nosed and untreated around the world. Even in developed nations, depressed patients consistently receive either no medication or dosages that are ineffective in treating their symptoms.[19,37,38]

Suicide is estimated to be the 10^th leading cause of death worldwide.[31] These estimates are based on nationally collected official data on suicide, which are thought to be significantly underestimated because of the stigma often associated with suicide. Reported rates of suicide vary widely throughout the world, with some of the highest rates being found in developing countries. For example, Sri Lanka [39] has the highest suicide rate in the world, followed closely by China.[40] Factors affecting the suicide rate among a given population include the rate of depression; the prevalence of alcohol abuse; the presence of high-risk occupational and demographic groups, including people with severe mental illness; the availability of easy means of suicide; the degree of social integration; and cultural attitudes toward suicide.

Psychological autopsy studies (which gather detailed information about the deceased from multiple key informants) indicate that more than 90 percent of people who commit suicide suffer from depression, substance abuse, psychosis, or some other form of mental illness.[ 41,42 and 43] In a major review of all studies of suicide reported in the English literature, Harris and Barraclough (1998) found that people with affective disorders combined (major depression, bipolar disorder, and affective disorder not otherwise specified) were 20 times more likely to kill themselves than the general population.[44] In non-Western countries, however, completed suicides may be less likely to have received a psychiatric diagnosis because of the paucity of mental health services.

Suicides often appear to be precipitated by a “last-straw phenomenon”: a recent social stress or life event in the context of multiple preexisting social stresses and an underlying mental illness. Official statistics tend to highlight the existence of social stresses rather than any underlying depression or other mental disorder. In settings where police officers, coroners, or physicians without mental health training are recording data about the principal causes of suicide, they are likely to focus on social and situational problems, rather than on preexisting depression. However, community surveys reveal that social problems are correlated with high rates of depression and anxiety.[45,46 and 47]

Individuals with limited or dysfunctional social networks have been shown to be predisposed to depression, suicidal thoughts, and suicide.[ 48] Similarly, at the broader societal level, social disruption in contemporary industrialized society is believed to contribute to anomie, depression, and suicide.[49] The suicide rate in Sri Lanka rose from 6.5 per 100,000 in 1950 to 47 per 100,000 in 1991 following