Suicide is an act with fatal outcome, which has been deliberately initiated and carried out by the deceased in the knowledge and expectation of fatal outcome. According to WHO, suicide is the 13th cause of death worldwide, and in the age range of 15 to 44 years, its importance rises to the fourth place. In 2000, according to different data, from 815 thousand to 1 million people in the whole world committed suicide, which gave an annual death rate from suicide of about 14,5/100000 people. And there are reasons to assume that the level of registered suicides remains underestimated by 20%, and in some regions of the world – by 100% as a result of prevailing social or religious views on suicide.
Suicide is a very significant moral and economic problem. The world economic losses from suicide in 1998 were 1.8% of the global burden of disease and will be 2.4% by 2020, when the number of people dying by suicide will reach 1530000 per year. In the Republic of Belarus suicides are the leading cause of death at the working age from external causes (1,286,000 people; 1,000,000 people; 1,000,000 people). – deaths from suicides; 1140 deaths from alcohol poisoning; 739 deaths from transport accidents). Suicide deaths exceed traffic and fire deaths combined (1,742-suicide deaths; 1,507 traffic deaths; 48 fire deaths).
Socio-economic burden of suicides is calculated at the international level [InselN.R. 2008; McDuid D., Kenmeily B., 2009]. In 2001, suicides closed the number of the 10 leading causes of death along with traffic accidents [WHO, 2001], in 2004 they took the eighth place in recalculation on the persons of 15-44 years old [WHO, 2008]. In 25 countries of the European Union, suicides of persons under 75 years old accounted for 30% of YLL due to external causes; the main “contribution” of deaths occurs due to suicides in 20-55 years old at the peak of social life [European Project, ANAMORT, 2008].
The global objective of the World Suicide Prevention Day is to reduce the level of suicides and suicide attempts among the population in all countries through the implementation of measures aimed at preventing suicidal behavior of the population, combining the efforts of many ministries, departments, local executive and administrative bodies, public associations, religious denominations. Prevention of suicidal behavior is one of the most important tasks of society, the implementation of which is possible only by integrating the efforts of many departments into a single preventive strategy.
The leading strategy of WHO to reduce the risk of suicide is the identification of specific risk groups in the population, with identification of specific problems and needs in each of these groups.
At present, the Republic of Belarus has developed a set of measures for the prevention of suicidal behavior for 2015-2019, which provides for preventive work with various categories of the population, including children and adolescents, as well as the active involvement of local executive bodies in the organization of this work. Despite the expansion of the scale of measures for suicide prevention the problem of suicides for the republic is still relevant and requires increased attention to the prevention of suicides in the general population and in hospitals, as well as to the identification of parasuicides, their registration and the timely involvement of parasuicides to provide the necessary assistance. It should be noted that a comprehensive state program of suicide prevention can only be effective with the joint implementation of organizational, social, economic and medical measures, based on the results of scientific research.
The group at maximum risk of suicide in Belarus are men of working age, especially those over 45. Such medical factors as depression and alcohol addiction significantly increase the risk in this subgroup. As a rule, this category of the population does not apply for specialized medical aid, which is connected not only with the prejudices existing in society, but also with insufficient informing of the population about the possibility and conditions of receiving psychological and psychotherapeutic aid. In this connection, a positive role in suicide prevention can be played by informing the population of the availability of specialized aid in the event of psychological crisis (specific information on the symptoms, specialists, the possibility of anonymous consultation) and an increase in the level of knowledge of specialists who come into contact with large numbers of people (teachers, university instructors, social workers, psychologists, etc.) about crises and suicides.
In our country certain successes in the prevention of suicides have been achieved. From 1995 to 2005, the suicide rate in the general population did not drop below 30.0 cases per 100,000 people. In 2006, the level of suicides for the first time fell below 30.0 and amounted to 29.0 cases per 100,000 people. Since 2007, for five years, the suicide rate decreased by 8.5 cases per 100,000 population and for the first time in the history of official registration the level of suicides in 2014 in the general population of the republic was less than 20.0 cases per 100,000 population -18.3 (2013 – 20.1). This positive dynamics continues for the last years.
Indicators of suicides committed in the republic for 2014 in comparison with 2013 decreased in all population groups:
- in the general population – by 8.7%, with a decrease in the relative indicator from 20.1 to 18.3 cases per 100.000 population;
- in the general urban population – by 3,8%, with a decrease in the relative index from 13,2 to 12,6 cases per 100.000 of urban population;
- in the general rural population: 23.7%, with a decrease from 42.2 to 37.2 cases per 100,000 of the rural population.
Indicators of suicides committed in the general population of working age of the republic for 2014 in comparison with 2013 decreased by 1.7%, while maintaining the level of the relative indicator from 15.5 to 14.7 per 100,000 population.
Taking into account the urgency of the problem, the specialists of the Ministry of Health developed and approved the Instructions on recognition of suicide risk factors, suicide signs and algorithm of actions when identifying them for medical and social workers, teachers, psychologists, employees of internal affairs bodies, military personnel, mass media workers.
The Republican Scientific and Practical Centre for Mental Health has two in-patient psychoneurological crisis units, and free telephone helplines have been set up to provide psychological assistance to persons in difficult circumstances (telephone numbers 8801100 16 11 and 8801100 21 21).
Similar telephone lines for emergency psychological assistance are available at the City Clinical Child and Adolescent Psychoneurological Dispensary in Minsk – 246 03 03 and the City Clinical Psychoneurological Dispensary in Minsk – 290 44 44 and other health care institutions (information on telephone numbers is available on the website of the Ministry of Health www. minzdrav.gov.by).
Providing assistance to a person in a crisis situation is impossible without the participation of such specialists as a psychotherapist and a psychologist. Psychotherapeutic aid is widely accessible to the population in the Republic and the procedures for providing it are constantly being improved. Fundamentals of psychological assistance to the population of the Republic of Belarus is legislatively fixed in the Law of the Republic of Belarus of July 1, 2010. “The problem of suicidal behavior is complicated, as it is not easy to solve.
The problem of suicidal behavior is complex and multifaceted. Many different factors influence a person’s ultimate choice in a crisis situation.
The comprehensive approach to suicide prevention implemented in the Republic of Belarus demonstrates an example of effective interdepartmental cooperation in addressing complex social issues that require participation of various state and public institutions, consolidation of efforts of the society as a whole to achieve the most important task – stabilization of the population of our country.