 2014; Hawton & van Heeringen, 2009). While suicide is the tenth leading cause of overall deaths, it is frequently cited as the second or third cause of death among adolescents and young adults ages 15-29 (Phillips & Cheng, 2012; WHO, 2014), and has consistently been a driver of deaths in older adults over the age of 70, with rates higher in low-and middle-income countries, rural areas, the unemployed and those with a psychiatric disorder (Carlson & Ong, 2014; Hawton & van Heeringen, 2009; WHO, 2014). When mental, neurological, and substance use burden was added to the 2010 Global Burden of Disease estimates, the burden associated with suicide from these disorders shifted the mental health GBD from fifth to third worldwide (Ferrari et al., 2014). Completed suicides are higher in men when compared to women, primarily due to the use of high lethal methods including firearms, hanging, jumping, and pesticide poisoning (Phillips & Cheng, 2012; Schlebusch, n.d.). Risk factors have been associated with disorders of mood, substance use, schizophrenia, prior attempt, chronic stress, and living in poorly resourced, crowded, and violent environments. Highest suicide rates are found in Asia (China, South Korea, Sri Lanka, India, and Russia), Africa (South Africa, Mozambique, and Tanzania), and Europe (Lithuania, Latvia, Finland) with lowest rates found in Greece, Islamic countries (Saudi Arabia, Kuwait, Oman), Mexico, Spain, and Caribbean countries such as Barbados and Jamaica (Hawton & van Heeringen, 2009; WHO, 2012). For every completed suicide, it is estimated that there are 10 or more unsuccessful attempts, making suicide a daunting and pervasive societal issue. Therefore, universal screening for self-harm intent is a recommended prevention activity that should be incorporated in all health care visits and taught to non-specialist health workers
who provide community-based interventions. Of note, risky behaviors such as reckless driving that results in death may actually be an intended suicide that was classified as an injury-related automobile accident in the absence of definitive suicide evidence, such as a note. Additional hazardous behaviors involving unprotected sex, polysubstance use, certain eating disorders, and frequent risk-taking actions can be viewed as self-harm behaviors with high potential for death.
