Executive Summary

Suicide Section of Intentional Injuries Background Paper

Listening for Directions on Injury

Prepared by

Brian L. Mishara, Ph.D.

There are more deaths by suicide worldwide than by violence, including all acts or

war, terrorism and murder combined. Canada’s suicide rates are in the middle of 22

western industrialized countries, at 14 suicide per 100,000 population per year. Suicide is

the leading cause of death for men aged 25-29 and 40-44 and for women aged 30-34 and

the second leading cause of death for both men and women aged 10-24. Unlike most

developed countries where the elderly have the highest rates, middle age Canadian age

30-44 and women age 44-59 commit suicide more than other age groups. There are over

100 attempts for each completed suicide and over 23,000 (87 per 100,000) Canadians are

hospitalized each year for a suicide attempt. Suicide ranks third after cancer and heart

disease in potential years of life lost for men and tied for fourth for women.

Suicide is multi-determined and risk is associated with risk factors including

personal dispositions, genetic-biological variables, precipitating events, and most notably

psychiatric disorders, particularly mood disorders, alcoholism and drug abuse. Protective

factors include social supports, coping abilities and the availability of adequate treatment

and help in crisis situations.

In setting priorities for research on suicide there are several fundamental issues:

The first concerns the extent to which priorities should be driven by needs for reducing

the short and medium term burden of suicide injury and the extent to which fundamental

research whose immediate practical implications are not evident should be supported.

Second, one may consider whether it is best to build upon current Canadian suicidology

research strengths, as opposed to developing research in new areas, even if other

countries have extensive projects in those areas. A third challenge is the nature and

extent of investment in aboriginal suicide research.

Several key areas have been identified in a previous meeting of suicide

researchers in February, 2003. The 43 participants identified 12 cross-cutting research

priorities and over 50 specific research questions. Without having unlimited funding

available, one may ask irf a more limited number of key research priorities should be

established.

A few examples are: There is a need for developing a knowledge base for

evidence-based prevention and intervention. Ethical issues specific to suicide research

pose special methodological challenges. Data systems need to be improved and

standardized and this may be conducted in collaboration with researchers concerned with

other intentional and unintentional injuries. Mental health promotion has been proposed

as a means of preventing suicide. Perhaps suicidologists could profit from collaboration

with researchers in other intentional and unintentional injury prevention areas who have

had success in promotion activities. There have been significant recent advances in

biomedical and genetic research on suicide as well as psychological and sociological

studies, but relatively few truly integrative and trans-disciplinary research activities.

There is a greater need for understanding the full spectrum of suicidal behaviours,

including ideation, attempts and self injurious behaviours and their relationships to

completed suicides. The concept of intentionality needs clarification, as well as the

similarities and differences between suicidal behaviours and euthanasia and assisted

suicide..

Canadian researchers publish proportionately fewer empirical investigations of

suicide compare to many other developed countries. Although there are noteworthy

examples of past successes in small easily delimited areas, the effect of wide ranging

efforts to significantly effect national suicide rates have yet to be clearly demonstrated.

Strong existing research teams are a current strength, although collaborations between

researchers in Quebec and elsewhere in Canada is still limited. There is an imperative

need to increased knowledge translation – a recent survey of stakeholder needs in

knowledge translation indicated that many areas where needs for new research were

expressed concerned areas where there significant existing knowledge already exists.