The effect of national suicide prevention programs on suicide rates in 21 OECD nations

Abstract

Suicide has become a serious and growing public health problem in many countries. To address the problem of suicide, some countries have developed comprehensive suicide prevention programs as a collective political effort. However, no prior research has offered a systematic test of their effectiveness using cross-national data. This paper evaluates whether the national suicide prevention programs in twenty-one OECD nations had the anticipated effect of reducing suicide rates. By analyzing data between 1980 and 2004 with a fixed-effect estimator, we test whether there is a statistically meaningful difference in the suicide rates before and after the implementation of national suicide prevention programs. Our panel data analysis shows that the overall suicide rates decreased after nationwide suicide prevention programs were introduced. These government-led suicide prevention programs are most effective in preventing suicides among the elderly and young populations. By contrast, the suicide rates of working-age groups, regardless of gender, do not seem to respond to the introduction of national prevention programs. Our findings suggest that the presence of a national strategy can be effective in reducing suicide rates.

Introduction

Suicide has become a serious and growing public health problem in many countries. According to statistics from the World Health Organization (World Health Organization, 2010), the situation surrounding suicide is alarming. For example, about one million people worldwide die as a result of suicide every year, which amounts to one death every forty seconds. Mortality by suicidal acts has steadily increased over the last several decades at the global level. In some countries, suicide constitutes one of the leading causes of death among relatively young populations. The youth suicide rate has recently become a more serious problem, while seniors have exhibited high suicide rates for years.

To address the problem of suicide, some countries have developed comprehensive suicide prevention programs as a collective political effort. According to the WHO European monitoring surveys on national suicide prevention programs, 17 of 37 member states that responded to the surveys have launched national suicide prevention initiatives as of 2004 (World Health Organization Regional Office for Europe Copenhagen, 2002). Among those 17 nations, Finland was the first country to launch a nationwide suicide prevention program in 1992 (De Leo & Evans, 2003). Comprehensive national programs for suicide prevention are also seen outside of Europe. Australia and New Zealand established national programs to prevent suicide among young people in the 1990s (De Leo and Evans, 2003, Taylor et al., 1997). In Asia, Japan and South Korea enacted legislation in the 2000s that sets up a comprehensive suicide prevention program to tackle the growing problem of suicide, according to Japanese Cabinet Office and Korean Ministry of Health and Welfare.

Despite the prevalence of nationwide suicide prevention programs around the world, no prior research has offered a systematic test of their effectiveness using cross-national data. Do nationwide programs for suicide prevention reduce the suicide rate? To answer this question, this paper evaluates whether government intervention through a comprehensive suicide prevention program has a notable impact on the total suicide rate as well as the age- and gender-specific suicide rates in subsequent years, using panel data from twenty-one developed nations between 1980 and 2004.

Table 1 lists the countries included in our analysis by the presence of a nationwide suicide prevention program as of 2004. If countries “have countrywide integrated activities carried out by government bodies,” we code countries as having a national program for suicide prevention using an elite survey conducted by the World Health Organization Regional Office for Europe Copenhagen (2002, 8). As reported in Table 1, eleven nations had nationwide programs for suicide prevention as of 2004. Austria developed a national plan for suicide prevention in 2000, but it has not been approved and implemented by the national government. Belgium has an official document on suicide prevention but conducts a comprehensive program only in the Flemish region (World Health Organization Regional Office for Europe Copenhagen, 2002). Ireland initiated a prevention program when the government developed the “Health Strategy” in 2001, which it subsequently expanded into a comprehensive program in 2005. The Netherlands developed a national policy on suicide prevention in 1989 (Taylor et al., 1997), but the expert survey by the WHO Regional Office for Europe (2002) suggests that the government had implemented no action at the national level as of 2002. In this paper, we follow the definition of the WHO’s expert survey. Both Australia and New Zealand initiated prevention programs for youth and expanded them for the entire population later. Both Finland and Norway completed their national programs in 1998, but we assume that they have a spill-over effect on suicide rates after 1998 because the infrastructure for suicide prevention remains. Thus, we treat Finland and Norway as having suicide prevention programs after 1992 and 1994, respectively.

These national suicide prevention strategies share common themes. They include “public education, responsible media reporting, school-based programs, detection and treatment of depression and other mental disorders, attention to those abusing alcohol and drugs, attention to individuals experiencing somatic illness, enhanced access to mental health services, improvement in assessment of attempted suicide, postvention, crisis intervention, work and unemployment policy, training of health professionals, and reduced access to lethal means” (Anderson & Jenkins, 2005, 249).

At the same time, specific components and the focus of the nationwide suicide prevention programs can differ across countries. Taylor et al. (1997) summarized the differences in the components of the national programs across five countries with respect to the degree of community involvement, the targeted demographic groups, the agencies that are involved, and the themes of intervention. While we anticipate that the differences in the national programs play an important role because some prevention methods are more useful than others (Mann et al., 2005), we decided not to explore these differences. Instead, our focus lies on testing whether the initiation of any comprehensive program by the government causes any change in the rate of death by suicide.