Suicidal behavior and its prevention: strategies and therapies

The multicausality of the suicide act phenomenon suggests that prevention strategies must also be multiple and must be applied together to be effective. There is no univocal solution in the prevention of suicide and the best approach is a multidisciplinary approach, and at the same time from an individual and public health level. Being a problem with so much incidence and that, in turn, causes so much pain, in Psychology-Online we wanted to dedicate an article to suicidal behavior and its prevention.

The approach to suicide prevention at the individual level emphasizes the diagnosis, treatment and follow-up of the mental disorder (depression, schizophrenia, drug dependence and stress).

The public health approach has strategies for suicide prevention:

• Carry out mental health campaigns, screening in schools, early diagnosis of drug abuse, depression and stress.
• Carry out specific suicide prevention programs and avoid the stigmatization of suicidal behavior.
• Control access to the means to commit suicide. There is evidence that controlling the possession of weapons decreases the suicide rate, as well as controlling the use of drugs and pesticides. Other measures may include fencing high-rise bridges and windows in tall buildings.
• Support to the media so that the information is adapted to prevention: Training of journalists in the management of information about suicidal behavior, as the media can play a proactive role in helping to prevent suicide. suicide.

The prevention of the suicidal act comprises a series of activities that go from the provision of the best conditions possible for the education of children and young people, the effective treatment of mental illness and the control of risky.

Although risk factors have been identified for the person at high risk for suicide, there is no definitive measure to prevent suicide and very few people with these factors will commit suicide.

Efforts to prevent suicide must be based on research, showing which risk factors and protection can be modified and which groups of people are most appropriate for the intervention (Public Health Service, 2001).

To prevent attempted suicide and completed suicide, it is essential to know the risk factors, which are those that predispose them.

An appropriate dissemination of information and a campaign of social awareness of the problem are elements essential for the success of prevention programs, but suicide prevention can be subdivided into three types:

1. General prevention, which is the set of psychological, social, institutional support or support measures that contribute to citizens are better able to handle stressful life events and mitigate the damage that they may cause.

The World Health Organization (2000) suggests some general measures to prevent suicide:

• Treat mental illness.
• Control the gases of motor vehicles.
• Control domestic gas.
• Control possession of firearms
• Control the availability of toxic substances.

• Reduce sensational reports in the media.

1. Indirect prevention made up of the set of measures aimed at treating mental and behavioral disorders, illnesses physical activities that lead to suicide, crisis situations, reduced access to the methods by which people can self-harm, etc.

Help Centers can offer confidential support for anyone in distress or despair who may be experiencing suicidal feelings.

1. Direct prevention constituted by those measures that help to resolve suicidal ideas and thoughts through alternative solutions. The Practical Guides can help Primary Care health workers to detect and manage the people with suicidal behavior and to refer them for an early assessment by health professionals mental.

And Self-Help Groups allow you to meet other people to share feelings and experiences, which can bring you comfort.

The prevention of the suicidal act is not an exclusive problem of mental health institutions, but of the entire community, its organizations, institutions and individuals.

Early intervention in the person at risk of suicide is necessary and suicide threats and attempts must always be taken seriously, because almost a third of people who attempt suicide try again in a period of one year and about 10% of those who threaten or attempt suicide end up committing the act (Pérez Barrero and Mosquera, 2002).

It is necessary as a preventive measure to have human resources where listening and understanding work is carried out to prevent the person commits the suicidal act (hotline services), as a threat or attempted suicide should never be ignored suicide.

Generally, a person with suicidal risk behavior is a very unhappy person who thinks about committing suicide because they do not have other ways of adapting to stressful life events.

The approach and evaluation of the person with suicidal behavior from mental health is necessary and must be carried out immediately.

The approach and evaluation of the person with suicidal behavior from mental health is necessary and it has to be done immediately.

It is considered useful to know the ten common characteristics in every person with suicidal behavior to do what is appropriate at all times Shneidman (2001):

• The pain psychological is unbearable, therefore, it must be reduced by using understanding and listening, favoring any type of emotional expression that serves as an escape valve from that pain.
• It is convenient to take into account the frustration of psychological needs and accept those needs as real and be impartial.
• Must be given opportunity to the subject to express their situation and understand that for him the solution to the suicidal act is serious, so it can be asked if he has considered other solutions other than suicide and invite you to think of alternatives and inform you that you will help it.
• You need to provide emotional support.
• It is convenient acknowledge feelings of hopelessness and do not fight them with pessimistic expressions, because sometimes these symptoms respond to serious depressions that are not modified with good intentions and advice.
• Given the ambivalence that the person may manifest, it is necessary to seek more positive alternatives and reinforce them.
• The constriction must be recognized early and explore other options that allow a broader vision of possibilities for solving problems.
• Be alert to messages of suicidal intent, because they can be the prelude to suicidal behavior. Therefore, it is essential to ask questions about the presence of a suicidal idea or plan.
• Faced with the possibility of a suicidal act, one must listen and act quickly, because in this condition the individual is at the limit of his possibilities to carry out the suicidal act, and it is necessary to restrict the methods by which the subject can get damaged.
• You need to pay attention to Personality traits of the person, since they can be revealed in the behavior during the interview, as well as their previous ways of reacting in critical situations.

The first psychological help is an immediate supportive intervention that has to reestablish a certain emotional stability, and that can be done by a primary care doctor, psychiatrist, psychologist, neighbor, friend, family member or colleague from study or work. This first aid Matusevich and Pérez Barrero, 2009) may consist of:

• Listen in an empathetic way, without criticism (it is not judged, it is not questioned, it is not advised, nor is it an opinion).
• Create an environment of support, understanding and unconditional acceptance, accepting her feelings and the person at risk of suicide and showing interest in her.

• Ask open questions to facilitate the expression of feelings and thoughts and generate a climate of trust.
• Generate alternatives and strategies for the problems that you raise without giving advice.
• Do not express confidentiality.
• Assess suicidal danger and ask directly if necessary, suicidal danger cannot be ignored or not explored.
• Make the practical and necessary decisions to protect the person at risk of suicide, being directive and involving family members and health care providers.

If the person has already made a suicide attempt, the first measure is to save your lifeTherefore, it is necessary to rely on a doctor who evaluates the possible damages and imposes the opportune treatment that prevents future sequelae. But if the subject is in a condition to cooperate, communication must be facilitated with the intention of knowing what the motive behind said behavior has been (Maris, Berman & Silverman, 2000).

Some signs of a suicide attempt can be:

1. Being able to rest from the overwhelm of an intolerable situation.
2. Express anger, dissatisfaction, frustration.
3. Outbreak of a relevant psychiatric illness.
4. Reaction to the loss of an emotional relationship.
5. Emotional blackmail and claim for support.
6. Assaulting others
7. Avoid physical pain or fatal illness.

When faced with signs of a suicidal act, it is advisable to try to find out if there is an immediate risk of suicide, asking if you intend to do it or have you just thought about it, if you have a plan and when you would take it cape. Most of the time there is no imminent risk of suicide, but if so, don't hesitate to call the police.

In this situation it is convenient (Ancinas and Ancinas and Muñoz Prieto, 2008):

• Do not leave the person alone You should not leave the person alone even if you have already made telephone contact with an appropriate professional. They need to feel accompanied.
• Don't make him feel guilty.
• Don't dismiss his feelings by pointing out that to him. that suicidal thoughts and wishes are always temporary.
• Express support and understanding. And allow the expression of feelings.
• Avoid access to instruments that can be used to carry out the suicidal act.
• Support you to be treated by a mental health professional or a health center.

There is no single therapeutic approach to the suicidal act, but the beneficial effects of drug therapy and cognitive behavioral therapy or the combination of the two.

Cognitive behavioral therapy It is intended to modify behaviors and thoughts and uses techniques such as assertiveness, relaxation, cognitive restructuring, problem solving, social skills training, and contingency management, which can reduce depression, anxiety, and lack of social skill.

Suicide causes suffering in the victim but also in close people (Jacobsson and Renberg, 1999).

Suicide involves the emotional, social, and sometimes financial devastation of family and friends. Both a suicide attempt and a completed suicide have emotional consequences for anyone involved. The person's family, friends, and doctor may feel guilty, ashamed, and remorseful for not being able to prevent suicide.

Family members and friends of the person who commits suicide may experience a wide range of conflicting emotions about the deceased person, feeling all the intense emotional pain and sadness over the loss, and anger at the deceased because the person abandoned by the suicide of a loved one, tends to experience a complicated grief in reaction to that loss with symptoms such as intense emotions, intrusive thoughts about the loss and a feeling of isolation and emptiness (Sáiz Martínez, 2005).

After the suicide of a loved one, family and / or friends can often have a feeling of shame, which leads to not wanting to talk about the circumstances of death. You can also give a guilt. Guilt is normal after such a death. One reproaches oneself for not having realized how bad it was... and there is usually a strong feeling of not having known how to take care of him. You may also feel rage and anger towards the person who committed suicide and towards all those who have been able to contribute directly or indirectly in carrying out this action.

So when someone is lost to suicide, a wide variety of feelings, including guilt, resentment, confusion, regrets, and concern about unrelated problems. resolved.

Many will feel guilty thinking that they have failed to support you or will blame themselves for not realizing it.

The family member or friend must be able to express their pain and his feelings, as it alleviates suffering and helps to move forward.

It is possible that you will not be the same as before, because there are things that are never completely overcome and you have to learn to live with that.

You have to be able to grieve to overcome the loss of a loved one; And so that it does not turn into a complicated grief, it is necessary to go through an emotional process that allows accepting the death of the loved one, assuming wear and tear and emotions that death generates, adapting to the absence of a loved one, learning to live without him and internalizing death as something else that is part of life (Rocamora Bonilla, 2000).

Children should be told the truth. Not knowing what happened will not do them any good and if they find out through someone else they could lose trust in you.

When someone they love commits suicide children may feel the following: (Maris, Berman and Silverman, 2000):

1. They may think that the person who committed suicide did not love them and they feel abandoned.
2. They may think that they are guilty of suicide, especially if at some point of anger they wished the death of that person.
3. They may be afraid of dying too.
4. They may feel sad, confused, lonely.
5. They may feel ashamed to see other people or to go back to school, because they feel different.
6. They may feel anger towards the suicide or towards the whole world.
7. They can deny what happened or pretend that nothing happened.
8. They can enter a state of emotional numbness.

It is convenient to explain to children that people die in different ways: some from illness, others from car accidents, and others kill themselves. They must be told that despite the suicidal act their father or mother loved them very much, but that her illness prevented them from doing so.

On the other hand, it is advisable that the media (WHO, 2000) observe some conditions to favor prevention:

1. Have authentic and reliable sources.
2. Avoid expressions of suicide epidemic.
3. Report suicide as inexplicable or simplistic.
4. Describe suicidal act as a method to cope with problems.
5. Praising suicidal behavior as having values.
6. Describe the impact and suffering on family members.

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.