The other day I found out that my friend’s daughter had attempted suicide. What a disappointment! Good thing she didn’t make it and that she’s recovering from the attempt. María, 23, is nice, has many friends and is studying medicine, which is the dream of her life.

Apparently no problem. His friends would never have thought that something like this could happen. And yet, perhaps Maria had sent signals that went unnoticed in her environment.

A global problem

Each year, more than 700,000 people die by suicide . In America alone in 2019 , more than 97,000 deaths were reported for this reason . The region with the highest suicide rate is North America with 14.1 per 100,000 inhabitants. In South America there are 3.9 per 100,000 inhabitants.

In Spain, according to INE data , 4,003 people took their lives in 2021, which represents an increase of 1.6% compared to the previous year. This means that every day 11 people die by suicide. These are very worrying data, since in 2020 the figure already increased by more than 7.3% compared to 2019.

Regarding sex, 75% of the Spanish deceased are male (2,982), compared to 25% female (1,021), although the latter register more attempts.

It should also be noted that it is the leading cause of mortality in people under 29 years of age. 316 individuals in this age range died by suicide compared to the 299 who died from traffic accidents or the 295 who succumbed to tumors.

And furthermore, deaths in children under 15 years of age have doubled .

Access to university is a turning point . Students begin to become young adults and have to adjust to many changes in their lives. Many will move, stop living with their parents, meet new classmates… In addition, they will have to face new academic requirements, evaluation forms, jobs, etc.

As an aggravating circumstance, health professions students have to face clinical practices, the first gateway to experiences such as illness, suffering or death. To this must be added the responsibility and burden that an error can entail. In a recent study in the United States, it was possible to see how the risk of suicide in health personnel was greater than in the general population.

What are the warning signs?

Ideation is a fundamental element in the process of suicidal behavior, since it generally arises as a precursor and trigger of the attempt.

The signs that can alert us to whether a person is having these types of ideas can be of two types: verbal, what they say with their words, and non-verbal, what they communicate to us with their actions.

• Verbal signals range from derogatory comments about their life or towards themselves to farewell phrases, about the desire not to be there, to sleep and not wake up again, or about death.
• As non-verbal signals or behaviors, it is worth mentioning the search for information about suicide methods, sudden changes in behavior or their way of being and acting (irritability, isolation and changes in sleep rhythms, appearance or hygiene), haste to close unfinished business, gifts of personal belongings, etc.

Given the suspicion, what should we do?

If at any time we come across someone who may be considering taking their own life, we must take into account some basic guidelines for action.

First of all, keep your own calm. The person in crisis is afraid and is suffering a lot; it is important not to overrespond. They need to feel understood and respected and that their feelings are not trivialized. You have to talk to him, convey to him that we care and that we are concerned about his problems.

We must maintain a proactive attitude, provide presence and availability. Tell them: “I’m here for whatever you need”, “let’s have a coffee”, “let’s talk”… Do not wait for the person to ask for help, since many times they will not do it.

If it seems that the risk of suicide is immediate, we must accompany that person to the hospital emergency room or ask for help by calling 112, the emergency telephone number in a large number of countries , the specific number for suicide care in Spain (024) or the Hope Telephone (717 00 37 17). It is important not to leave him alone and keep him away from objects that could injure him.

In Spain, despite the seriousness of the problem, there is still no national suicide prevention plan, although at the regional level there are multiple action plans for suicidal behaviour. On February 23, the proposal for paid leave to accompany people at risk of taking their own life was approved in Congress .

If there does not seem to be an imminent risk, then we must look for support figures, seek professional help and call 024 or the Hope Telephone.

Books, applications and associations

For those who want to continue learning about suicidal behavior, there are institutional guides or specific books such as Suicide Prevention. A guide to help you help , by Paula G. Valverde Fonseca; Stop suffering or stop living. The duality of suicide , by Enrique Galindo Bonilla and Francisco José Celada Cajal; or The table of life , by Enrique Galindo Bonilla.

Help apps can also be very useful for both professionals and the general public, as they offer quick and accessible information . Prevensuic and Más caminos stand out .

It is also essential to offer and learn about the work carried out by associations and aid resources:

• Mental Health Confederation Spain .
• The Association for Investigation, Prevention and Intervention of Suicide and Relatives and Relatives in Grief by Suicide (RedAIPIS-FAeDS) .
• Spanish Foundation for Suicide Prevention .
• Spanish Society of Suicidology .
• Association for Suicide Prevention and Survivor Care (APSAS) .
• Association of Professionals in Suicide Prevention and Postvention (PAPAGENO) .

And, finally, it is important that the universities hold informative awareness days and events. They should talk about suicidal behavior; explain the influential factors, both risk and protective; dismantle the myths and false beliefs around suicide; and provide prevention and intervention tools to act against suicidal ideation.

Author Bios: Ana Isabel Cobo Cuenca is Professor at the University of Castilla la Macha (UCLM). IMCU Group and Francisco Jose Celada Cajal is in Health Psychology, Emergency Picology, Emergency Nursing, Critical Patient Care both at the University of Castilla-La Mancha