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Johns Hopkins International Injury Research Unit


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Responding to the Increasing Need for Global Suicide Prevention

The COVID-19-induced lockdown and restricted lifestyle that followed have heightened our sense of loneliness, fear, depression, and anxiety. Research over the past few months in the United States and other high-income countries have corroborated this phenomenon–increased stress and physiological distress have grappled a large proportion of the population.

Earlier this month, World Suicide Prevention Day focused on acknowledging the ways in which COVID-19 has increased the need for accessible mental health care. The pandemic has created a new sense of urgency to engage communities in finding sustainable solutions for accessing quality mental health care that will help individuals struggling with mental health issues and can prevent suicides.

Suicide is preventable but it’s also a complex and multi-faceted issue, and accounts for more than 800,000 lives lost across the world every year. For more than a decade, suicide has consistently been the second leading cause of death for adolescents and adults 15 to 29 years of age; the numbers continue to rise. Further alarmingly, teen and adolescent suicides increased in the U.S. by 56% in the past two decades. However, it is important to acknowledge that suicide disproportionality affects low- and middle-income countries (LMICs). In 2016 for instance, 79% of all suicides occurred in LMICs. What is more concerning is that a prior suicide attempt is the most common risk factor for suicide, and for every individual who dies by suicide, there are at least 20 more suicide attempts.

Research has shown that suicide does not discriminate by gender, race, or socio-economic status. Mental and behavioral disorders, alcohol and substance abuse, and chronic pain are among other main risk factors associated with suicide. Economic and financial crises or difficulties can also lead individuals to develop mental and behavioral problems due to feelings of uncertainty and increased stress. More recently, the COVID-19 pandemic — combined with systemic problems such as racism, poverty, discrimination, and oppression — has created a unique and overwhelming combination of risk factors to suicide.

The increase in suicide rates intensifies in part due to health systems deficiencies such as lack of accessible resources in the form of counseling, mental health services, and treatment and in part due to societal and communal issues such as stigmatization, inappropriate media coverage, and stressors that come with certain cultures. Access to treatment and supportive, safe spaces for sharing are not available for adolescents in many settings, creating a challenge to drive change in how suicide and related circumstances are viewed. These barriers also affect other vulnerable populations such as the elderly, females, individuals with mental disorders, disabled people, ethnic and indigenous groups, migrants, and refugees disproportionately making them more susceptible to suicide.

Globally, three times as many males die of suicide compared to women, however, this gap is much lower or even inverse in LMICs, and research has shown substantial variations across regions and countries. Cultural and social norms, pre-established gender roles, financial disparities, and domestic violence are potential drivers of this gender association in low resource settings.

Organizations in the United States, such as the Center for Disease Control and Prevention and National Institute for Mental Health, have developed overarching prevention strategies for suicide that range from strengthening economic support, access and delivery of care, creating safe and protective environments, promoting connectedness, teaching coping and problem-solving skills, identifying and supporting people at risk, and reducing harm and preventing future risk. As recent research has highlighted, the prevalence of suicidal ideation and suicide-associated risk factors of depression, anxiety, stress, and mental disorders at much younger ages, identification of such risk factors, and subsequent treatment, as well as prevention are key to shifting the ever-increasing paradigm of suicide amongst children. Additionally, policies have been put in place to limit access to pesticides, drugs and medications and have shown reduction in suicide rates in some countries.

Yet, around the world, many LMICs lack the appropriate foundation of evidence-based systems to address suicide. Many of these programs can be implemented across various groups within the community, such as students, teachers, counselors, parents, and peers, and across different work settings – helping to build a cadre of “first responders” who could identify individuals at risk and avail necessary services. Raising community awareness and providing adequate data on suicide across the globe are essential in breaking down the barriers individuals encounter when deciding whether or not to seek mental health care in their community. Education about risk factors and warning signs of suicide and suicidal ideation requires a coordinated and comprehensive public health approach. With a clear unmet need for treatment in LMICs, there is an opportunity to model the existing prevention strategies into regionally and culturally appropriate prevention tactics applicable to these settings.

More recently, the World Health Organization (WHO) implemented its Special Initiative for Mental Health (2019-2023), dedicated to ensuring access to quality and affordable care for mental health conditions with a goal of reaching 100 million people. WHO intends to advance mental health policies, advocacy, and human rights through evidence-based interventions, and is aimed at providing quality mental health services through community-based and general health and specialist settings. Additionally, promoting mental health and well-being is a part of one of the Sustainable Development Goals, targeted to be achieved by 2030.

Perhaps now, more than ever, it’s critical that we acknowledge the need and urgency for suicide prevention interventions at the global level and work tirelessly to reduce the suffering by those affected. The Johns Hopkins International Injury Research Unit family of faculty, staff, and students know and recognize the tragic reach caused by suicide around the world and encourage all to ask what can we collectively do to prevent suicide?”

One initiative to help counter this gap is the Adolescent Violence and Injury Detection System (AVID), an innovative research project set up in India and Vietnam to develop and implement a community-based system for early detection of adolescents at risk and link them to appropriate service providers, as well as avail support. Through proven, evidence-based measures, we see a path to lives saved and families changed for the better.

If you are in the U.S. and you or someone you know is struggling, please call the National Suicide Prevention Lifeline at 1-800-273-8255 or visit www. for more information.

This blog post was co-authored by Johns Hopkins International Injury Research Unit Director Dr. Abdul Bachani, Research Associates Drs. Priyanka Agrawal and Lamisa Ashraf, and Program Coordinator Abigail Green. 

CDC Officials Discuss Scalability of Injury Interventions with the International Injury Research Unit

Dr. Grant Baldwin and Dr. Mick Ballesteros of the Division of Unintentional Injury Prevention in the Centers for Disease Control’s Injury Center visited the International Injury Research Unit today during its regular meeting. As part of CDC’s increasing involvement in global health issues, Dr. Baldwin and Dr. Ballesteros discussed the importance of collaboration and knowledge sharing, particularly in the area of international injury prevention. The group agreed that scalable, replicable interventions are critical for the future of the field.

The Division of Unintentional Injury Prevention monitors trends in unintentional injuries, conducts research to better understand risk factors, and evaluates injury interventions. Its research and prevention programs focus on two categories: motor vehicle-related injuries, and home and recreation related injuries.

Given its current work in road traffic safety and other injury-related research, the International Injury Research Unit anticipates that collaboration with the CDC will be mutually beneficial. The Unit looks forward to continuing this partnership as we work together toward reducing the burden of injuries around the world.

IIRU joined the Global Road Safety Decade of Action Working Group Meeting

On February 24th, 2010, the working group meeting for Global Road Safety Decade of Action (2011-2020) was held in Washington, DC. IIRU was invited to attend this conference organized by the FIA Foundation. The objectives of this meeting were to disseminate information from First Global Ministerial Conference on Road Safety held in Moscow in November 2009, and identify strategies for the Decade of Action and mechanisms for continued coordination of activities. Over seventy representatives from governmental sectors, private sectors and non-governmental organizations participated in the meeting.

In the opening presentation, Nancy Carter-Foster from U.S. Department of State called for greater international collaboration and cooperation in support of increased global road safety and reducing the number of life lost due to road crashes. Dr. David Sleet from Centers for Disease Control & Prevention (CDC) addressed the burden of road traffic injuries around the world and the importance of injury surveillance. In reframing road infrastructure and land use, speakers in the panel discussion suggested the governments should raise public awareness, develop capacity and set a goal of intervention for institutions to follow.

Panelists stated that road safety is a development priority and highlighted the need to accelerate the transfer of knowledge to low and middle-income countries, and to help scale up their road safety investment to unprecedented levels. Another panel discussed that all-inclusive approaches to road safety should include technology and the proper training to implement technologies, including collection and use of statistics, low cost safety improvements, safety toolkits and pedestrian safety.

At the conclusion of the meeting, all NGO representatives agreed that 1) infrastructure, 2) vehicle safety, 3) police enforcement and 4) technical assistance & management system are the key points to develop sustainable strategies for Decade of Action. IIRU looks forward to working with partners in the global road safety community and contributing towards a successful Decade of Action.