Societal Stigma and Suicide Prevention

To the Editor: Although we fully agree with Dr. Caine's commentary (1) in the December 2010 issue that it is hard to prevent suicide, we would like to note that societal prevention is an important option. In our opinion, such an approach is the only way to reduce suicides. Dr. Caine rightly notes that most people who commit suicide do not have a history of psychiatric treatment, “despite the high frequency of psychopathological findings revealed by using postmortem psychological autopsy methods.” And most people do not seek professional help for their suicidal intentions.

Dr. Caine believes that when we have programs that deal with adverse factors, such as “family turmoil, early-life abuse,” and so forth, suicide will become less common. This may be true; however, this focus addresses only risk factors, which is not enough. What needs to be done, and Dr. Caine hints at this, is lifting the stigma on suicide and suicidal ideation. This task can be undertaken in two ways. First, we can take practical measures, such as constructing physical barriers in places that are known to attract suicidal persons. Such barriers have been erected at many so-called suicide bridges, and they may influence impulsive suicidal behavior. Telephones with a direct connection to crisis teams have also been installed at several of these places.

More important, however, is prevention in the public domain, analogous to the prevention of smoking. Initially, it did not have much effect to tell smokers that smoking is bad for one's health. However, large-scale prevention programs eventually reduced the number of smokers significantly. Of course, it may be argued that suicidal thoughts and behavior differ from lighting a cigarette, but this does not mean that such an approach cannot be taken. Efforts to improve knowledge, attitudes, and help-seeking behavior are being made in middle and high schools, and they seem to have yielded results as far as knowledge and attitudes are concerned (2). It is too early to conclude that such efforts prevent suicide, but we should not forget that it took some time before antismoking campaigns produced an effect. In our view, campaigns to prevent suicide need a much wider audience than adolescents in schoolrooms. Antisuicide messages should receive wide exposure in the media, such as television and radio.