The intentional killing of oneself can
be evidence not only of personal breakdown, but also of a deterioration of the social
context in which an individual lives. Suicide may be the end-point of a number of
different contributing factors. It is more likely to occur during crisis periods
associated with upheavals in personal relationships, through alcohol and drug abuse,
unemployment, clinical depression or other forms of mental illness. Because of this,
suicide is often used as a proxy indicator of the mental health status of a population.
However, the number of suicides in certain countries may be under-reported because of the
stigma that is associated with the act, or because of data issues associated with
reporting criteria (see "Definition and comparability" ).
Intentional self-harm is a significant
cause of death in many OECD countries, and there were almost 150 000 suicide deaths
in 2009. Rates were lowest in southern European countries (Greece, Italy and Spain) and in
Mexico and Israel, at six or fewer deaths per 100 000 population (Figure 1.6.1). They were highest in Korea, the Russian Federation, Hungary,
and Japan, at more than 19 deaths per 100 000 population. There is a ten-fold difference
between Korea and Greece, the countries with the highest and lowest suicide rates.
Death rates from suicide are
three-to-four times greater for men than for women across OECD countries (Figure 1.6.1), a gap that has remained fairly stable over time. The exception
is Korea, where women are much more likely to take their own lives, although male rates
are still twice those of females. The gender gap is narrower for attempted suicides,
reflecting the fact that women tend to use less fatal methods than men. Suicide is also
related to age, with young people aged under 25 and elderly people especially at risk.
While suicide rates among the latter have generally declined over the past two decades,
less progress has been observed among younger people.
Since 1995, suicide rates have
decreased in many OECD countries, with pronounced declines of close to 40% or more in
Estonia, Luxembourg and Austria (Figure 1.6.2). However, death rates from
suicides have increased in Korea, Chile, Japan, Mexico and Portugal, although in Mexico
rates remain at low levels, and in Japan rates have been static since the late 1990s. In
Korea, male suicide rates more than doubled from 17 per 100 000 in 1995 to 39 in 2009, and
rates among women are the highest in the OECD, at 20 per 100 000 (Figure 1.6.3). Between 2006 and 2010, the number of persons treated for
depression and bipolar disease in Korea rose sharply (increases of 17 and 29 per cent
respectively), with those in low socio-economic groups more likely to be affected (HIRA,
2011). Economic downturn, weakening social integration and the erosion of the traditional
family support base for the elderly have all been implicated in Korea's recent increase in
suicide rates (Kwon et al., 2009).
Suicide is often linked with
depression and the abuse of alcohol and other substances. Early detection of these
psycho-social problems in high-risk groups by families and health professionals is an
important part of suicide prevention campaigns, together with the provision of effective
support and treatment. Many countries are promoting mental health and developing national
strategies for prevention, focussing on at-risk groups (Hawton and van Heeringen, 2009).
In Germany, as well as Finland and Iceland, suicide prevention programmes have been based
on efforts to promote strong multisectoral collaboration and networking (NOMESCO,
Definition and comparability
The World Health Organization
defines suicide as an act deliberately initiated and performed by a person in the full
knowledge or expectation of its fatal outcome. Comparability of data between countries
is affected by a number of reporting criteria, including how a person's intention of
killing themselves is ascertained, who is responsible for completing the death
certificate, whether a forensic investigation is carried out, and the provisions for
confidentiality of the cause of death. Caution is required therefore in interpreting
variations across countries.
Mortality rates are based on
numbers of deaths registered in a country in a year divided by the size of the
corresponding population. The rates have been directly age-standardised to the 1980
OECD population to remove variations arising from differences in age structures across
countries and over time. The source is the WHO Mortality
Database. Deaths from suicide are classified to ICD-10 codes X60-X84.
Mathers et al. (2005) have provided a general
assessment of the coverage, completeness and reliability of data on causes of