Decriminalizing suicide attempt in the 21st century: an examination of suicide rates in countries that penalize suicide, a critical review

Abstract

Background Decriminalizing suicide may decrease overall suicide rates because then individuals who are at risk of suicide would be more willing to seek help from the community and from mental health professionals, therefore enabling early interventions for preventing suicidality. We aimed to examine the suicide trends over the last 20 years in 20 countries that still criminalize attempted suicide, and to compare the suicide rates of these 20 countries against the global average suicide rate and to a comparison sample of 20 countries that do not criminalize suicide, matched according to region and majority religion. Methods Age-standardized suicide rates were extracted from the WHO Global Health Estimates, available for the period 2000-2019. Population data were extracted from the World Bank. We analyzed only countries which criminalize attempted suicide under its criminal justice system. Countries were further categorized according to their membership in the Commonwealth of Nations and countries in Africa. Countries from the same region and with the same majority religion were chosen as a matching group. Joinpoint analysis was used to compare the trends of the two groups with the global average. Results Based on the 2019 WHO Global Health Estimates data, there is a large range in the suicide rates of the countries that criminalize attempted suicide, from 2.5 (Brunei) to 40.9 (Guyana) per 100,000 population. The mean suicide rate was 8.3 (Standard Deviation = 10.6). Out of the 20 countries, seven have suicide rates higher than the global average, covering a total population of about 387.3 million. Of these seven countries, five are in the African region. The other thirteen countries have suicide rates between 2.5 to 8.2. Mean scores of the countries which criminalized attempted suicide was lower than the global average and 20 comparison countries over the 20 years, but average annual percentage in the decrease of suicide was greater for countries in which attempted suicide was not criminalized. Conclusions Based on our review, there was no substantial evidence here to indicate that countries which criminalized attempted suicide had consistently lower suicide rates compared to the global average. There is a need to acknowledge that the currently available evidence is inadequate to definitively claim that criminalizing suicide is beneficial or harmful for the reduction of suicide rate for the entire populations. Future studies should continue to evaluate the unique effects of decriminalizing attempted suicide while controlling for other key associated factors.

Knowledge, attitudes, and experiences in suicide assessment and management: a qualitative study among primary health care workers in southwestern Uganda

“…No evidence suggests that criminalizing suicide has reduced the risk [ 8 ]. Evidence shows that criminalizing suicide hinders health-seeking behavior in a suicide crisis and receiving support to improve their mental health [ 43 ]. In addition, individuals may use more lethal means for suicide to fear the repercussions of a failed suicide attempt.…”

Centering decriminalization of suicide in low – and middle – income countries on effective suicide prevention strategies

“…Literature suggests that this belief is misleading, and is at worst, erroneous. A recent study found no consistent evidence for lower suicide rates in countries that criminalize suicide compared to the global average ( 18 ). In fact, seven out of the 20 countries that criminalize suicide had higher rates than the global average and five out these seven were African countries ( 18 ).…”

“…A recent study found no consistent evidence for lower suicide rates in countries that criminalize suicide compared to the global average ( 18 ). In fact, seven out of the 20 countries that criminalize suicide had higher rates than the global average and five out these seven were African countries ( 18 ). Moreover, studies that have looked at the rates of suicide post – decriminalization have found that in many countries, de-criminalizing suicide has not led to significant increases in suicide.…”

“…of surviving a suicide attempt and possibly facing imprisonment and societal stigma (18). The second is that criminalization of suicide limits the accuracy of suicide surveillance and reporting.…”

“…Added to that is the additional stigma of being a criminal ( 22 , 23 ). This may lead some to utilize more lethal means to avoid the possibility of surviving a suicide attempt and possibly facing imprisonment and societal stigma ( 18 ).…”