Towards a greater understanding of suicidal behaviour and its prevention.

Suicidal behaviour continues to be an important topic of research and significant public health
concern globally [1–3]. Each year, approximately 800,000 people worldwide die by suicide, and by
region, the rates are highest in Europe (especially Eastern Europe), South-East Asia, and in some
regions of Africa [2–4]. There are notable gender and age differences in suicidal behaviour, and in most
regions, males are associated with higher suicide rates than females and risk of dying by suicide is
increasing with age [5]. Official suicide statistics are only the tip of the iceberg and the magnitude of the
problem becomes evident when the whole range of suicidal behaviour—attempts, plans, thoughts—are
taken into account [6].
The World Health Organization recommends a public health approach to prevent suicidal
behaviour that focuses on identifying the patterns of suicide and suicidal behaviour of a group
or population. The aim is to change environments in order to protect people against suicidality and to
change the behaviour that put people at risk. The public health approach comprises surveillance, risk
(protective) factor identification, prevention/intervention, and evaluation [3,7].
Research to date has shown that suicide prevention strategies with strong evidence are restricting
access to lethal means, effective pharmacological and psychological treatments of depression,
and school-based mental health awareness programmes. Other promising interventions, with
insufficient evidence so far, are screening in primary care, primary care physicians’ education, general
public education, media guidelines, gatekeeper training, and internet and helpline support [8–10].