132 Suicide prevention in Cuba

In Cuba, family and forensic doctors determine the diagnosis for the cause of death as suicide, although in uncertain cases, the police and official services of forensic medicine contribute to the diagnosis. This procedure prevents problems of concealment of suicide death that are connected to religious or life insurance issues, and strengthens the reliability of the diagnosis of the cause of death as suicide in Cuba.

Suicide ranks among the top ten leading causes of death in the country (Perez Barrero 1996), and although suicide rates have decreased substantially, they continue to be high in comparison with other countries in South America (World Health Organization 1999, 2000a). The truth is that suicide rates in Cuba are often misinterpreted. Mortality statistics in Cuba are highly reliable, and this may partially explain why Cuba has higher suicide rates than other South American countries. Moreover, the high suicide mortality dates back to the nineteenth century.

The causes behind suicide in Cuba are similar to those of other countries. Purportedly, suicide is considered as having multivariate causes, including biological, psychological, social, existential and genetic factors (Perez Barrero 2005; Correa and Perez Barrero 2005, 2008).

The trigger factors for Cubans to commit suicide are similar to those in other countries, and among the most frequent reasons are conflicts among couples, thwarted love, the rupture of a valuable relationship and family conflicts (Perez Barrero and Mosquera 2006).

The most common method for Cubans to commit suicide is hanging, burning and the ingestion of pesticides. Suicide by firearms is not a frequent suicide method in Cuba, due to the strict control of the holding of firearms, and the prohibition of their sale to the population. Burning is a common method for suicide in Cuba, and historically was often used because of disappointment in love by adolescents whose parents were immigrants to Cuba from the Far East; however, it is now utilized by adults of both sexes, although it is more prevalent in females (Perez Barrero 1994; Bahram et al. 2006).

Since 1989, Cuba, like many countries around the world, has had a National Program for Suicide Prevention (MINSAP 1989).

Cuba is represented among the main international organizations for suicide prevention, such as the International Association for Suicide Prevention (IASP), the International Academy of Suicide Research (IASR), and the International Association of Thanatology and Suicidology.

Cuba has also been represented in the Group of Experts of the World Health Organization for suicide prevention, and has participated in the preparation of documents for the World Health Organization, which are related to the prevention of suicide (World Health Organization 1999, 2000a, b, c).

Cuba initiated the process for the establishment of the Section of Suicidology of the World Psychiatric Association. In Cuba, several events of international character have taken place, in which national investigations regarding suicidal behaviour have been presented, and experiences shared with professionals from other countries. Cuba has also been represented in multinational investigations related to topics on ‘survivors of loss due to suicide’ and addressing the problems of ‘assisted suicide’ in projects that were directed by the members of the IASP, Professors Norman Farberow and Michael Kelleher, respectively.

Finally, the Cuban experience in suicide prevention has been presented in several countries, and has provided good examples on how to prepare suicide prevention programmes (Government State of Puebla 2005; Ministry of Health 2005).