DR. CLAUDINA E. CAYETANO REGIONAL MENTAL ADVISOR Pan-American Health Organization/ World Health Organization

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1 DR. CLAUDINA E. CAYETANO REGIONAL MENTAL ADVISOR Pan-American / World

2 Outline Facts and Figures Suicide a major Public problem Suicide in the Americas Risk and Protective factors and related interventions Most Promising interventions Key Messages

3 The

4 OF THE UN AND INTER AMERICAN SYSTEMS PURPOSES: o The fundamental purposes of the shall be to promote and coordinate efforts of the countries of the Western Hemisphere to combat disease, lengthen life, and promote the physical and mental health of the people MEMBERSHIP: o All American States are entitled to membership in the. American States which are members of the are hereinafter called Member Governments)

5 PRESENCE OF PAHO IN THE AMERICAS Headquarters Country Offices 26* Centers 3 PANAFTOSA BIREME CLAP The Caribbean Program Coordination and Eastern Caribbean Countries (ECC) Offices provide technical cooperation for smaller English Speaking Caribbean countries and territories, as well as French and Dutch territories and Associate Members 5

6 PAHO MEMBER STATES Antigua and Barbuda Argentina Bahamas Barbados Belize Bolivia Brazil Canada Chile Colombia Costa Rica Cuba Dominica Dominican Republic Ecuador El Salvador Grenada Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago United States Uruguay Venezuela Participating States France Kingdom of the Netherlands United Kingdom of Great Britain and Northern Ireland Associate Member Aruba Curacao Saint Maarten Puerto Rico Observer States Spain Portugal 6

7 FACTS AND FIGURES Every year, over 800,000 people die from suicide; this roughly corresponds to one death every 40 seconds. Suicide rates are highest in persons aged 70 years or over for both men and women in almost all region 75% of all global suicide deaths occur in low-middle income countries. It is estimated that during 2012 for each adult who died of suicide there were over 20 others who made suicide attempts.

8 Suicide is a Serious Public Problem o Globally suicide is the second leading cause of death in year olds. o Top methods used ingestion of pesticide, hanging and firearms o suicidal behavior: suicidal ideation, planning and attempts. Many do not result in death. o The strongest risk factor for suicide is a previous suicide attempt.

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10 FACT

11 Suicide in the Americas Of the over 800,000 people who die from suicide in the world each year, some 68,444 are in the Americas. This Corresponds to an average mortality rate of 7.6 per 100,000 population (ranging from 5.8 to 13.4) Suicide is one of the leading preventable causes of death for both sexes 11

12 Suicide Mortality in the Americas Regional Report, PAHO 2014 Data on suicide mortality are based on the number of deaths reported to the by its Member States between 1990 and

13 Gender and Suicide (Americas) PAHO

14 Age Group and Suicide (Americas PAHO ) 14

15 Rate of suicide per 100,000 population in the Americas age adjusted rates, both sexes Montserrat Grenada Cayman Islands Anguilla Bolivia Haiti Barbados Virgin Islands UK Peru Saint Kitts and Nevis Antigua & Barbuda Turks and Caicos Bermuda Bahamas Dominica Guatemala Netherlands Antilles Dominican Republic Virgin Islands US Mexico Paraguay Ecuador Brazil Saint Vincent & Colombia Venezuela Puerto Rico Panama Costa Rica Saint Lucia Martinique Guadeloupe Belize Argentina Aruba El Salvador French Guiana United States Chile Canada Trinidad & Tobago Cuba Uruguay Nicaragua Suriname Guyana 15 Pan 0.0 American Rate per 100,000

16 Countries and Sub-region North America Central America, Latin Caribbean & Mexico South America Non-latin Caribbean Central American Isthmus Canada Costa Rica Argentina Anguilla Costa Rica Puerto Rico Cuba Boliva Barbados El Salvador USA US Virgin Islands Dominican Republic Brazil Belize Guatemala El Salvador Chile ECC Countries Honduras Guatemala Columbia Guyana Panama Mexico Ecuador Jamaica Honduras Peru Trinidad and Tobago Panama Paraguay Suriname Uruguay Venezuela St Martin

17 Percent of suicides attributable to males compared to females Age-adjusted rates, Male Female 100% 80% 60% 40% 20% 0% 17 Pan Americas American Latin America and the Caribbean North America* Central American Isthmus Latin Caribbean Non-Latin Caribbean South America*

18 Rates for suicide per 100,000 population age group Region Age Total Americas Latin America and the Caribbean North America* Central American Isthmus Latin Caribbean Non-Latin Caribbean South America*

19 Suicide rate by year from age-unadjusted rate, both sexes 19

20 Methods used in suicide, , percent of total for both sexes, age unadjusted 20

21 Methods used in suicide, , percent for male age Region / Country Suffocation Poisoning Fall Firearm Fire/Flame Drowning Cut/Pierce Other Americas Latin America and the Caribbean North America* Central American Isthmus Latin Caribbean South America* Non-Latin Caribbean

22 Methods used in suicide, , percent for female age Region / Country Suffocation Poisoning Fall Firearm Fire/Flame Drowning Cut/Pierce Other Americas Latin America and the Caribbean North America* Central American Isthmus Latin Caribbean South America* Non-Latin Caribbean

23 Methods used in suicide by age group, , percent of total for both sexes, age unadjusted 23

24 EACH SUICIDE IS A TRAGEDY what causes suicide? why do so many people end their lives every year? poverty? unemployment? Impulsive acts? breakdown of relationships? depression -serious mental illness? 24

25 NO SINGLE FACTOR IS SUFFICIENT TO EXPLAIN WHY Suicide is a complex phenomenon that is influenced by several interacting factorspersonal, with psychological, social, biological, cultural and environmental factors involved. 25

26 Preventing Suicide A Global Imperative This report is the first WHO publication of its kind. It aims to increase awareness of the public health significance of suicide and suicide attempts, and to make suicide prevention a higher priority on the global public health agenda. 26

27 Important: Identify Problems that increase Suicide Risk Mental disorders are a risk factor for suicide in Europe and North America; however, in Asian countries impulsiveness plays an important role Some of the most significant Individual risk Factors: o Previous suicide attempt o Harmful use of alcohol and other substances o Mental Disorder (Depression, PTSD) o Job or financial loss o Chronic Pain and illness o Hopelessness o Family history of suicide

28 Relevant Interventions for Individual risk factors 1. Follow up care after suicide attempt 2. Improve the effectiveness of case management 3. Community support 4. Assessment and management of suicidal behaviors 5. Assessment and management of mental and substance use disorders 28

29 Relevant Interventions for Community and relationship risk factors 1. Interventions for vulnerable groups 1. Persons who have experienced trauma or abuse 2. Refugees and migrants 3. Indigenous peoples 4. Support for those bereaved or affected by suicide (family, school or community based) 2. Gatekeeper training 1. Primary, mental and emergency health providers 2. Teacher and school staff 3. Police and military officers 4. Spiritual and religious leaders 5. Social welfare workers 3. Crisis Helplines 29

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31 FACT

32 What protects people from the risks of suicide Strong personal relationships Religious or Spiritual beliefs Lifestyle practice of positive coping strategies and well-being 32

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34 FACT

35 Most promising areas of interventions Engage Key Stakeholders Policies to reduce harmful use of alcohol Mobilize the health system and provide training Restriction of access to means Responsible media reporting Raising awareness, changing attitudes and beliefs Conduct surveillance and improve the data quality Conduct research and implement suicide prevention strategy. 35

36 Key messages 1) Suicides are preventable. For national responses to be effective, a comprehensive multisectoral suicide prevention strategy is needed. 2) Communities play a critical role in suicide prevention, they can provide social support to vulnerable Individuals and engage in follow-up care, fight stigma and support those bereaved by suicide. 3) Early identificación and effective management are key to ensuring that people receive the care they need 4 )Restricting access to the means to the means for suicide works. An effective strategy for preventing suicides and suicides attempts is to restrict access to the most common means, including pesticides, firearms and certain medications. 36

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38 FACT

39 World Suicide Prevention Day SEPTEMBER 10 World Mental Day Day October 10 39

40 T H A N K Y O U cayetanoc@paho.org 40