Every year, more than 727,000 people worldwide take their own lives. Many more thousands make suicide attempts. Every suicide is a tragedy that affects families, communities, and entire countries and has long-lasting effects on the people left behind. The phenomenon occurs at all income levels. Sadly, it was the third leading cause of death among 15-29-year-olds globally in 2021.
Malta is no exception, though the outcry whenever a suicide occurs is more of a natural reaction to a life snuffed out, than because it is a major problem. In fact, the suicide rate in Malta in 2022 (the last year for which Eurostat has published figures) was 5.2%. This was lower than the average for the previous 11 years and a drop from the 2021 rate.
In the EU, the rate has been rather stable, with some exceptions. The lowest suicide rate in the EU is that of Greece, while the highest is that in Lithuania, though the latter's rate has dropped hugely.
While Malta's rate has been half that of the EU on average, there has been a spike since the Covid pandemic. It is unclear whether the trend is necessarily rising or whether it will eventually revert to previous levels.
Males are more likely to commit suicide than females, the respective average rates being 9.36% to 1.98%. The female rate was below average in 2022 and less than half the previous year's figure.
The absolute number has averaged 29 since 2014, though it dropped to an average of 24 between 2016 and 2020. This is the figure most people look at, rather than the rate, but even the absolute number does not support the claim that we have more suicides than ever. In fact, from some parliamentary replies, the suicide numbers in 2023 and 2024 were respectively 27 and 28 ̶ below the average.
The magnitude of the problem can be assessed from the perspective of the latest standardised death rates published by Eurostat, where our rate of death by self-harm ranked 42nd among 86 causes of death in 2010. By comparison, diseases of the circulatory system had a standardised death rate of 386.5. I cannot remember ever seeing a headline about this in the Press.
Many suicides are the outcome of abrupt impulses, when the person concerned suffers a crisis and succumbs to stresses such as financial problems, relationship disputes, or chronic pain and illness. But at the end of the day, suicide and mental disorders ̶ in particular, depression and alcohol use disorders ̶ are linked. This is quite common in medium-income countries like Malta,
The urge to take one's life also occurs when a person experiences abuse or violence, a disaster of some kind, loses a close friend or relative, or is overwhelmed by a sense of isolation. Suicide rates are also high among vulnerable groups who experience discrimination, such as refugees, LGBTI persons, and prisoners.
Dr. Jane Pearson, who heads a suicide research consortium at the National Institute of Health in Maryland, explains that "When you're in a suicidal state, you're kind of closing down your options. You see it as the only solution. You're not really able to entertain other ideas."
It is quite clear that the stigma surrounding mental disorders and suicide leads many people who are thinking of taking their own lives, or who have attempted suicide, not to seek help. Even if they do, there is always the risk that their situation is more desperate than anybody realises. I was struck by a Facebook post, by Alan Montanaro, about a late suicide victim. In it, the well-known creative director said that "there are difficult lessons that I need to learn about myself. About those around me. It's about paying more attention. About validation and understanding. About reaching out and not assuming people are fine just because they say they are."
Although Mr Montanaro's j'accuse is understandable, it is not that easy to decipher whether somebody is contemplating suicide. However, Dr. David Brent, a psychiatrist at the University of Pittsburgh who studies suicide in families, helpfully says that one of the biggest indicators of suicide risk is when somebody begins talking about suicide. "We used to think that talking about suicide meant you weren't going to do it, but it's really the opposite. Other warning signs include withdrawal from usual activities, a change in mood or a change in sleep patterns," he says.
Many scientists used to believe that suicide was a side effect of other mental disorders. However, if it were the case, why is it that only a small proportion of people with depression or other mental problems attempt suicide? Now, it is accepted that there is something unique about some people's biology that can trigger suicidal thoughts.
Dr. Victoria Arango, a neuroscientist at the New York State Psychiatric Institute, points the finger at various parts of the brain, such as those in the front part above the eye (called the orbitofrontal cortex). If damaged, such parts might impair inhibitors to such behaviours as the urge to kill oneself, she says.
Arango and her colleagues have studied brain structure and biology in hundreds of victims. Two of their findings are that certain brain regions in suicidal persons have fewer nerve cells than in other persons, and that suicidal persons also have altered receptors for neurotransmitters. Could it be that flaws in neurotransmitter serotonin directly contribute to suicide, or is it more likely that serotonin is one part of a chemical pathway to suicide? After all, serotonin is also believed to play a key role in depression and the response to stress and trauma.
Other scientists claim that stress and trauma play a big role in suicide. Dr. Douglas Meinecke, Program Chief at the US National Institute of Health, has found evidence that traumatic childhood experiences ̶ such as abuse or violence ̶ can "tag" certain epigenetic genes in the brain. The molecular tags or markers attach to genes and can have a lasting effect on whether the genes are turned on or off. These unique markers were not found in suicide victims with no history of childhood abuse or in people who died in accidents.
The emotional, physical, and economic effects of suicide should not be underestimated. When people kill themselves, their surviving family and friends may experience prolonged grief, shock, anger, guilt, symptoms of depression or anxiety, and even thoughts of suicide themselves. Suicide attempts also exact a heavy toll.
In 2015, Blaźej Lyszczarz, Associate Professor at Poland's Nicolaus Copernicus University, calculated the years of productive potential life lost (YPPLL) in Malta due to suicide mortality at 601, or 13.3 per 10,000 population (compared to 14.6 YPPLL in the EU). He estimated the indirect cost at €5.5m Purchasing Power Parity (a measure of the price of specific goods in different countries that is used to compare the absolute purchasing power of the countries' currencies). This was equivalent to 0.046% of Malta's GDP at the time (EU: 0.061%). It worked out at €186,868 PPP per suicide.
Different causes of suicide require different treatments. Medications can help, as does psychotherapy. Raising community awareness and breaking down the taboo are essential to make progress in preventing suicide. Although the figures do not make suicide a major public health problem in Malta, a greater effort in prevention is desireable. It is good that Malta is one of only 38 countries that report having a national suicide prevention strategy.
Frans Camilleri is an economist. He studied at Oxford and University of East Anglia, is a former corporate head at Air Malta, and has served on various public and private boards.