Suicide in Asia: Opportunities and Challenges

Asian countries account for approximately 60% of the world's suicides, but there is a great mismatch in the region between the scale of the problem and the resources available to tackle it. Despite certain commonalities, the continent itself is culturally, economically, and socially diverse. This paper reviews current epidemiologic patterns of suicide, including suicide trends, sociodemographic factors, urban/rural living, suicide methods, sociocultural religious influences, and risk and protective factors in Asia, as well as their implications. The observed epidemiologic distributions of suicides reflect complex interplays among the traditional value/culture system, rapid economic transitions under market globalization, availability/desirability of suicide methods, and sociocultural permission/ prohibitions regarding suicides. In general, compared with Western countries, Asian countries still have a higher average suicide rate, lower male-to-female suicide gender ratio, and higher elderly-to-general-population suicide ratios. The role of mental illness in suicide is not as important as that in Western countries. In contrast, aggravated by access to lethal means in Asia (e.g., pesticide poisoning and jumping), acute life stress (e.g., family conflicts, job and financial security issues) plays a more important role than it does in Western countries. Some promising suicide prevention programs in Asia are illustrated. Considering the specific socioeconomic and cultural aspects of the region, community-based suicide intervention programs integrating multiple layers of intervention targets may be the most feasible and cost-effective strategy in Asia, with its populous areas and limited resources. Asia; primary prevention; suicide Phillips, 2002 (42) China Case: 519; control (injury deaths): 536 All age/sex groups Case-control Depression, previous suicide attempt, acute and chronic stress, low quality of life, interpersonal conflict, suicidal behavior in family or friends Zhang, 2004 (151) China Case: 66; control: 66 All age/sex groups in rural areas Case-control Mental disorders, acute life stress, poor physical health, low social status, poor social support, family disputes, religious belief Conner, 2005 (126) China 505 suicides Age >18 years Case series Women and younger individuals, acute stress, pesticides stored at home Yang, 2005 (56) China 895 suicides All age/sex groups Case series Availability of pesticide, high lethality of pesticide and limited availability, acute life stress (particularly for young, rural women) Li, 2008 (43) China Case: 114; control (unintentional injury deaths): 91 Ages 15-24 years Case-control Life events, depressive symptoms, low quality of life, acute stress, mental illness, prior suicide attempt Zhang, 2009 (152) China 105 suicides Ages 15-34 years in rural areas Case series Depression, mental disorders, psychological strain, negative life events Kasckow, 2010 (153) China Case: 74; control (unintentional injury deaths): 24 Schizophrenics Case-control Depression, prior history of suicide attempt Tong, 2010 (154) China Case: 895; control (injury deaths): 701 All age/sex groups Case-control Mood disorder, anxiety disorder, psychotic disorder, substance use disorder