How to maintain falling suicide rate

Suicide is a major public health issue across the world. It is the cause of 800,000 premature deaths globally, according to latest statistics.

In the 1990s, China had one of the highest suicide rates (23.2 per 100,000 people). An estimated 250,000 suicides were reported every year in the 1990s, accounting for about a quarter of all suicides in the world. In fact, suicide was the fifth leading cause of deaths in China.

Besides, more women than men committed suicides in China during the period, which was drastically different from the about 3:1 male-female suicide ratio in Western countries. Also, the suicide rate in China was substantially higher in rural areas than in cities, with older adults more prone to committing suicide.

Perhaps the imbalance in medical and social welfare between urban and rural areas in China put older residents in the countryside at greater risk of committing suicide. Although mental illness plays a relatively low role in suicides in China, psychiatric help and other related support are far from sufficient. And the low social status of Chinese women and the limited opportunities they have to fulfill their dreams have been blamed for the relatively high rate of suicide among women, especially in rural regions.

The good news is that the overall suicide rate in China has declined significantly because of the country's fast-paced economic development. The estimated mean national suicide rate now is 9.8 per 100,000 people, nearly 60 percent lower than in the 1990s. Urbanization and economic growth in the past decade have created more education and employment opportunities for everyone, especially those women in rural areas, and reduced gender inequality. Controls on the sale of pesticides, which many rural people used to drink to commit suicide, and the improvement in healthcare services have also contributed to the decline in the suicide rate.

China's experience seems to be at odds with French sociologist Emile Durkheim's suicide theory, which says that economic growth epitomized by industrialization, urbanization and modernization usually leads to higher level of social anomie and lower level of social integration as a result of popularized individualism and egoism, and subsequently increases the suicide rate. In China, however, these factors can work as protective shield against suicides.

An increasing number of rural women are migrating to cities in search of better livelihood. Relocation from rural to urban areas provides women with an escape route - from familiar obligations and undesired marriage proposals - and employment provides them with financial means to pursue a career and/or find their Mr Right. In the past, Chinese women were often trapped in a routine life in which they rarely realized their personal goals. But today, women in China have more opportunities for better education and employment. The traditional tension within Chinese families and the associated social pressures have also lessened, and divorce has become an acceptable way of dealing with family problems and conflicts. Gender discrimination in employment is still a major social problem, which is visible in hiring, dismissals and wage differences, denial of certain social welfare benefits, sexual harassment and fines for violation of family planning regulations. But the situation is better than it was a decade ago.

But simply improving the GDP may not be enough to guarantee the well-being of the people and a continuous drop in the suicide rate. There are still many areas and regions in China which are yet to taste the fruits of the country's economic development and the people living there are more prone to committing suicide. The resilience level of the youth and the growing disparity between the rich and the poor are still a cause for worry. The uncertainty of economic growth has also caused considerable anxiety among Chinese people.

The rapid socio-economic development in any country has its cost. For example, South Korea and Japan have high GDP but their suicide are amongst the highest in OECD countries. The rapid socio-economic change could be a source of more stress for the Chinese people and a new cause of suicides in China. Research conducted by the University of Hong Kong's Centre for Suicide Research and Prevention shows that the increasing suicide rates in some East/Southeast Asia countries could be attributed to the 1997-98 Asian financial crisis. Similarly, an increase in suicides in European countries and the United States can be blamed on the 2008-09 global financial crisis.

Therefore, the declining rate of suicide in China could reverse in the next decade because of social stress associated with the slowdown in economic growth, rapid aging of the population, increased economic burden, income inequality and social instability. The risks associated with urbanization will start emerging by the next decade and could lead to a weakening of ties with family, friends, institutions and hometowns. So, it is important to prepare in advance to meet the challenges to maintain the well-being of the people.

No health without mental health, says the World Health Organization. Healthcare services have to be people-oriented to help prevent people from committing suicide and save those who try to kill themselves. Availability and affordability of psychiatric services should be improved, and public awareness of depression and suicidal risk should be enhanced. Also, tailor-made programs should be developed to help those in need, such as the unemployed, older adults and single parents.

The government has to take measures to ensure that economic development benefits all the people rather than a selected few. Better governance is needed to redress public grievances, and more work has to be done to maintain the downward trend of the suicide rate in China. Once there is hope, people will have the courage and ability to face life's adversities.

The author is the director of Centre for Suicide Research and Prevention at the University of Hong Kong, Hong Kong.