DEFEATING DESPAIR: SUICIDE IS DECLINING ALMOST EVERYWHERE / THE ECONOMIST

Defeating despair

Suicide is declining almost everywhere

Thank urbanisation, greater freedom and some helpful policies



ZOZH IS A Russian neologism, born of an acronym for a healthy lifestyle. It is visible on Instagram, where millions of posts celebrate newly toned bodies; in the boom in health clubs in Russia’s cities; in the proliferation of cafés where the young sip soft drinks and munch muesli. It is so popular that Russia’s most famous rock band, Leningrad, has satirised it: “They say drinking isn’t trendy, the trend is some sort of zozh. Before he was a drunk, and now he’s muscleman.” The video of the song depicts men dying gruesome deaths while exercising.

For a band that trades on degenerate cynicism, zozh may be laughable, but for the rest of Russia it is great news. It is part of a social transformation that has helped banish Russia’s demons. As exercise and smoothies have replaced despair and alcohol, the suicide rate in Russia has crashed. And this trend is not unique to Russia (see chart).



Globally, the rate has fallen by 38% from its peak in 1994. As a result, over 4m lives have been saved—more than four times as many people as were killed in combat over the period. The decline has happened at different rates and different times in different parts of the world. In the West, it started long ago: in Britain, for instance, the male rate peaked at around 30 per 100,000 a year in 1905, and again at the same level in 1934, during the Great Depression; among women it peaked at 12 in 1964. In most of the West, it has been flat or falling for the past two decades.

In other parts of the world, rates have dropped more recently. China’s started to come down in the 1990s and declined steadily, flattening out in recent years. Russia’s, Japan’s, South Korea’s and India’s rates, still high, have all fallen.

America is the big exception. Until the turn of the century the rate there dropped along with those in other rich countries. But since then, it has risen by 18% to 12.8—well above China’s current rate of seven. The declines in those other big countries, however, far outweigh the rise in America.

Although America’s numbers are probably reliable, there is reason to treat some of these data with caution. Some countries where powerful religions forbid suicide have historically underreported the act; some still do so. For example, a recent study in Iran of attempted suicides came up with a rate ten times higher than the health ministry’s figure. But the trends are probably broadly correct. Experts mostly reckon data are getting better rather than worse, which (given past underreporting) would tend to push rates up rather than down, yet the opposite is happening. Why?

Half the sky

One big reason seems to be an improvement in the lot of Asian women. In most countries, men are more likely to kill themselves than women, and older people more than younger ones. But in both China and India the suicide rate among young women has long been unusually high.

That has changed. Among Chinese women in their 20s, the rate has dropped by nine-tenths since the mid-1990s; that group accounts for around half a million of those 4m lives saved.

Greater social freedom is one of the reasons, suggests Jing Jun, a professor at Tsinghua University in Beijing: “Female independence has saved a lot of women.” In a study in 2002 looking at high rates among young rural women, two-thirds who attempted suicide cited unhappy marriages, two-fifths said they were beaten by their spouses and a third complained of conflict with their mothers-in-law. Professor Jing explains: “They married into their husbands’ families; they’d leave their home town; they’d go to a place where they knew nobody.” These days, scarcity may enhance the value and power of rural women: in Chinese villages, among 30- to 34-year-olds, there are three unmarried men for every unmarried woman.

There may be something similar going on in India. “Young women face particularly challenging gender norms in India,” says Vikram Patel of the Harvard Medical School. If parents disapprove of a relationship, they will tell the police their daughter has been abducted. The cops will then take a 21-year-old away from a consensual relationship. So, he concludes, many suicides in India “are related to the lack of agency for young people to choose their own romantic partners”. As social mores have liberalised, that is changing. Rates among young women have fallen faster than among any other group since 1990; Mr Patel believes they will continue to improve as social liberalisation continues.

Urbanisation has probably helped in both China and India. That seems counter-intuitive since it is associated with the weakening of the social bonds which, according to Emile Durkheim, a 19th-century sociologist and theorist of suicide, helped protect people against suicidal urges. Yet all over the world, suicide rates tend to be higher in rural areas than in urban ones. Social bonds sometimes constrain people as well as sustaining them; escaping an abusive husband or tyrannical mother-in-law is easier in a city than in a village. And the means to kill oneself are harder to come by in a town than in the countryside.

While the demographic oddity in China and India was the high rate among young women, that in Russia was the high rate among middle-aged men. They, it seemed, were the victims of the huge social dislocation that happened after the collapse of the Soviet Union. The period is brought to life by “Second-Hand Time”, an oral history by Svetlana Alexievich, a Nobel-prizewinning author, notable for a bleak pattern: its characters keep killing themselves.

Worn down by hunger and poverty, one man set himself on fire in his vegetable patch. An ageing veteran survived the second world war, only to throw himself under a train in 1992. An officer who took part in the attempted coup against Mikhail Gorbachev in 1991 later hanged himself in the Kremlin. “Everything I heretofore considered to be the meaning of my life is being destroyed,” he wrote in a suicide note.

Hyperinflation, falling incomes and rampant unemployment in the first years of transition left many facing misery and want. The 1998 financial crisis, when the Russian government defaulted on its debts, wiped out many families’ savings. Since the early 2000s, however, the trends have been reversing. Russia’s suicide rate now sits at 25—very high by global standards, but down by half from its peak. The decline has happened disproportionately among middle-aged men, the group that suffered most in the 1990s.

A big reason is probably that society is settling down after the upheaval of the post-Soviet era. According to Olga Kalashnikova, a psychologist at the suicide and crisis-psychiatry department of Moscow City Hospital No 20, “Now people know how to get by, and how to get by without the state.” Since 2000 GDP per head has nearly doubled. Wages recovered their losses from the 1990s and more. Unemployment is below 5%. Relatively high current levels of suicide among males in rural areas, which tend to be less well-off, reinforce the socioeconomic hypothesis. Ilnur Aminov, a demographer, points out that nearly 40% of all suicides in his home region of Bashkiria are by unemployed people.

There are parallels between the rise in suicide in post-Soviet Russia and the “deaths of despair” in America identified by Anne Case and Sir Angus Deaton, economists at Princeton University. Suicide rates among white Americans are higher, and have risen faster since 2000, than among any other group except native Americans (see chart). The same trend can be seen among the middle-aged. At the turn of the century, older people were much more likely to kill themselves than those in their 50s, but that is no longer true. Rates among people in rural areas are higher, and have been increasing faster, than those among people in towns and cities.




It is hard to conclude that the explanation is a simple economic one of stagnating median incomes and falling employment rates. Blacks and Hispanics have faced similar economic problems to whites, and employment rates among the young tend to be lower than those among the middle-aged. Ms Case and Sir Angus put it down to “familiar stories about globalisation and automation, changes in social customs that have allowed dysfunctional changes in patterns of marriage and child-rearing, the decline of unions, and others. Ultimately, we see our story as about the collapse of the white working class after its heyday in the early 1970s, and the pathologies that accompany this decline.”

The increase in the American suicide rate predated the economic crash, but accelerated in the recession that followed it. Research suggests that, after the global economic crisis, an uptick in suicide rates in Europe, America and Canada led to 10,000 more deaths between 2007 and 2010. Debt, foreclosure and unemployment are all implicated in suicide: unemployed people kill themselves at a rate 2.5 times higher than those in work. A spike of suicides in South Korea followed the Asian financial crisis of 1997-98.

Policy can mitigate the effects of recession. According to research by David Stuckler of Bocconi University in Milan, Sweden saw no increase in suicide in either its recession of 1991-92 or after 2007. Mr Stuckler attributes this in part to better health services—unemployment is less daunting where health care is available to all than in countries such as America where it is linked to employment—and government efforts to get people back into the workplace. A study of 26 European countries showed suicide rates to be inversely correlated with spending on active labour-market policies. Japan’s suicide-watchers attribute the decline there in part to the success of Abenomics in bringing down unemployment. Michiko Ueda of Waseda University thinks the economy is the “number one reason” for the decline in suicide.

Also clearly linked to suicide is alcohol—at least in “dry drinking” cultures, such as Russia, eastern Europe and Scandinavia, where people drink to get drunk, though not in “wet drinking” places such as southern and central Europe, where people drink socially over a meal. In Russia, drinking and suicide have risen and fallen in tandem. Alcohol consumption halved between 2003 and 2016; by then, Russians were drinking less per head than French or Germans. As Russians adopt healthier lifestyles, beer’s share of the market has been rising and that of spirits falling.

Suicide and drinking do seem to go together—but both might be the effect of social turbulence. Evidence from before the collapse of the Soviet Union, however, suggests that, to some extent at least, alcohol leads to suicide. In 1985 Mr Gorbachev imposed tough regulations on the production and distribution of alcohol. Vodka sales fell by half between 1984 and 1986. Over that period, the male suicide rate dropped by 41% and the female rate by 24%. When the Soviet Union collapsed, the state’s alcohol monopoly was abolished and the regulations were ripped up. Alcohol consumption and suicide both soared.

State intervention is probably in part responsible for the recent fall in suicide, too. In 2006 new rules on alcohol production and distribution pushed up prices. Statistical analysis suggests that those restrictions led to a 9% decline in male suicide, which saved 4,000 lives a year; a similar policy in Slovenia in 2003 led to a 10% decline.

Improvements in the lives of the elderly are also believed to have helped bring down suicide rates. Globally, the rate among the old has tended to be higher than among the young and middle-aged, but in most places it has also fallen faster.

One reason may be that, as Diego de Leo, former head of the Australian Institute for Suicide Prevention and Research, points out, across the world poverty rates among the old (often the poorest group in society) have been declining faster than those among other groups. Better health services, used by the old more than the young, may be another reason. Long-term sickness is a common reason for suicide, and efforts to ease patients’ pain can make a big difference. Britain’s palliative-care system, regarded as the best in the world, helps explain a remarkable fall in the suicide rate among old people.



Home care, too, can cheer up the elderly. Mr de Leo points to the influx of badanti, migrant care workers, in Italy. Italian children are reluctant to consign their parents to old people’s homes, but also often have neither the time nor the inclination to look after the elderly themselves. Migrant workers, says Professor de Leo, have brought “a massive improvement”. (Too much so, grumble some middle-aged Italians, aghast at their aged parents’ hooking up with supposedly gold-digging migrants.)



Tsinghua University’s Jing Jun believes that China also needs to focus on reducing suicides among the old. He blames the Chinese tradition of responsibility for parental care. With the one-child policy, there are too few children to bear the burden, and if there is more than one, parents may find themselves causing conflict. “In the West, your children are bickering only about the time they’re spending with you. In China they’re fighting over the money they’re spending on you.” But he says things are moving in the right direction: rates among the old have come down as pension and health-care provision have improved.




Restricting access to the means to kill oneself can also make a big difference. Suicide is a surprisingly impulsive act, especially among the young. According to that 2002 study of young Chinese women who had tried to kill themselves, three-fifths had been thinking of suicide for two hours or less, including two-fifths who had been thinking of it for ten minutes or less, and one in ten for just a minute. Reaching for the rat-poison—88% of them had used agricultural pesticides—is likely to lead to many more deaths than, say, grabbing a bottle of pills. That may help explain why the decline in rates among Chinese women has been sharper than among men. In urban areas, men favour violent means such as hanging or jumping off buildings, whereas women tend to favour medication, which is less likely to kill them. So moving away from rural areas tends to save more women than men.

Better never than late

People tend to believe that those who intend to kill themselves are very likely to end up doing so. In a survey carried out by Matthew Miller of Northeastern University, 34% of respondents thought that all or most of those who jumped from the Golden Gate Bridge would have found another way of killing themselves if a barrier had stopped them; a further 40% thought most would have. But a study of 515 people who had survived the leap between 1937 and 1971 showed that 94% were still alive when the study was carried out in 1978, which suggests that suicide is often a fleeting impulse rather than a settled intention.

Britain in the 1960s offers a sharp illustration of what can happen if access to an easy means of killing oneself is foreclosed. When the country switched from toxic coal gas—the favoured means of suicide among women and elderly men—to harmless North Sea gas, rates among those groups crashed. At the time, rates were rising among young men, lending support to the idea that the gas switch played a role.

That was the fortuitous consequence of an energy find, but deliberate policy can play a role in restricting access to the means of suicide. A series of bans in Sri Lanka—most recently of paraquat, in 2008-11—helped bring the rate down from 45 in the early 1990s to 20 now. When South Korea banned paraquat in 2011, the reduction in suicide deaths is reckoned to have contributed half of the overall decline in suicides over the next two years. Paraquat is now banned in the EU; China has said it will ban it; distribution is restricted in America; but in many parts of the world it remains freely available.

In western Europe, where pesticides are no longer a serious risk, the focus has been on limiting access to dangerous pills. In Britain, for instance, a law was passed in 1998 to limit the number of aspirin and paracetamol that could be sold in a single pack. In the following year, aspirin suicides were down by 46% and paracetamol ones by 22%. Blister packs help, too, because pills must be pushed out tediously one by one, allowing a would-be suicide time to reconsider. In America, alas, paracetamol is still sold loose in bottles, so 50 pills can be chugged in one go.

But the main means of suicide in America is guns. They account for half of suicides, and suicides account for more firearms deaths than homicides do. Guns are more efficient than pills, so people who impulsively shoot themselves are more likely to end up in the morgue than in the emergency ward. According to Matthew Miller of Harvard University, gun-ownership levels largely explain the variation in suicide rates, which range from 26 per 100,000 in Montana to five in Washington, DC. If America gave up its guns, suicides would crash.

Self-restraint on the part of the media can also play a role. Even in death, people are influenced by celebrities. This is known as the “Werther effect”, after the rash of suicides that followed the publication in 1774 of a novel by Goethe which ends with the eponymous hero’s suicide. Particularly common in Asia, the phenomenon has been observed all over the world. After Robin Williams, an American comedian, hanged himself in 2014, researchers calculated that there were 1,841 more suicides—a 10% increase—than would have been expected during the next four months. The rise in hangings, and among the middle-aged, was particularly marked.

Suicide experts criticised the sheriff of Marin County for describing in detail the method that Williams had used. Reporting clearly makes a difference. Paul Yip of Hong Kong University points to trends in the territory after a front-page story in 1998 on the suicide of a woman who had killed herself by sealing up a room and burning charcoal, thus poisoning herself with carbon monoxide. Within a year, charcoal-burner suicides had gone from zero to 10% of the total. When Ahn Jae-hwan, a South Korean actor, killed himself in his car with a charcoal-burner in 2008, the method went from less than 1% of South Korean suicides to 8% in 2011, accounting for most of the overall rise in the rate in that period.

Many countries have media guidelines, which basically say the same things: don’t write about suicides in a heroic light and don’t report the location or method in detail. Media restraint seems to make a difference. After a spate of suicides on the underground in Vienna, when people were killing themselves at a rate of nine every six months, newspapers were persuaded to stop reporting suicides or at least to keep them off the front page. Numbers went down to one to four every six months. But in some countries media guidelines are widely ignored. A study of South Korean suicide-reporting earlier this year showed that three-quarters of articles gave details of method and location, and half revealed the contents of the dead person’s suicide note. Readers’ prurient fascination with the gory details of suicide trumps responsible journalism.

Faced with the horror of a suicidal friend or relation, people feel scared and impotent. Yet just as individuals can make a difference—talking, listening, helping people through a difficult time—so can societies. Giving women more control over their lives, cushioning the impacts of social change, providing better care for the elderly, restraining the way that suicide is reported, restricting access to the means of killing oneself: all these things can make life a little more worth living, or at least persuade the desperate to hold onto it until it seems that way.