Suicide constitutes a significant public health issue contributing significantly to global mortality rates. According to the World Mental Health Organization (WHO), more than 700,000 people die yearly, and many more attempt suicide.1
Suicidal behavior needs to be understood and addressed from its multi-level and complex nature, as it emerges from the interaction of dynamic individual and group-level risk factors.2,3 Despite considerable efforts, advances in this area are still needed, not only to better understand how and why suicidal behavior occurs but also to develop and implement prevention programs to effectively reduce suicide rates, especially for high-risk groups.
This issue gathers relevant work that expands the current knowledge regarding essential topics. Considered together, this issue aims to contribute to a better understanding of suicide trends and their interplay with personal and contextual factors and provide insight into effective preventive actions.
Differences in suicide rates are based on age, sex, country, and time period. Studies presented in this issue shed light on suicide trends in Spain, considering different perspectives and pre-and-post pandemic periods. On the one hand, Cayuela et al.4 analyzed the effects of age, period, and cohort suicide mortality trends in Spain from 1984 to 2018, while Blanco and colleagues5 studied epidemiological characteristics and hospitalization trajectories before suicide in Galicia from 2013 to 2016. Two other reports focused on the post-pandemic era to better elucidate the impact of COVID-19 on suicide behavior. An original article by de la Torre-Luque et al.6 used national data to study mortality trends in the COVID-19 period, finding that despite an initial lack of effect, suicide risk seems to have increased post-pandemic. Adding to this report, Merayo-Cano7 et al. shed light on the worrisome socio-economic side-effect of the pandemic translated in terms of the years of potential life lost.
A couple of articles in this issue studied relevant determinants of suicidal behavior, including environmental factors such as temperature (Asimakopoulos8) and the use and abuse of ethanol and illicit drugs (Morentin et al.9), showing the importance of taking a broad perspective when considering suicide determinants.
Caldieraro et al.10 and Gomes-da-Costa et al.11 present data on follow-up programs for at-risk individuals. The findings by Calieraro et al.10 remind us of the relevance of going beyond standard care for individuals at risk of suicide and providing them with tailored interventions that could specifically tackle suicide risk. In this line, Gomes-da-Costa11 et al., showed that a specialized protocol reduced hospitalizations and mental care use in the first year after presenting a suicide attempt, known as the most critical period for re-attempting.
Other relevant studies in this issue address essential issues regarding suicidal behavior in specific vulnerable populations. Using network analysis, the study by Fonseca-Pedrero12 highlights the interconnected and dynamic nature of suicidal behavior and claims to consider this complexity when developing theoretical models of suicidal behavior. On the other hand, García-Ramos et al.13 provide evidence of the vulnerability of the police force and the importance of implementing preventive actions in this group.
Finally, this issue includes a thorough systematic review and meta-analysis on the efficacy of psychotherapeutic interventions for non-suicidal self-injury in adolescents by Pérez Arqueros14 and colleagues and an indispensable overview of the history of child psychiatry in Span by Castro-Fornieles and Toro.15
Efforts to understand suicide trends and risk/protective factors are starting to pay off, as research has demonstrated that the complexity and multi-determined nature of suicide behavior is undeniable. Still, much work is needed. We now must elucidate how these factors interplay to translate that knowledge into effective public policies that, once and for all, reduce suicide rates.