There is a suicide death every 40 seconds. That is more than 2000 people, who commit suicide every day. Is it possible to prevent suicide? And if so, how?
Suicide is one of those things we just don't talk about. And when we do discuss it, we desperately try to avoid the heart of the matter, especially when we talk to people who have lost friends or relatives through suicide.
Suicide is stigmatized. It's a taboo.
This lack of talk makes it even harder for doctors, psychotherapists and relief groups to employ effective preventative measures. What’s more, people's reasons for suicide vary around the world.
That's according to Matthis Muijen of the World Health Organization's (WHO) Europe office.
"It's often because of poverty in rural areas," says Muijen. "It's people who have lost their livelihoods and don't know what to do. Often they drink pesticides to take their own lives."
They are the same pesticides as those used in farming, and as a result, they’re extremely poisonous.
"It's very tragic. And it can take days for the pesticide to work. But once it starts to work, it's impossible to reverse the effects," Muijen says.
Global suicide rates
In its report on suicide prevention, published at the start of September, the WHO ranks North Korea as having one of the highest suicide rates in the world - 39.5 cases for every 100,000 people.
Statistics for Eastern Europe - for instance, in Russia - remain equally alarming.
Cultural, social, religious and financial factors all play a role in suicide. In some countries, suicide is illegal, while in others it is tolerated.
But the WHO says governments - wherever they are in the world and no matter the cultural or legal stance on suicide - could do more to reduce the number of suicides committed each year. That's about 800,000 suicides on average - not to mention suicide attempts.
Germany's suicide rate
In Germany, the most common form of suicide is not with poison. It's hanging.
"That's true for about 4000 out of every 10,000 suicides," says Georg Fiedler, a psychologist with the German Society for the Prevention of Suicide (Deutsche Gesellschaft für Suizidprävention, DGS).
"Overdosing on medication is second on the list of this sad statistic," says Fiedler, "followed by jumping."
Then there is what a DGS report lists as "Legen vor ein sich bewegendes Objeckt" - the direct translation being, "lying down in front of a moving object."
This rather opaque description refers to people who jump in front of trains.
Four times as many men as women commit suicide in Germany.
But prevention is possible. Muijen is convinced of it.
One suggestion is to restrict the access to medication that is currently freely available to buy. Such restrictions exist in Britain.
Muijen says erecting fences and railings around certain buildings and bridges could also help prevent suicide.
"Many people think the person who's trying to commit suicide will simply look for another location," says Muijen. "But that's often not the case. If a person feels they can't carry out their suicide as they had planned, often they end up rethinking the whole idea, and don't do it."
Depression and loneliness
Among young people in Germany, aged between 15 and 29 years, suicide is a more common cause of death than traffic accidents or drugs. Fiedler says it is often a spontaneous act.
The situation appears more dramatic among people over the age of 65. More seniors kill themselves than young people. Often they suffer from physical illnesses and also depression.
"Many are lonely," says Fiedler. "Every second woman who commits suicide is over the age of 60, and according to estimates, between 40 and 60 percent suffer from a form of depression."
A greater awareness
One of the most effective methods for prevention is raising awareness of the problem.
"It's about the feeling of not being alone. It's about explaining that it's not abnormal to be depressed, or tired of life," says the WHO's Matthis Muijen. "But it's also about there being help. You'll find understanding people, who will look for solutions."
It is seldom the case, says Muijen, that solutions cannot by found.
Muijen would like to see poster campaigns on busses and in other public spaces to aid prevention. And doctors could get better at helping patients.
"Many people who commit suicide visit their doctors before, but the doctor fails to read the signs," says Muijen.
There need to be flyers and information pamphlets to inform patients of the dangers and to suggest solutions to the problems they perceive.
The DGS's Georg Fiedler, meanwhile, is concerned about the coverage of suicide by the media.
Fiedler cites the suicide of football player Robert Enke.
Enke committed suicide in November 2009 at a railway crossing, and his story remained top news for a long time. Fiedler says the affect was damaging.
"The number of suicides on railway lines increased fourfold in the days after his death," Fiedler says.
It's hoped World Suicide Prevention Day (September 10) will raise awareness and understanding for people at risk of suicide. It's a call for doctors, hospitals, support groups and everyday people to counter the stigma and do more to help people before it is too late.