Suicide is still a taboo subject in our society today; it’s difficult for us to understand how such a radical and permanent decision can be made in the face of aspects and perceptions that are sometimes only temporary, a topic around which many myths still revolve, which we will debunk in this article. From healthcare settings, we continue to fight to raise awareness about this issue, as suicide is an increasingly serious public health problem.
According to data from the World Health Organization (Värnik, 2012), between 800,000 and 1,000,000 people commit suicide worldwide each year, representing a rate of 11.4 people per 100,000 inhabitants, while in Spain, there are between 2,500 and 4,500 completed suicides annually and around 25,000-50,000 suicide attempts. With these alarming figures, there is a noticeable lack of clear and visible preventive awareness, unlike other potential causes of death, such as traffic accident victims, despite their numbers being lower (Sáiz and Bobes, 2014).
Predisposing and Protective Factors for Suicide
There are several predisposing factors for suicidal attempts, such as having suffered traumatic events in childhood, having a previous history of suicide attempts or suicide in the family, showing a high level of impulsivity/emotional instability, or lacking adequate coping resources.
Social isolation is especially relevant in the elderly and adolescents (Blasco-Fontecilla et al., 2010), and among adults, we increasingly encounter what is called “balance suicide” – individuals who find themselves in an economic, family, or social situation where they judge that life has lost its value and meaning, or they feel they lack the strength to face more difficulties, there is a weariness of life, and a radical loss of the desire to live occurs (Bobes et al., 2011).
At a psychological level, protective factors include adequate self-esteem, cognitive flexibility, or controlled impulsivity, emotional stability, and appropriate psychological coping resources, especially in the area of conflict resolution or social skills. Likewise, an individual’s repertoire of values, whether religious, spiritual, or altruistic, can to some extent neutralize defeatist thoughts or suicidal ideation (Mann et al., 2005).
Finally, certain social factors such as having rich social relationships, being culturally integrated, having family support, or having young children (especially in the case of women) enhance resilience against suicide. Even domestic animals (dogs especially) can constitute a protective shield against their owners’ suicidal tendencies because they are expressive, offer companionship, and bring joy to their owners (WHO, 2014). Furthermore, a very important protective factor is seeking medical or psychological treatment.
What are the main false beliefs about suicidal acts?
- Is it true that if we dare someone to commit suicide, they won’t do it? This attitude is playing with fire and reveals a lack of empathy towards the affected person. To debunk this belief, it’s important to understand that most of the time, we are talking about people whose protective mechanisms have all failed, who feel they have lost all control over their lives, reaching a state of learned helplessness (Seligman 1975). Therefore, the last thing they need is a provocation to commit such an act. On the contrary, we must encourage the patient to develop some kind of hope and control over their behavior (Bobes et al., 2011; Saiz et al., 2014; Tarrier et al., 2008) and focus on factors that can be modified, such as mental disorders, stress situations, coping strategies, or social isolation (Bobes et al., 2011; WHO, 2014).
- Is suicide an act of courage? The conclusion that life is no longer worth living is not a desirable outcome. Self-destruction is a tragedy that brings a high level of suffering to the potential victim even before it happens, and it persists long after the act is perpetrated, affecting family, friends, and close ones, leaving an intense feeling of consternation and emptiness; it never inspires admiration among those left behind.
- Do we inherit suicidal tendencies? This belief is used in some family branches that have suffered a comorbid history of mental disorders and will ultimately depend on their coping mechanisms.
What we can state is that suicide covaries with factors such as age and sex. We know that the elderly make fewer suicidal attempts than young people but use more effective methods when attempting it, leading to higher lethality (Värnik, 2012), or that women make three times more suicide attempts than men, but men succeed in completing suicide three times more often than women. - Is suicide characteristic of people with mental disorders or illnesses? It is true that suicide occurs more frequently among this group, especially when there is an exacerbation of a psychopathological disorder or a painful chronic illness, or when unwanted social isolation occurs, but this does not imply direct causality.
In fact, multiple life stresses (job loss, death of a spouse, etc.) have a certain predictive value, but only in vulnerable personalities with impulsive and aggressive tendencies and few coping responses (Blasco-Fontecilla et al., 2010). Therefore, illness or disorder is neither a sufficient nor a necessary condition.
Regarding assessment, it is important to use validated instruments, such as the Beck Depression Inventories BDI-II (Beck, Brown, and Steer 1996) or Hamilton (HDRS, 1960), or the Hopelessness Scale (Beck, Weissman Lester, and Trexler, 1974), along with clinical interviews with the patient and family members. - If they say it, they won’t do it? A false belief based on the supposed secondary benefits the victim would gain from stating suicidal behavior. In reality, it denotes a clear lack of empathy. From a professional standpoint, we must understand that the individual presents in an ambivalent position: they wish to die if and only if their life continues in the same way, but they wish to live if significant changes occur in it (Blasco-Fontecilla et al., 2010).
- If they do it, they don’t say it? More than 50% of people who complete a suicidal act express their intentions beforehand in one way or another. Many people who take their own lives have talked about it before or given warnings, so any announcement of self-inflicted death should always trigger a red alarm light (Mann et al., 2005; Saiz and Bobes, 2014).
- Does talking about suicide encourage it? Absolutely not. This is a widespread popular belief, related to a misinterpretation of the Werther effect, and **it has no support among psychology professionals. Suicide is not contagious.** A professional will never fail to address the topic with frankness, honesty, and unconditional acceptance. We must consider that in the appropriate treatment of a disorder comorbid with the possibility of suicidal acts, for example, depression, suicidal intentions will progressively disappear as therapy progresses. We will encounter three levels: emotionally, intense suffering; behaviorally, a lack of psychological resources to cope; and cognitively, a deep hopelessness about the future, accompanied by the perception of death as the only way out (Bobes, Giner, and Saiz 2011). After treatment and in interviews with victims of non-completed suicides, they express satisfaction at not having died once the suffering has been controlled (Spirito and Donaldson, 1998).