مقاله انگلیسی رایگان در مورد جلوگیری از خودکشی – الزویر 2024

Summary

The public health approach to suicide prevention requires us to move away from thinking about suicide as a purely clinical problem and to pay heed to the array of social determinants (such as financial hardship or domestic violence and abuse) that might lead people to consider suicide as an option. Clinical factors are important, and, indeed, clinical or indicated interventions are entirely appropriate for people who have reached a point of crisis and should be a mainstay of national suicide prevention strategies. However, our Series stresses the need for selective and universal interventions that tackle the pervasive problem of suicide in a more upstream way, preventing people reaching a crisis point. Many social determinants can best be addressed by sectors outside health, so we are calling for a whole-of-government commitment to suicide prevention. We make recommendations for actions in the areas of policy, practice, research, and advocacy. People with lived experience of suicide should have genuine involvement in all of these actions.

Introduction

The Comprehensive Mental Health Action Plan, initially released by WHO in 2013 and updated in 2021, sets a target of a 30% reduction in the suicide rate internationally by 2030.1 Figure 1 indicates how the annual figures are tracking against that target.2 In 2013, the age-adjusted global suicide rate was 10·0 per 100 000 population, and by 2019, the year for which the most recent international data are available, the figure was 9·0 per 100 000 (a 10% decrease), which seems promising. However, the trend line suggests that the reduction might be levelling off. In addition, the aggregate figures mask between-country and between-region inequalities. Low-income and-middle-income countries (LMICs), which account for 77% of the world’s suicides,3 have not fared as well as high-income countries (HICs) in reducing suicide, with factors such as access to means,4 poverty,5 alcohol use,6 and domestic violence and abuse7 being implicated. Suicide rates have also varied over time according to region, with a notable outlier being the Americas. The suicide rate in that region has not reduced, potentially due—at least in part—to a failure to address gun ownership in the USA.8 In this Series, we have argued that the only way we will make substantial inroads into the major problem of suicide is by reorienting suicide prevention activities through a public health approach.

Conclusion

Widespread adoption of a public health approach to suicide prevention is crucial for ensuring that the overall decreases in suicide rates that are being seen globally continue on a downward trajectory and occur across countries and regions. Suicide is a societal issue that requires a societal response; preventing suicide is everybody’s business. Garnering cross-sectoral commitment from all levels of government and meaningfully involving all stakeholders at every step on the journey will be transformative.