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Suicidal Behavior Prevention: The Time to Act is Now

prevention strategies save lives. Thus, suicidal behavior prevention is everyone’s business. An important fact to remember about suicidal behaviors is how widespread they are. Globally, suicide is an enormous social and public health issue accounting for almost a million deaths annually, with another twenty attempts for each death by suicide (World Health Organization [WHO, 2014]). The human cost associated with suicidal behavior for individuals, families, communities, health care, and society is beyond doubt. Despite these data and decades of research into suicidal behavior, there are still significant gaps among policy, research, prevention, and clinical practice. For example, in Spain, in the 21st century there is still no national strategy for suicidal behavior prevention (although there are interesting local and provincial multidisciplinary initiatives). Nor is there a national Spanish center for the prevention of youth suicide—or anything similar—to address this issue in adolescents and the general population. Nonetheless, increases in the rates of death by suicide are not inevitable. In fact, currently we are facing a situation which, by its very nature, can only be tackled by prevention. This is a moment in history when suicidal behavior prevention must be prioritized as a global health concern. If specific and evidence-based strategies can be implemented with COVID-19-specific threats to the population’s mental health and suicide risk in mind, this pandemic may provide not only a sense of “now is the time”, but also a path forward for addressing suicide risk at national and community levels. Completed suicide is one of the leading causes of years of life lost due to premature death, the leading external cause of death in many countries, and one of the world’s leading causes of death among adolescents and young people (WHO, 2014). In Spain, the latest report from the National Institute of Statistics states that 3,671 people lost their lives by suicide (Instituto Nacional de Estadística [INE, 2019]). On average that is ten deaths a day, one death every two and a half hours (one every forty seconds if we consider the global level), and almost 73,000 attempts (some with serious consequences). The surprise that people usually feel when someone reveals these numbers is only comparable to the importance of the issue. Despite these overwhelming numbers, it is still a phenomenon surrounded by stigma and taboo as well as myths and false beliefs, even among mental health professionals (Al-Halabí, García Haro, Rodríguez Muñoz, et al., 2021), which is another barrier to tackling and preventing it (Fonseca-Pedrero & Pérez de Albéniz, 2020). In many situations, the stigma associated with completed suicide leads to a death being declared an accident rather than a suicide if there is ambiguity around the circumstances in which it occurred. Faced with this, we must stop thinking that the taboo of suicide comes from any “natural” principal preventing attempts on one’s own life, and instead face the challenges (including the existential challenges) it raises. However, there is more. This is not only about completed suicide, we must also be aware of the broad range of suicidal behaviors that can be present. Suicidal behavior refers to a variety of manifestations, ranging from ideation and planning, through suicidal communication to suicidal attempts and completed suicide. Attempted suicide is much more common than completed suicide, and suicidal ideation, or thinking about suicide, is by far the most common form of suicidality (Chiles et al., 2019). In any case, this is not one single phenomenon, as each of its manifestations can vary in intensity, control, duration, lethality, impulsivity, or functionality, among other aspects. The numbers can also vary depending on different factors such as age, gender, education, or country. Cultural differences can be important. For example, during the last twelve months, 4.5% of adolescents have tried to end their lives, 7.5% had a plan to attempt suicide, and 14.2% had suicidal ideation (Lim et al., 2019). Women attempt suicide three times more than men, but men die by suicide three times more than women, with some exceptions, such as in China (Chiles et al., 2019). Moreover, these expressions which do not result in completed suicide, such as previous attempts, are among the main risk factors for completed suicide, although not without some debate (Berman & Silverman, 2017; Chiles et al., 2019). Regardless of that, each attempted or completed suicide means not only suffering for persons themselves, but for their families and those close to them, who often feel helpless, left unable to respond by the potency of a suicidal act, and without institutional resources to fall back on. It is not the aim of this text to talk about postvention, but if prevention fails, support must be offered to those close to the person who has died by suicide. Most receive help within their own wider social environment. In some countries and areas, therapeutic support is available and offered in a Clínica y Salud (2021) 32(2) 89-92