7.3.5. Intentional injuries

 

Intentional injuries (suicide and homicide, assault, other violence) account for 27% of fatal injuries but only for 7.4% of all medically treated cases (See Table 7.1).

 

Suicide and self harm

 

Suicides represent a serious public health problem. as they are one of are the main causes of injury mortality in the EU27 (24% of all cases, almost 61 000 people a year – see Figure 7.2 ) In Europe suicide rates vary from about 2 per 100 000 people in Cyprus to 35 per 100 000 in Lithuania (Figure 7.15.A).

 

Figure 7.15.a. Suicide and self harm in the EU27

 

 

More men than women commit suicide in the European Union (Figure 7.15.b. Suicide and intentional self-harm by gender in the EU27 whereas more women commit more suicide attempts (Figure 7.16).

 

Figure 7.15.b. Suicide and intentional self-harm by gender in the EU27

 

The majority of researchers and professionals involved in suicide prevention agree that suicide is associated with a complex array of factors such as:

 

·          mental illness

·          social isolation

·          a previous suicide attempt

·          physical illness

·          substance abuse

·          family violence

·          access to means of suicide.

 

Research has shown that more than 90% of people who commit suicide had depression or another diagnosable mental or substance abuse disorder. Some risk factors vary with age, gender and ethnic group. Risk factors may change over time, while some factors frequently occur in combination.

 

Identified risk factors also vary in their degree of effect and no one single factor has been found to be a sufficient cause of suicide (Guo and Harstall, 2004).

 

Globally seen, in modern societies there is still a lack of awareness of suicide as a major health problem. At the same time, there is also still a taboo to discuss the issue in an open manner.

 

Morbidity data on suicide attempts and self harms are not adequately documented. Hospital discharge data only deliver a rough picture, and no details on the background and risk factors of suicide attempts and self-harm.

 

Figure 7.16. Hospital deaths and discharges due to suicide and suicide attempts by sex, selected EUGLOREH countries

 

This situation might be changed as the European Injury Database will also contain in the future details on self harm injuries of hospital treated patients.

 

For sure, tackling the problem of suicide and self harm requires a comprehensive multisectoral approach involving different scientific disciplines.

 

Interpersonal violence: Homicide, assault

 

Interpersonal violence (IPV) is defined as "the intentional use of physical force or power, threatened or actual, against another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation“. The definition used by the World Health Organization associates intentionality to the committing of the act itself, irrespective of the outcome it produces. Interpersonal violence related mortality includes deaths due to homicide, sexual assault, neglect and abandonment, and other forms of maltreatment (WHO, 2002).

 

For all age groups taken together, interpersonal violence accounts for 2% of fatal injuries in the EU27 and in particular for 5% in the 1-4 age group. Again, differences between countries in the European Union indicate a high potential for improvement and confirm the nature of preventability of violence (Figure 7.17).

 

Like many other health problems in the EU, violence is not distributed evenly among sex or age groups. More men than women are victims of violence (Figure 7.17. Homicide, assault by sex selected EUGLOREH countries).

 

Figure 7.17. Homicide, assault by sex selected EUGLOREH countries

 

The above-mentioned mortality figures  almost certainly underestimate the true burden of violence. In all parts of the world deaths represent the ‘‘tip of the iceberg’’ as far as violence is concerned. Physical and sexual assaults occur daily, though precise national and international estimates of each are lacking. Not all assaults result in injuries severe enough to require medical attention and – even among those that do result in serious injuries – surveillance systems for reporting and compiling these injuries are in many countries either lacking or are still being developed (WHO, 2002).

 

Again, hospital discharge data only give a rough picture of the circumstances of non-fatal injuries due to homicide, assault and other violence.

 

The currently developed European Injury Database will in future deliver information on injuries due to violence of hospital treated patients.

 

The WHO World Report on Violence and Health provides an excellent introduction into  the global perspective of the problem of violence (WHO, 2002)