The Geography Of Suicide

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The World Health Organization recently released a report (pdf) illustrating suicide risk across the globe. Tanya Basu unpacks it:

One dramatic trend the WHO reports is that countries in the developing world have suicide rates that are many times higher than the Western world. “Despite preconceptions that suicide is more prevalent in high-income countries,” the report states, “in reality, 75 percent of suicides occur in low- and middle-income countries.”

The high male-to-female ratio of suicide victims is also rapidly equalizing, particularly in the developing world. The changing makeup of the global workforce and its increasing inclusion of women have made women more susceptible to the socioeconomic stress that increases the likelihood for suicide. While the male-to-female ratio for high-income countries is 3.5, the ratio is almost even in low-income countries at 1.6. The divide is particularly close in the Western Pacific (0.9), Southeast Asia (1.6), and the Eastern Mediterranean (1.4).  Variation in suicide rates by age is also important. Younger women in the 15-to-29 age bracket are as likely as their male counterparts to commit suicide in developing countries at a 1:1 ratio. The gap widens up to middle age, but in general, data indicates that the gender of suicide victims can be male or female, unlike the male dominance of suicides in the developed world.

Steven E. Hyman argues that rich and poor countries alike are failing their mentally ill citizens:

In the United States, for example, the federal Mental Health Parity and Addiction Equity Act, which banned much of the previously existing health insurance discrimination against people with mental illness, was passed only as recently as 2008. However, the regulations needed to implement the law languished for five years, issuing only in 2013. Such late but laudable reforms notwithstanding, in the United States and other high-income countries, many individuals with chronic mental illness become homeless or are imprisoned, often for offenses that stem from their disorders.

The low priority of mental illness in the health care systems of many [low- and middle-income countries (LMICs)] is attested to by health budget allocations that generally lie in the range of 1 to 2 percent of health expenditure. As a result, health care spending on mental disorders is often less than US$0.25 per capita in low-income countries and averages less than US$2.00 per capita globally. The WHO estimates that 80 percent of individuals with mental illnesses in LMICs do not receive meaningful treatment. And when treatments are available, they are often in the form of medications dating from the 1950s that should have been long superseded by more modern medicines.

Bill Gardner considers one reason why:

[W]ith cost-effective means to treat mental illnesses we could relieve an enormous burden of human suffering and greatly increase human productivity. But we neglect the care of the mentally ill relative to our care for those with other disorders. Hyman documents how policy makers discount the importance of mental illness and asks why. One reason is the stigmatization of the mentally ill. But then what explains stigmatization? [Hyman writes:]

I believe that a seemingly more arcane but powerful cognitive distortion also plays a role in the deprioritization of mental illness: the belief that mental disorders should somehow be controllable, if only the affected person tried hard enough or adhered to a better set of beliefs.

The symptoms of mental disorders are derangements of thought and emotion. Our sense of personal autonomy tells us that we determine what we think and can at least shape what we feel. So if we can control ourselves, why can’t they?  The suspicion that the mentally ill are responsible for their state may be built into who we are.