Suicidal behaviour is a serious public health concern causing approximately 800,000 deaths per year worldwide. In 2016, the global age-standardised suicide rate was 10.5 per 100,000 inhabitants.1,2 Suicide is among the 10 most common causes of premature death and potential years of life lost (PYLL) in several regions of Europe, Central Asia, Australasia, South America, the Caribbean, and North America, representing 2.2% of total PYLL worldwide.3
According to the World Health Organisation (WHO), suicidal behaviour encompasses a range of behaviours including suicidal ideation (thoughts of suicide), suicide planning (planning of the method or suicidal procedure), attempted suicide (potentially harmful, self-inflicted non-fatal behaviour, with implicit or explicit evidence of intention to provoke one’s own death) and suicide (self-inflicted death with implicit or explicit evidence of the intention to provoke one’s own death).1,4
Suicidal behaviour can occur at any point in the life cycle. Suicide is the second cause of death among young persons aged 15 to 29 years worldwide (after traffic accidents), causing 8.5% of all deaths, and is the fourth cause of death in persons aged 35 to 54 years;1 the highest suicide rates, however, are found in older adults.3 Differences are also observed by sex, with rates being higher in men than in women. In 2016, the worldwide age-standardised suicide rate was 1.8 times higher in men than in women.2
Suicide and suicide attempts have terrible consequences, not only for the individuals themselves but also for their families, friends, and society in general. In terms of health, persons making a suicide attempt may experience depression, feelings of rage or guilt, and more or less permanent physical effects, depending on the suicide method used and the seriousness of the attempt.5 The families, friends and people close to individuals who have lost their lives through suicide (suicide survivors) may experience complicated mourning, depression, anxiety, and post-traumatic stress syndrome, and have a higher risk of suicidal ideation and suicide.6,7 In economic terms, the estimated medical and occupational costs (productivity losses) due to suicide in the United States represent $50.8 billion per year.8 In Spain, these costs amount to approximately €565 million.9
In Spain, 3,679 persons (2,718 men and 961 women) died by suicide in 2017, representing a suicide rate of 7.9 per 100,000 inhabitants.10 In Catalonia, the suicide rate was 6.6 per 100,000 inhabitants, but suicide represents the third cause of premature death, both in men and in women (with a mean of 24 and 23.2 PYLL, respectively).11,12
Suicidal behaviour is a complex and multifactorial phenomenon. Multiple risk factors and protective factors have been identified–biological, psychological, cultural, and environmental (for example, mental health problems, drug abuse, socioeconomic deprivation, and difficulty in accessing treatment, among other factors).1 However, there is still no consensus-based explanatory framework for suicidal behaviour.
One of the main risk factors for suicide is a prior suicide attempt. Attempted suicide is more common than suicide and it is estimated that for each suicide there are more than 20 suicide attempts.1 Worldwide, the estimated lifetime prevalence of adult suicide attempts is 2.7%.13 However, the reliability of surveillance of suicide attempts is lower than that of suicide deaths, due to the lack of standardised procedures for registering suicide attempts.1,14
In this regard, the WHO advocates centralisation of electronic medical records to improve surveillance of suicide attempts and risk factors possibly associated with suicidal behaviour. 15 Analysis of big data and the use of new data science technologies, such as machine learning, can offer new opportunities to gain greater insight into suicidal behaviour. 16
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