Understanding and Preventing Suicide: Risk Factors & Help

Understanding Suicidal Behavior

Suicide is a complex issue with a range of behaviors and underlying factors. It's crucial to understand the different aspects of suicidal behavior to effectively identify and support individuals at risk.

Definitions:

• Suicide: An individual's death is intentional.
• Suicide Attempt: An attempt is made, but death does not occur.
• Suicidal Ideation: Thoughts or planning of suicide.
• Suicide Threat: Verbalizing the intention to kill oneself; this is a significant risk factor.
• Suicidal Gesture: Exhibiting some suicidal ideation.
• Passive Suicide: Displacement of responsibility, for example, a hunger strike.
• Attempted Suicide: Suicidal intent exists, but the method fails.
• Completed Suicide: Death is achieved.
• Extended or Mass Suicide: Multiple individuals die by suicide, often in a coordinated manner.
• Suicide-Homicide: An individual commits murder and then dies by suicide.
• Assisted Suicide: An individual, not necessarily seeking death, requires external help to die.

Epidemiology

According to the WHO, approximately 3000 suicides occur per year in Spain. It is estimated that there are 20 attempts for each completed suicide. Higher frequencies are observed in Andalusia, particularly in Cordoba and Jaen. Men complete suicide more frequently and use more violent methods. Women make more attempts and use less violent methods. The age range with the highest incidence is 19-29, with a plateau until 60, where the incidence increases again.

Explanatory Model of Suicide

At birth, we possess an instinct for life. Over time, we develop hopes and goals that constitute the will to live. When frustration and stress are present, the desire to die or not to live may emerge.

Contributing Factors

Several factors contribute to suicidal behavior, and the risk increases as more factors are present:

• Family history and genetic factors
• Biological factors
• Psychiatric disorders
• Psychosocial factors and personality traits

Risk Factors (SAD PERSONS Scale)

A helpful mnemonic for remembering risk factors is the SAD PERSONS scale:

• Sex (Male)
• Age (19-29, or 60+)
• Depression
• Previous Attempt
• Ethanol Abuse
• Rational Thought Loss
• Social Supports Lacking (No spouse/partner)
• Organized Plan
• No spouse
• Sickness (Access to lethal mechanisms)

Approach to Suicidal Behavior

Prevention is most effective through the identification and treatment of individuals exhibiting suicidal behavior. Many individuals who are suicidal seek medical attention for other reasons. It's crucial to detect signs of low mood, such as:

• Sadness
• Anhedonia (inability to feel pleasure)
• Seemingly banal pathological complaints
• Inhibition
• Loss of future vision

A significant percentage (65%) of individuals who die by suicide have communicated their intentions, and 41% have consulted a medical professional in the 28 days prior.

Sequential Assessment of Suicidal Risk

When assessing suicidal risk, it's important to ask questions in a sensitive and sequential manner. Start with less direct questions and progress to more specific inquiries:

1. "Would you like to sleep and not wake up again?" (This explores fantasies of death without directly mentioning suicide.)
2. "Do you think about death?" (Focuses on death in general.)
3. "Have you thought about your own death?" (Introduces the concept of the individual's own death.)
4. "Would you like to die?" (A direct question about the desire to die.)
5. "Have you thought about doing something to facilitate your death?" (Assesses the seriousness of intent and planning.)
6. "What has stopped you?" (Identifies protective factors, such as minor children or religious beliefs.)

Treatment (TTO)

• Approach intentionality openly within a proper doctor-patient relationship.
• Treat any underlying condition.
• Consider a "no-suicide contract."
• Involve family and friends.
• Assess the need for hospitalization (including involuntary hospitalization if necessary).
• Utilize psychopharmacological and psychotherapeutic treatments.