Suicides have been a controversy since the Covid-19 lockdown in 2020. The significant rise in the number of cases warrants attention.

A photo of the taxi driver's shoes and car after he committed suicide.

"I can’t take this life any more.”  

These were the last words of a taxi driver before he jumped off the Rama VII bridge into the Chao Phraya River, leaving behind his shoes. Tragedies like this are being seen more frequently in the media, and are inevitably being linked to the economic depression following the Covid-19 pandemic and the government’s handling of the crisis.

Suicide is not a new issue. A statement at the start of the Covid-19 pandemic in 2020 by a team funded by Thailand Science Research and Innovation (TSRI) which had been conducting research about changes among the poor in urban society since July 2019 noted that between 1-21 April 2020, 38 suicide attempts were reported in the media, 10 of which failed and 28 were successful. The number equalled the number of Covid-19 deaths at that time.

Responding to the finding, Dr Kiatiphum Wongrajit, then Director-General of the Department of Mental Health, argued that the figures represented only an analysis of the media and not the true suicide rate in Thailand. He said that by not comparing the information in April 2020 to previous months, because of the lack of data on the cause of each suicide, and by making a link to the deaths from Covid-19, the statement could cause public misunderstanding.

The connection between suicides and the pandemic has been a controversial topic since last year. Nevertheless, figures on the Department of Mental Health’s website show that there has been a significant increase in suicide rates over the past year.

Covid-19 pandemic and suicide

In 1999, two years after the 1997 financial crisis (Tom Yum Kung crisis) and economic recession caused by the floating of Thai baht, the suicide rate in Thailand rose to its highest level of 8.59 per 100,000 people. The rate came down to under 7 over the next five years. 

The annual rates in 2016-2020 (6.35, 6.03, 6.32, 6.64 and 7.37), show a marked increase in 2019 and 2020.

Dr Nattakorn Jampathong, Director of the National Suicide Prevention Centre and of Khon Kaen Rajanagarindra Psychiatric Hospital, said that the usual suicide rate in Thailand is around 6.0-6.5 per 100,000 people, or 4,000-4,500 cases per year. He added that the suicide rate did not suddenly rise during the crisis, but increased over 1-2 years.

Dr Nattakorn Jampathong

He explained that one of the reasons for the rise in the suicide rate was that some people recovered and others did not.  He added that since the 2020 rate was quite high, he will keep an eye on 2021 to see whether it will be like the Tom Yum Kung crisis or not.

Dr Nattakorn said that the number of suicides as seen from death certificates during the first 3 months of this year does not seem very high, compared with the first 3 months of 2020. Data from 3 months may not be significant, but the figures for the months since then, which has not yet arrived, could be significant.

“Generally, the suicide rate will not immediately reflect the situation in society, but it will around 1-2 months later. At this time, I cannot say anything definite because the data has not yet come in.”

Economic hits harder in 2020

In talking about suicide, the question of cause is crucial. Normally, the main causes of suicide are, in order, problems in relationships, especially between family members or intimate partners; chronic physical and mental disease; alcohol abuse; economic factor; and substance abuse, according to Dr Nattakorn.

The reasons that drive a person to commit suicide may be too complicated to identify a major cause. Even when the causes are known, it is still impossible to identify the main cause.
During 2020, economic factors have been more frequent than alcohol abuse, but many details need to be looked into.

“In 2020, what happened? It has to be accepted that economic factors overtook alcohol. I did not mean that the economy become a more serious factor, because for one thing, the alcohol problem was reduced in 2020.  There were measures and other things in society which made people drink less, especially during the period when there were measures by the Communicable Disease Committees in several provinces to control alcohol consumption and distribution,"

These had a great effect, so the alcohol factor decreased. The economic factor became more serious to one level, and it must be accepted that the result was that the economic factor was pretty much neck and neck with chronic disease. For each month they were neck and neck like that. In some months it must be accepted that economic factors took second place and chronic disease was third, but in some months chronic disease was second,” said Dr Nattakorn.

Complex issue, complex solution

Dr Nattakorn said that Thai suicides are a complex social problem, and are not only a health problem, but also have social and economic components. Therefore, the solution has to cover every aspect of the problem.

“If we know that in 2020, the economic factor will be serious and in some areas we have information that groups of workers have a serious problem, in some areas groups with no income have a serious problem, and in some areas farmers have no serious problem and traders have no serious problem, we will be able to focus properly and if there are areas where workers have a serious problem, can we coordinate with the workers? In areas where the elderly have a serious problem, can we coordinate with agencies that care for the elderly?"

"It is a perspective of integrating many sectors, and not looking at the problem of suicides as a health problem, but as a social and economic problem that has a complex relationship with personal factors.”

We have to wait and see whether the government can manage the economy, vaccine procurement, and recovery for affected people and how it can prioritize budgets.