ALTHOUGH SUICIDE IS a global public health problem, data on suicide rate are unavailable for 73% of developing countries.1 In Bali, Suryani et al. demonstrated that the suicide rate in the period following the 2002 Bali bombings was 8.10 for male and 3.68 for female subjects per 100 000 population.2 But they investigated the suicide rate in only three of nine administrative regencies in Bali, and did not indicate the overall year-by-year suicide rate of the targeted population. The aim of the present study was therefore to investigate the suicide rate in all nine regencies in Bali in 2006. The study was approved by the Indonesian Institute of Science.
Data on suicides were extracted from case records for the period between January and December 2006 from 53 police stations accounting for the entire population of Bali. For each suicide, the first author (T.K.) collected information regarding the conditions of death from police, community leaders, doctors, and the victims' families. After all information was thoroughly reviewed by the research team, the cause of death in all cases was determined to be suicide. The entire population count and population estimates by age group in 2006 were based on census data.3
We identified 149 suicides in 2006. The overall, male, and female suicide rates in 2006 were 4.6, 6.1, and 3.0 per 100 000 people, respectively. Suicide rates per 100 000 population by age groups were as follows: 10–14 years, 0.8; 15–24 years, 6.5; 25–34 years, 4.2; 35–44 years, 3.7; 45–54 years, 5.0; 55–64 years, 6.6; 65–74 years, 11.6; >74 years, 15.7. One hundred and seventeen (78.5%) of the 149 suicides occurred by hanging, 23 (15.4%) by poisoning, four (2.7%) by stabbing, two (1.3%) by drowning, two (1.3%) by jumping from a height, and one (0.7%) by burning.
To our knowledge, this is the first successful study examining the annual suicide rate of the entire population in Bali. The suicide rate found in the present study was slightly lower than that found by Suryani et al.2 and markedly lower than the world average. Suicide, however, remains a critical public concern in Bali, where Hinduism strongly prohibits suicidal behavior. Because the suicide rate in Bali has significantly increased in recent years,2 now is an appropriate time for health professionals to recognize suicide as a major health problem and focus on suicide prevention.
The suicide rate was higher among older people. Male subjects were approximately twice as likely to commit suicide as female subjects; this tendency is similar to that observed in developed countries, but not other developing countries in Asia. In China, for example, female suicides are 25% more common than male suicides,4 and in India, female adolescents are more than twice as likely as male adolescents to commit suicide.5
The suicide rate reported in the present study may be underestimated due to underreporting in areas where, because suicide is still considered a taboo topic, people might try to conceal the cause of death of relatives. An inadequate registration system or family efforts to avoid police investigation may also contribute to underestimation of the suicide rate. Despite this limitation, however, we believe that this study represents an initial step for further epidemiological research attempting to determine more accurate estimates of the suicide rate in Bali.