Suicidal behaviour: comments, advancements, challenges. A European perspective.

摘要: Suicidality is one of the most drastic indicators mental ill being. Considering complexity biological, psychological, existential and social causes behind it, as well suicide preventive effect well-being, utmost way counteracting suicidality finally seems to be promotion health activities belonging it. Suicidality in European countries marks out populations at risk, whole societies but also their different layers. Thus, it gives a hint about where burden stressful changes, both societal individual level, significant. The search for protecting factors here important elucidation risk suicide: example, when can seen that young males country, females another society, elderly third country are afflicted, whilst fourth have no all. Often polarity has been claimed exist between those who support idea being consequence disorder genetic biology underlining specific causalities related psychosocial, economic factors. However, modern research, this split having overcome by recognition mutual interaction nurture nature, biological spiritual influences. see pay regard depression majority all completed suicides not medicalize deny complex multidimensional multifactorial causality such, even if predisposition found. In cases, existing sociological, psychological needs depressive perceptual distortion get its decisive suicidogenic effect. As consequence, effective prevention programs complex. They address disorder, with symptomatology cognitive recognised strategies improving clinical practice, they involve sectors society afflicting human's life. That multidisciplinary teams psychiatrists, psychologists, nurses, workers sociologists, access anthropological advice. Regional, national local suicidal designed according these principles Europe today show efficacy. evidence always easy collect. In order statistical power, often single multiple attempts pooled together behaviour. By doing this, however, rather groups evaluated together. Many suicides. This valid regarding gender distribution, age variables such employment marital status. Actually, some elements attempting behaviour respect particular, help seeking through showing helplessness desperation. However, true rare event power should gained. To accomplish better might cluster death external or "undetermined" causes, taking destructive traffic on working places. Experience from countries, especially Eastern societies, shows numbers deaths accident more closely number than attempts, ones. It amazing how disparate results evaluation various types be. aiming only spectrum More consistent, positive results, obtained programs, respond problem comprehensive policy recommended World Health Organization (WHO) Europe. Another challenge present demand control randomisation designs, which difficult obtain research. suicidology, other fields concepts probably widened integrate qualitative research quasi-experimental example population own control, comparing situation before after intervention. Another represented issues. possible existence male depressive, aggressive, very syndrome explanations over-representation substance abuse, personality psychopathy amongst persons. crucial recognise psychopathic alcohol addiction syndrome, females. Its treatment must an intervention fight excessive destructivity. Especially suicide, violence mortality become public problem, urgent develop implement strategies. To prevent does mean counteract provoking facilitating It means strengthening resilience protective could identified. For female populations, many dramatic transition, seem protected against consequences stress, e.g. loss identity, cohesion strong impact males. One lesson learned behaviour, decrease mortality, would strategy increasing men's capacity, facilitate possibilities keep socially connected status times transition. However, screening identifying time tricky task. Diagnostic criteria focusing depressed used questionnaires. Here Gotland Scale Male Depression proved value. Even instruments, WHO-5-Well-being Scale, symptoms shown useful tool. Amongst ways suicides, two approaches special importance. reduction suicide. training programmes directed first line contact (in community, emergency psychiatry primary care), increase knowledge depression, assessment management. awareness raising educational projects schools places useful. In Europe, ardent partly inflamed discussion ongoing role antidepressants Experiences several antidepressant medication base effect, embedded programme detecting, treating monitoring depression. Others claim potential serotoninergic trigger aggressive auto-aggressive risk. Even there known paradoxical rebound effects drug treatments, seems, doubt prevented provoked it. overtreatment occurring, undertreatment dominant today. Finally, isolated phenomenon. part illness death, helplessness, identity insignificance. A linked lack manifested pattern conditions, including reactions, alcoholism, cardiovascular disorders lifestyles self-destructive behaviour. The integrated prevention, patterns morbidity stress society. Modern redefined psychiatric approaches, utilising recent body mind, creating integrated, multisectorial policies, ever foreseen WHO years come.