Suicidal behavior-advances in clinical and neurobiological research and improvement of prevention strategies

Abstract

Suicide is the 14^th leading cause of death worldwide. It is responsible for 1%-5% of all mortality. This article highlights the latest developments in universal, selective, and indicated prevention strategies. Concerning universal suicide prevention, current research has shown that strategies such as restricting access to lethal means (e.g., control of analgesics and hot-spots for suicide by jumping) and school-based awareness programs are most efficacious. Regarding selective prevention, substantial progress can be expected in psychological screening methods for suicidal behavior. The measurement of implicit cognition proved to be more valid in predicting future suicide attempts than classic clinical assessment. Latest developments are smartphone-based interventions and real-time monitoring of suicidal behavior. Great effort has been made to establish valid neurobiological screening methods (e.g., genetic and epigenetic risk factors for suicide, hypothalamic-pituitary-adrenal axis) without yielding a major bre-akthrough. Potentially, multiple biomarkers rather than a single one are necessary to identify individuals at risk. With regard to indicated prevention in form of psychopharmacological treatment, recent pharmacoepidemiological studies and meta-analyses have supported a protective role of antidepressants, lithium, and clozapine. However, the data concerning a specific anti-suicidal effect of these drugs are currently not consistent. Promising results exist for ketamine in reducing suicidal ideation, independently of its antidepressant effect. Concerning psychotherapy, recent findings suggest that psychotherapeutic interventions specifically designed to prevent suicide re-attempts are most efficacious. Specifically, cognitive behavioral therapy and psychodynamic therapy approaches proved to decrease the number of suicide re-attempts significantly.

Keywords: Antidepressants, Biomarkers, Cognitive behavioral therapy, Ketamine, Prevention, Suicide

Core Tip: This Editorial highlights recent developments concerning suicide prevention. According to current research, measures such as restricting access to lethal means and school-based awareness programs are the most efficacious universal prevention strategies. Novel psychological screening methods for suicidal behavior (implicit cognition, smartphone-based interventions, and real-time monitoring) have improved suicide risk assessment. Pharmacoepidemiological studies and meta-analyses support a protective role of antidepressants, lithium, and clozapine. Promising results exist for ketamine in reducing suicidal ideation. However, its suicide-preventive effect is under debate. Specific psychotherapeutic approaches for suicide attempters that focus on suicidal episodes proved to be efficacious for reducing suicide re-attempts.