Citation

Michail M, Witt K. Crisis 2023; 44(4): 261-266.

Copyright

(Copyright © 2023, International Association for Suicide Prevention, Publisher Hogrefe Publishing)

DOI

10.1027/0227-5910/a000905

PMID

37540133

Abstract

Over 700,000 people die by suicide every year (World Health Organization [WHO], 2021). Despite increasing investment in suicide prevention activities from many governments worldwide, rates have continued to rise over the past 30 years (Yip et al., 2022). This is because suicide is complex and addressing this complexity is our Achilles heel. There are several factors that contribute to the complexity behind suicide. First and foremost, suicide is rarely the outcome of a single factor. Many suicide deaths are associated with a gradual and increasing build-up of vulnerability associated with multiple, interacting, and interrelated biological, psychological, socioeconomic, cultural, and political factors (Hawton et al., 2012). Put simply, there are many and different pathways that could lead to suicide. This equifinality means that mapping the causal processes and interactions that underlie suicidal behavior, at least within the context of the methodological approaches currently favored by the field (e.g., meta-analyses, regression models), can be very challenging (Franklin et al., 2017).

Second, a multifaceted public health approach to suicide prevention requires planning and coordination between complex systems including health, social care, education, the justice system, and the voluntary sector (WHO, 2012). Each of these systems is characterized by multiple, interrelated entities including financial and human resources, organizational structures, funding models, and at the core of all, those with lived and living experience of self-harm/suicidal behavior, whose needs can change rapidly over time. When a system entails so many moving parts, it can be difficult to know when and how to intervene, what interventions to offer, for how long, and with what intensity to generate the most significant reductions in suicide rates (Occhipinti, Skinner, Iorfino et al., 2021). We therefore often resort to the deployment of comprehensive and multisectoral suicide prevention strategies (WHO, 2018), with the assumption that investing in more interventions or more policies across all levels (universal, selective, targeted) will simply confer better results (Occhipinti, Skinner, Iorfino et al., 2021; Occhipinti et al., 2022). The question remains, however, as to whether this is the most efficient and effective way of informing decision-making in suicide prevention policy and planning.

Language: en