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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. Suicidepreventionlifeline.org 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. 

Associate Director Represents Johns Hopkins International Injury Research Unit for Meetings, Workshops in Qatar

On January 23-24, 2019, Johns Hopkins International Injury Research Unit Associate Director Dr. Amber Mehmood joined together with leaders from Hamad Medical Corporation to participate in workshops and progress meetings on critical research subjects, such as occupational injury prevention and road safety. 

Mehmood, along with Hamad Medical Corporation’s leadership team first led a writing workshop focusing on work-related injuries and the evaluation of injury data sources. The workshop, attended by staff of the Hamad Medical Corporation’s injury prevention unit, and hospital trauma surgery and emergency room staff, also covered data analysis regarding cost on injury and trauma care in the Hamad Trauma Center.

Drs. Ruben Peralta, Rafael Consunji, Aisha Abeid, Monira Mollazehi, Nazia Hirani, Tsoler Sekayen, and Cecilia Claudio were part of the core group representing different units of Hamad Medical Corporation.

The team then held progress meetings for a pair of JH-IIRU-related projects, Work-place-injury Unified Registry for Qatar (WURQ) and Young Kids in Safe Seats (Y-KISS).  Mehmood and the Hamad’s core group discussed the sustainability and continuing efforts for work-related injury prevention and control in Qatar, as well as the interventions directed toward awareness and education of labor workforce in Qatar.

Both WURQ and Y-KISS are funded by the Qatar National Research Fund and began in 2015, respectively. The Y-KISS team set out to develop a child car seats program for new parents in Qatar, and determine the effectiveness of a child car seat program for new parents using a randomized study design. Through WURQ, JH-IIRU and its partners set out to understand the epidemiology of workplace injuries in Qatar, develop and pilot test an occupational injury registry for the state, and engage relevant stakeholders to consider occupational injuries as a key public health issue.

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Associate Director Dr. Amber Mehmood speaks at the 4th Annual AKU Surgical Conference in Karachi, Pakistan.

Johns Hopkins International Injury Research Unit Hosts Special Event on Road Safety and Sustainable Development Goals

On Monday, January 14, 2019, the Johns Hopkins International Injury Research Unit hosted “Achieving SDGs: Keys to Success for Road Safety.” The event welcomed public health experts from across the globe for a special 90-minute conversation held at the Johns Hopkins Bloomberg School of Public Health and streamed live to international virtual participants.

JH-IIRU Director Dr. Abdul Bachani moderated the panel, which featured Bloomberg Philanthropies’ Kelly Larson, World Health Organization’s Dr. Nhan Tran—a Bloomberg School of Public Health alum, Pan American Health Organization’s Dr. Eugenia Rodriguez, and Office of Public Services of Fortaleza’s Luiz Saboia.

“Today’s event brought together a diverse group of experts to hold a critical conversation on road safety and SDGs that will certainly help move towards progress and life-saving solutions,” said Dr. Bachani. “Being able to meet with leaders and decision-makers from around the world allowed us a unique opportunity to pose important questions and highlight innovative, evidence-based strategies in an effort to reduce the number of lives lost to motor vehicle crashes each and every day.”

The panel, which answered questions from members of the invite-only audience, discussed everything from the alcohol industry’s role in road safety to moving forward beyond the concluding decade of action in 2020. At the conclusion of the panel, Dr. Bachani presented the Johns Hopkins International Injury Research Unit Award for Leadership in Injury Prevention to Saboia, on behalf of Fortaleza and its mayor, Roberto Claudio.

To watch the full video replay of the event, please click here.alt

Kelly Larson of Bloomberg Philanthropies and Dr. Abdul Bachani served on the panel of road safety experts during "Achieving SDGs: Keys to Success for Road Safety."

Johns Hopkins International Injury Research Unit Joins Global Road Safety Experts in London

On December 10, 2018, representatives from the Johns Hopkins International Injury Research Unit participated in the first meeting of the Commonwealth Road Safety Initiative Expert Panel in London, England.

Director Abdul Bachani, along with Connie Hoe and Margie Peden, convened with researchers, practitioners, and policymakers to form the Panel, which is being tasked with producing a report on sustainable development goals and road safety strategies within the Commonwealth’s 53 countries.

“It’s an honor to be a part of such a talented, hardworking group, with experts from around the world,” said Bachani. “As part of the Panel’s first meeting, we had a productive series of conversations and came away with clear next steps on how to develop recommendations on reducing road traffic fatalities in the Commonwealth.”

After the conclusion of the meeting on December 12, Bachani and the JH-IIRU team joined Expert Panel members at the Prince Michael International Road Safety Awards. Prince Michael of Kent announced the award winners, which included the National Association of City Transportation Officials (NACTO) for its Global Designing Cities Initiative.

The CRSI was launched to promote the adoption of a target to halve deaths and serious injuries from road crashes in Commonwealth countries by 2030. As a group, the Initiative will develop a shared framework of best practice in road injury prevention for legislators, policy makers, private sector, and civil society.

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JH-IIRU Director Abdul Bachani meets with Prince Michael of Kent at the Prince Michael International Road Safety Awards in London, England.

Johns Hopkins International Injury Research Unit Leads Workshop on Road Safety in Ethiopia

On December 13-14, 2018, Johns Hopkins International Injury Research Unit Research Associate Isaac Botchey led a monitoring and evaluation workshop in Addis Ababa, Ethiopia as part of the Bloomberg Initiative for Global Road Safety (BIGRS).

More than 30 participants were in attendance and were given the opportunity to conduct roadside observational data collection, analyze data, and develop action plans.

“We believe that building local capacity is essential for a country to achieve its road safety objectives,” said Botchey. “The success we had here in Ethiopia will go a long way in reducing the number of lives lost to road traffic accidents.”

The workshop addressed a pair of sustainable development goals, outlined by the World Health Organization (WHO):

  • Goal 3, Target 3.6: By 2020, halve the number of global deaths and injuries from road traffic accidents
  • Goal 11, Target 11.2: By 2030, provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport, with special attention to the needs of those in vulnerable situations, women, children, persons with disabilities and older persons

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Workshop participants are seen here conducting roadside observational data collection in Addis Ababa, Ethiopia.