Do nations' mental health policies, programs and legislation influence their suicide rates? An ecological study of 100 countries

Objective: To test the hypothesis that the presence of national mental health policies, programs and legislation would be associated with lower national suicide rates. Method: Suicide rates from 100 countries were regressed on mental health policy, program and legislation indicators. Results: Contrary to the hypothesized relationship, the study found that after introducing mental health initiatives (with the exception of substance abuse policies), countries' suicide rates rose. Conclusion: It is of concern that most mental health initiatives are associated with an increase in suicide rates. However, there may be acceptable reasons for the observed findings, for example initiatives may have been introduced in areas of increasing need, or a case-finding effect may be operating. Data limitations must also be considered.