Citation

Nordentoft M, Erlangsen A. Science 2019; 365(6455): 725.

Affiliation

Annette Erlangsen is a senior researcher at the Danish Research Institute for Suicide Prevention at the Mental Health Centre Copenhagen, Copenhagen, Denmark, and an honorary associate professor at the Centre for Mental Health Research, Australian National University, Canberra, Australia. annette.erlangsen@regionh.dk.

Copyright

(Copyright © 2019, American Association for the Advancement of Science)

DOI

10.1126/science.aaz1568

PMID

31439766

Abstract

Suicide is a devastating public health problem, afflicting individuals, families, and societies. Fortunately, continuous striving by the World Health Organization to strengthen suicide prevention efforts is paying off. The annual number of suicide deaths decreased from 1 million to 800,000 worldwide during recent decades. A gloomy exception to this trend is the increasing rate of suicide in the United States (14.0 per 100,000 in 2017). But Denmark's experience offers some hope that prevention of suicide is possible. Why has its decline in suicide been steeper than in most other countries?

Historically, the Danish suicide rate was among the highest in the world. In 1980, it was 38 per 100,000 inhabitants over 15 years of age (Hungary's rate was 52 per 100,000). But the Danish rate then began to decline, reaching 11.4 per 100,000 in 2007, roughly where it still stands today. This is among the lowest in high-income countries.

Denmark's strategy for tackling suicide was multipronged and spanned decades. One of the most effective elements was restricting access to dangerous means of suicide. The government initiated restrictions on the availability of medication with high case fatalities, such as sedatives (barbiturates) and opioids (dextropropoxyphene), and introduced less-toxic antidepressants (such as selective serotonin reuptake inhibitors). Removal of carbon monoxide from household gas and the introduction of catalytic converters in car exhaust systems (to reduce the emission of toxic concentrations of carbon monoxide) are likely to have been beneficial. In addition, restrictions on firearm availability and regulations requiring that weapons and ammunition be stored separately and locked up probably aided the decline. Psychiatric wards that were redesigned to eliminate opportunity are also thought to be a valuable contributing factor.

As in other Nordic countries, the Danish tax-based, universal, and free health care system has included mental health since its introduction in 1933. All citizens have access ...

Language: en