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Review
. 2016 Jun;18(2):183-90.
doi: 10.31887/DCNS.2016.18.2/uhegerl.

Prevention of suicidal behavior

Ulrich Hegerl  1
Affiliations
Review

Prevention of suicidal behavior

Ulrich Hegerl. Dialogues Clin Neurosci. 2016 Jun.

Abstract
in English, Spanish, French

More than 800 000 people die every year from suicide, and about 20 times more attempt suicide. In most countries, suicide risk is highest in older males, and risk of attempted suicide is highest in younger females. The higher lethal level of suicidal acts in males is explained by the preference for more lethal methods, as well as other factors. In the vast majority of cases, suicidal behavior occurs in the context of psychiatric disorders, depression being the most important one. Improving the treatment of depression, restricting access to lethal means, and avoiding the Werther effect (imitation suicide) are central aspects of suicide prevention programs. In several European regions, the four-level intervention concept of the European Alliance Against Depression (www.EAAD.net), simultaneously targeting depression and suicidal behavior, has been found to have preventive effects on suicidal behavior. It has already been implemented in more than 100 regions in Europe.

Más de 800000 personas fallecen cada año por suicidio, y cerca de 20 veces más intentan suicidarse. En la mayoría de los países el riesgo suicida es más elevado en hombres de mayor edad y el riesgo de intento suicida es más alto en mujeres jóvenes. La mayor letalidad de los actos suicidas en los hombres se explica por la preferencia de métodos más letales como también por otros factores. En la gran mayoría de los casos, la conducta suicida ocurre en el contexto de los trastornos psiquiátricos, siendo la depresión uno de los más importantes. Aspectos centrales de los programas de prevención del suicidio lo constituyen la mejoría en el tratamiento de la depresión, la restricción en el acceso a medios letales y la evitación del efecto Werther (suicidio por imitación). En varias regiones europeas se ha encontrado que el concepto de intervención de cuarto nivel de la European Alliance Against Depression (www.EAAD.net), que se orienta simultáneamente a la depresión y la conducta suicida, tiene efectos preventivos en la conducta suicida. Esto ya ha sido implementado en más de 100 regiones de Europa.

Plus de 800 000 personnes meurent chaque année par suicide et environ 20 fois plus tentent de se suicider. Dans la plupart des pays, le risque suicidaire est plus élevé chez les hommes âgés et le risque de tentative de suicide est plus élevé chez les femmes jeunes. Le taux de décès plus élevé des actes suicidaires chez les hommes s'explique par le choix de méthodes plus létales et par d'autres facteurs. Dans la grande majorité des cas, le comportement suicidaire survient dans le contexte de troubles psychiatriques dont la dépression représente le plus important. Les programmes de prévention du suicide sont axés sur l'amélioration du traitement de la dépression, la restriction de l'accès aux moyens létaux et la prévention de l'effet Werther (suicide mimétique). Dans plusieurs régions européennes, le concept d'intervention a quatre niveaux de l'European Alliance Against Depression (www.EAAD.net), ciblant simultanément la dépression et le comportement suicidaire, a montré des effets préventifs sur le comportement suicidaire. Il est déjà mis en oeuvre dans plus de 100 régions en Europe.

Keywords: antidepressant; depression; multifaceted intervention; suicide prevention.

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Figures

Figure 1.
Figure 1.. Frequency of suicidal acts and suicides (data derived from OSPI-Europe intervention and control regions [2 or 3 years per country between 2008 and 2011 ]; see ref 2 for details of the study). OSPI-Europe, Optimizing Suicide Prevention Programs and their Implementation in Europe
Figure 2.
Figure 2.. Partly interacting factors contributing to lethality and gender differences in lethality of suicidal acts. Reproduced from ref 2: Mergl R, Koburger N, Heinrichs K, et al. What are reasons for the large gender differences in the lethality of suicidal acts? An epidemiological analysis in four European countries. PLoS One. 2015;10(7):e0129062. Reproduced under the Creative Commons Attribution License
Figure 3.
Figure 3.. Two models concerning the causal relationships between depression and other mental disorders, psychosocial factors, and suicides. Model A is often preferred by sociologists and health politicians, as well as lay people; and Model B, by psychiatrists. Reproduced from ref 26: Hegerl U, Koburger N, Hug J. Depression and suicidality [in German], Nervenheilkunde. 2015;34(11):900-905. Copyright @ Schattauer, 2015
See this image and copyright information in PMC

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