AJPH -- eLetters for Knox et al., 94 (1) 37-45

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PUBLIC HEALTH MATTERS:
Kerry L. Knox, Yeates Conwell, and Eric D. Caine
If Suicide Is a Public Health Problem, What Are We Doing to Prevent It?
Am J Public Health 2004; 94: 37-45 [Abstract] [Full text] [PDF]

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Suicide: a public health problem in South Asia: Adnan A. Hyder (17 February 2004)

Suicide: a public health problem in South Asia 17 February 2004

Adnan A. Hyder,
Assistant Professor & Leon Robertson Faculty Development Chair
Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E-8132, Baltimore, MD 21205, USA
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Re: Suicide: a public health problem in South Asia

ahyder{at}jhsph.edu Adnan A. Hyder

The paper by Knox et al is a welcome addition to the public health discourse in the American Journal of Public Health.1 It raises an important public health issue for appropriate recognition by researchers and practitioners and calls for an evaluation of interventions for suicide prevention. However, it is equally important to identify suicides as an important burden in developing societies - especially in Asia.
Pakistan and Bangladesh as low income, developing nations present a case study illustrative of the complex issues surrounding suicides. There are strong religious sanctions against suicide, and negative socio- cultural implications for the person and family. Suicide is also a crime under the penal codes of these countries.
Data from the police in one province of Pakistan (Sind) shows a 250% increase in suicides from 1985 to 1999.2 The majority of completed suicides are younger males, and they use more violent methods (hanging, drowning, shooting) than their female counterparts. Overall, poisoning seems to be the commonest means of suicide in the country.
Suicides have also been studied in Bangladesh demonstrating high rates in rural areas and in married women.3 Poverty, female gender, marital discord, and younger age at marriage were found to be risk factors for suicide.
An important issue is the lack of reliable data and under reporting of suicides by usual sources in developing countries. A pilot study in Pakistan demonstrated how 90 suicides reported in newspapers could not be found in police records.4
The global public health community should not ignore the challenges of measuring and intervening against suicides in the developing world. It is time for calling for greater investments in research on suicides in low income nations.
References:
1. Kerry L. Knox, Yeates Conwell, and Eric D. Caine If Suicide Is a Public Health Problem, What Are We Doing to Prevent It? Am J Public Health 2004;94:37-45 2. Khan MM. Personal Communication. Aug 2003. 3. Yusuf RH, Akhter HH, Rahman MH, Chowdhry MEK, Rochat RW. Injury related deaths among women aged 10-50 years in Bangladesh 1996-97. The Lancet 2000;355:1220- 4. Ghaffar A, Hyder AA, Bishai D. Newspaper reports as a source for injury data in developing countries. Health Policy Plan. 2001;16(3):322-5.