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Abstract. This chapter draws on internationally available data to describe the epidemiology of suicide and self-harm in the World Health Organization (WHO) Western Pacific Region. It then describes the suicide prevention activities in the region, using in-depth case studies to highlight some key suicide prevention activities in certain countries/areas and the Global Survey on Suicide Prevention conducted in 2013 by the International Association for Suicide Prevention (IASP) and WHO. It demonstrates that there is considerable variability both between and within low and middle income countries and high income countries, both in terms of rates of suicide and self-harm and in terms of the preventive efforts that have been mobilised to address them. Adequate funding for suicide prevention efforts in the region should be a priority, as should the delivery of a range of suicide prevention approaches. Evaluation and monitoring efforts are also crucial.

Abstract. Background: Suicidal behavior comprises a diverse set of behaviors with significant differences among several behavioral categories. One noteworthy category includes individuals who have made serious suicide attempts, epidemiologically very similar to those completing suicide. This behavioral category is important, since interviewing survivors of a potentially lethal incident of self-harm enables a detailed investigation of the psychological process leading to the suicidal act. Aim: To achieve a consensus definition and operational criteria of serious suicide attempts. Method: We reviewed studies that included the term serious suicide attempt or related terms (e.g., highly lethal), with a focus on the variety of operational criteria employed across studies. Results: More than 60 papers addressing various types of serious suicide attempt were explored. We found a large variety of operational definitions, reflecting the lack of consensus regarding terminology and criteria related to the term. Conclusion: We undertook the challenge of developing an integrative and comprehensive set of criteria of serious suicide attempt and suggest a definition comprising three key dimensions: medical lethality, potential lethality of the method used, and severity of the objective circumstances of the suicide intent. Clinicians and researchers are strongly encouraged to consider using the term serious suicide attempt with its attendant components.

Abstract. Research on suicide by jumping is summarized. The incidence of suicide by this method varies but tends to be higher in cities, city states, or countries that have extensive high-rise housing. Most suicides by jumping occur from high-rise residential housing units. However, our knowledge about suicide by jumping tends to be limited to a small number of reports from sites, often bridges, which become well-known as places from which to take one's life. Media reports of newsworthy suicides from these sites appear to encourage imitative behavior. Prevention strategies have focused upon limiting suicides from iconic sites by surveillance, barriers, muted media reporting, and signage offering help and telephone hotlines. A small number of studies provides evidence that installing barriers at popular jumping sites reduces suicides from those sites. There are few reports of efforts to reduce suicides from high-rise residential buildings.

Research on suicide by jumping is summarized. The incidence of suicide by this method varies but tends to be higher in cities, city states, or countries that have extensive high-rise housing. Most suicides by jumping occur from high-rise residential housing units. However, our knowledge about suicide by jumping tends to be limited to a small number of reports from sites, often bridges, which become well-known as places from which to take one's life. Media reports of newsworthy suicides from these sites appear to encourage imitative behavior. Prevention strategies have focused upon limiting suicides from iconic sites by surveillance, barriers, muted media reporting, and signage offering help and telephone hotlines. A small number of studies provides evidence that installing barriers at popular jumping sites reduces suicides from those sites. There are few reports of efforts to reduce suicides from high-rise residential buildings.

There is now a large body of research literature suggesting that restricting access to a particular method of suicide may successfully reduce suicides by that method. However, the extent to which reductions in rates of suicide by one method that is restricted are paralleled by reductions in overall suicide rates is less clear, and this has led to debates about the extent to which restriction of one method may lead to substitution through an equally lethal method. While the risk of substitution has often been used as an argument against restricting access to specific methods of suicide, even in cases in which substitution may occur, method restriction may still be justified. In particular, if it becomes apparent that some particular feature of the environment facilitates or encourages suicidal behavior it may be ethical to remove access to that feature even though there is a risk of substitution. The accumulated evidence suggests that restricting access to a wide range of means and sites of suicide can be an effective, relatively simple approach to suicide prevention – an approach that is, perhaps, sometimes undervalued. At the very least, restriction of method should be considered as one component of any integrated plan for local, regional, and national suicide prevention. This supplement presents a series of papers focusing on specific means of suicide and discusses, for each method, current developments in restricting access to that method and the impact thereof on suicide. Hawton (2007) provides an overview of major issues in restricting access to means of suicidal behavior, including the rationale for this approach, the feasibility of suicide prevention by restricting access to methods of suicide, and the fact that suicidal behavior is often ambivalent and impulsive and may not be pursued if access to a favored method of suicide is thwarted. He summarizes evidence from a range of studies reviewing the impact of restricting access to particular methods of suicide on suicidal behavior. In addition, studies that have explored subsequent suicidal behavior among persons who have survived near-fatal suicide attempts have found that most of those who survive such attempts do not go on to make further attempts by the same – or some alternative – method. Hawton, notes, in particular, that clinical assessment of suicide risk should routinely inquire about access to means of suicide, and that clinicians should strongly advocate the removal of potentially dangerous means of suicide from the households of vulnerable individuals. In the 21st century there has been increasing recognition of the contribution to world rates of suicide from countries in Asia, and a corresponding focus on restricting access to pesticides, which account for many of these deaths. In fact, poisoning by pesticides is the most common method of suicide worldwide. Mishara (2007a) explores the extent of pesticide suicide around the world. In rural Asia the ready availability of highly lethal pesticides, often coupled with limited access to prompt and adequate medical treatment, results in a profile of suicide as less planned, more impulsive, and less likely to be associated with mental illness than in the West. The pesticides available in Asia are often highly toxic (compared with those in the West) and, moreover, highly toxic even in small doses. This feature contributes to high case fatality coupled with inadequate training in medical interventions for pesticide poisoning, limited access to appropriate medical care, and lack of antidotes. Mishara also discusses the context within which pesticide suicides occur, often as impulsive responses to short-term family conflicts and stresses. A range of strategies might be employed to reduce pesticide suicides, including controlling or restricting access to the most dangerous pesticides, reducing the use of highly lethal agents, safer storage practices, education concerning the lethality of pesticides, improved medical training, treatment, and facilities, and developing supportive approaches to address the sources of family conflicts. In 1998 a single case of suicide by charcoal burning was widely publicized by the Hong Kong media as a novel way to end one’s life. The media accounts were explicit and graphic, and they provided, in effect, an advertorial guide to the use of this method. This event occurred during the Asian financial crisis of the late 1990s; the media linked charcoal burning with personal financial despair and portrayed suicide by this method as a painless, peaceful solution to such stress. Within the year charcoal burning had

There is strong evidence for the existence of the Werther effect, or the phenomenon of an observer copying suicidal behavior he or she has seen modelled in the media. As a consequence, a number of countries have developed guidelines that promote responsible reporting of suicide. Using nine such guidelines as examples, this paper demonstrates that they tend to have similar content (emphasizing, for example, that suicide should not be glamorized or sensationalized and that explicit descriptions should be avoided, and stressing the importance of providing information about help services), but differ in the way in which they have been developed (e.g., the extent to which media professionals have been involved) and implemented (e.g., whether their “roll-out” has involved a considered dissemination strategy). The paper also reviews the evidence from evaluations of media guidelines, and concludes that it is too limited to determine whether the guidelines have had an impact on the behavior of media professionals or on completed and attempted suicide rates. It makes recommendations for further evaluative work, and suggests that the lessons from well-designed evaluations should be shared.

The goals of the Postvention Taskforce of the International Association for Suicide Prevention (IASP) are to increase awareness of postvention and survivor issues. One of the strategies is to organize meetings. We report on the 1st International Suicide Postvention Seminar, held as a 1-day preevent at the 11th European Symposium on Suicide and Suicidal Behavior in Portoroz, Slovenia, September 2006. The seminar provided a state of the art review of the postvention field, with plenary presentations on research, psychotherapeutic care, development of national networks, and of postvention materials. We summarize the presentations below.

The available data suggest that suicide deaths in Asia may account for the majority of suicides that occur in the world every year. This significant contribution occurs primarily because of the large population sizes of some Asian countries. Together, China, India, and Japan account for more than 40% of all world suicides, and Asia in total may in fact account for up to 60% of all suicides (World Health Organization, accessed 2006). If we apply to Asia commonly used estimates (namely, that there are approximately one million suicides in the world each year, 10 to 20 times as many suicide attempts as deaths, and 5 to 6 people affected by each suicide death or serious suicide attempt), then these figures suggest that up to 60 million people, each and every year, may be affected by suicide in Asia. These estimates provide a compelling case for more research into the etiology of suicidal behavior in Asian countries and for the development of suicide prevention programs tailored to fit the specific profiles of suicidal behavior in Asian countries. Currently, much of our research about suicide is dominated by a rather Western perspective, and we know much less about suicidal behavior in Asia than we do about suicidal behavior in the West.

This article describes trends in suicide attempt visits to emergency departments in the United States (US). Data were obtained from the National Hospital Ambulatory Medical Care Survey using mental-health-related ICD-9-CM, E and V codes, and mental-health reasons for visit. From 1992 to 2001, mental-health-related visits increased 27.5% from 17.1 to 23.6 per 1000 (p < .001). Emergency Department (ED) visits for suicide attempt and self injury increased by 47%, from 0.8 to 1.5 visits per 1000 US population (ptrend = .04). Suicide-attempt-related visits increased significantly among males over the decade and among females from 1992/1993 to 1998/1999. Suicide attempt visits increased in non-Hispanic whites, patients under 15 years or those between 50–69 years of age, and the privately insured. Hospitalization rates for suicide attempt-related ED visits declined from 49% to 32% between 1992 and 2001 (p = .04). Suicide attempt-related visits increased significantly in urban areas, but in rural areas suicide attempt visits stayed relatively constant, despite significant rural decreases in mental-health related visits overall. Ten-year regional increases in suicide attempt-related visits were significant for the West and Northeast only. US emergency departments have witnessed increasing rates of ED visits for suicide attempts during a decade of significant reciprocal decreases in postattempt hospitalization. Emergency departments are increasingly important sites for identifying, assessing and treating individuals with suicidal behavior.