Suicide every 40 seconds: a problem that must be made visible

In almost all Western European countries, suicide was considered a serious crime from the Middle Ages until at least the French Revolution. In England, one of the last European countries to decriminalize it, it was a crime until 1961. In a few nations, it is still considered a punishable act. Because of this, historical data on this subject is not readily available. The stigma surrounding this issue makes it difficult to measure, even today.

Suicide is considered the extreme expression of violence, as the subject against himself applies it. It has several manifestations, consummated suicide and attempted suicide are those with the greatest repercussions and imply direct damage to the integrity of the individual, the family and society, and therefore deserve urgent preventive action, effective attention, comprehensive follow-up and investigation.

This behavior includes suicidal ideation (which are the desires, thoughts and plans to commit a suicidal act); the suicide attempt (voluntary act performed by the person with the intention of causing death, but without actually achieving it); completed suicide (act of killing oneself consciously, considering death as an end); and parasuicide (non-fatal self-injurious behavior in which intentionality or orientation towards death is not essential).

A first classification of suicidal behavior is that which differentiates suicide from attempted suicide, in this case suicide is understood, according to Durkheim, as "any case of death resulting directly or indirectly, from a positive or negative act, carried out by the victim himself, knowing that it should produce this result".

A continuum in increasing order of severity

Suicidal behavior is a continuum in increasing order of severity that begins with suicidal ideation, and passes through the threat, the attempt and finally the completed suicide and always constitutes a psychiatric emergency.

• Suicidal ideation: Refers to cognitions, which express some kind of assessment of the subject's self-injurious behavior and it may have a greater or lesser degree of structuring.

• Suicidal threat: Refers to the verbalization of the suicidal idea, that is, the intention to commit suicide and it may have a greater or lesser degree of structuring.

• Suicidal act: An act by which a subject causes an injury regardless of intent and knowledge of motives.

• Suicide: When death occurs, because of this injury.

• Suicide attempt: Suicidal act that does not result in death. Therefore, the suicide attempt would be the fact by which a subject causes an injury independently of his intention and knowledge of the motives.

In the last decades, suicide has shown an increase worldwide, it is clearly a serious public health problem, it is estimated that every year about 800 thousand people take their lives worldwide and it is expected that this figure will increase to reach one and a half million deaths by suicide.

In more shocking figures, which tend to reach the population better, it is estimated that every 40 seconds a person commits suicide somewhere in the world, and many more attempt suicide. In fact, suicide is the second leading cause of death in people between the ages of 15 and 29.

World Health Organization (WHO) mortality statistics suggest that the prevalence and characteristics of suicidal behavior vary widely among different communities, demographic groups and over time. An important difference occurs by gender: suicide rates are much higher in men than in women, particularly in high-income countries.

Suicide is an extremely complex issue, and although it is not possible to determine its causes, there are some risk factors that have been identified through correlations. Mental illness, specifically depression, is widely recognized as the most important risk factor.

Every suicide is a tragedy that affects families, communities and entire countries and has lasting effects among those affected. It occurs not only in high-income countries, but it is a global phenomenon in all regions of the world.

Many suicides occur impulsively, in times of crisis, due to difficulty in coping with life stresses, problems of various kinds, relationship breakdown or chronic pain and illness. Suicide rates are also high among vulnerable groups that suffer discrimination, such as refugees and migrants; indigenous population; people from the LGBTI community; and prisoners.

A public health problem that offers opportunities for prevention

Suicidal behavior has been described as a serious public health problem but one that offers possibilities for prevention. There are actions or behaviors that can be observed in people who wish to end their existence, such as threats to kill themselves, which are sometimes not taken seriously, or phrases such as "no one will miss me when I am gone".

Added to this is the search on the Internet for "how to take one's own life" and "how to have access to firearms". Saying goodbye to family and friends, giving away valuable possessions or writing a will, especially when there are not supposed to be reasons for doing so, also catches the eye.

These signs should not be overlooked. In the face of these behaviors, the person should not be left alone. Seek professional help from emergency services, a crisis line or a health professional. Close (trusted) family and friends, teachers, community leaders, priests and church pastors, among other significant figures, can also be called upon.

Also, find "an appropriate time and a quiet place" to talk about suicide with the person who has expressed suicidal intentions or has given indirect signs of suicide, letting them know that they have someone who can listen.

Identification and follow-up

Another method of prevention is early identification, treatment, and care of people with mental disorders and use of substance, chronic pain, and acute emotional distress. Training of non-specialized health care workers in the assessment and management of suicidal behavior is important. In addition, follow-up care for people who have attempted suicide and community support should be added. Finally, ensure that there is no access to means of self-harm in the home.

Suicide prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and others such as education, labor, justice, law, advocacy, politics, nongovernmental organizations, and the media.

These efforts must be "comprehensive and integrated, as no single approach alone can have an impact on such a complex problem."