Congress on Preventive Psychiatry
Athens, 1999 Feb. 24-28

Biopsychosocial background and prevention of suicide

In this synthetic review, we briefly describe the possible risk factors of suicide and those recent strategies that have been proved to be effective methods of reducing the suicide rate. Psychiatric illness, first of all the affective disorders (particularly in the case of a previous suicide attempt), are the most powerful predictors of this manner of death. The contributing role of depression in suicide mortality may be of particular relevance in Hungary which traditionally has one of the highest rates in the world. In agreement with the international data we found that the vast majority of 200 consecutive suicide victims have had a recent psychiatric disorder, in 50% primary major depression. Besides biological factors suicide can be understood by terms of social psychology, so macrosocial, microsocial and individual levels can be analysed to perceive these phenomena. To work on prevention of suicide, first we have to know the risk factors. These can be divided to primary, secondary and tertiary ones. Primaries are psychiatric and somatic illness, previous suicide attempt, and notification of suicide intent. Secondary risk factors are early parental loss, isolation, financial problems, negative life events. As tertiary risk factors male gender, old age, spring and premenstrual period can be accepted.

Early recognition and appropriate treatment of affective and other psychiatric disorders, as well as aftercare of persons with a high suicide risk are, consequently, the most successful methods of preventing suicide. Training health care workers, in order to increase their knowledge on the means of suicide prevention and educating patients so as to improve their compliance is highly beneficial.

Marked increased activity in postgraduate training in depression, in emergency training, and in public education is reflected in the significant increase of anti-depressant prescription during the last 7-8 years in Hungary. These data suggest that better recognition and better treatment of depression play an important role in suicide prevention. Sufficient care for attempted suicide patients means not only an adequate anti-depressant and mood stabilizer medication, but widely used psychotherapeutic interventions too.

J. Furedi, Z. Rihmer
Imre Haynal University
Institute of Psychiatry, Budapest

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