Suicide Prevention. Interview with Prof. Giuseppe Bersani.
In Italy, around 4,000 suicides are recorded each year (source: ISS). The data refers to people over 15 years old, as suicide episodes are very rare in childhood. According to UNICEF's publication (“Child and Adolescent Mental Health - The State of Children in the European Union 2024”), suicide is the second leading cause of death among young people aged 15 to 19 in Europe, after road accidents. These are significant numbers. Despite suicide prevention being identified as a priority by many international institutions, only a few countries in the world have developed or are developing a strategy on the matter, and Italy is not yet among them. We asked Professor Giuseppe Bersani, a medical doctor specialized in psychiatry at UPMC Salvator Mundi International Hospital, to talk to us about this topic, which is still too often taboo.
Professor, why is it important to talk about suicide?
The death of a person by suicide deeply affects family members, friends, and the community. Recognizing verbal and behavioral warning signs is an important step in preventing it, but it's not easy. Often, people try to interpret what they see, but what they see is not always what it is. Moreover, even when these signs are identified, it is not always clear what to do and how to intervene. There are still false beliefs and common myths about suicide. Most people consider suicide a difficult topic to address. They might think that asking someone if they are having suicidal thoughts means putting the idea of suicide into their head, or they fear they might not be able to help or might make the situation worse.
If you suspect someone may be depressed or having suicidal thoughts, asking them can open up a conversation and show that person you are there for them and want to help. You may not have the necessary clinical skills, but compassion, empathy, and attention are often very helpful. You can ask direct questions like “Are you thinking about killing yourself? Have you done anything or are you ready to do anything to end your life?”
These questions show that you care about the person and their suicidal thoughts and that you are willing to talk about it. It's important that they know you won't judge them. I believe we have a responsibility to overcome the stigma, to raise awareness that this is not a sign of weakness, but is like any other medical situation, illness, or disorder.
Who is most at risk?
Suicidal thoughts can affect anyone, but the presence of a known mental health condition certainly plays a predominant role. In fact, only a small part of those who take their own lives show no psychiatric symptoms before death. 90% of suicides are associated with the presence of a mental disorder; in 60% of cases, it is major depression. According to statistical data, the main risk factors in suicidal ideation are depression, schizophrenia, bipolar disorder, post-traumatic stress disorder, eating disorders such as anorexia or bulimia, and borderline personality disorder.
But the disorders listed above are not the only risk factors. Suicide is the result of various genetic, biological, individual, and environmental factors, including a family history of suicide, trauma or abuse, stress, recent tragedy or loss, alcohol or drug use, access to firearms, severe or chronic health conditions, gender (women attempt suicide more often than men, but men are much more likely to die by suicide), and episodes of bullying and cyberbullying, especially among young people.
Often, the link between all the risk factors is uncertainty and loss of hope for the future, the belief of being a burden to others, and little fear of death and pain. However, suicide can be prevented if we can intervene in psychological distress and restore hope to the person in crisis.
Professor, what are the signs that should not be underestimated and to which attention should be paid?
Although some attempted or completed suicides happen unpredictably for family members and friends, most do not occur without warning, but are preceded by warning signs. Identifying and assessing the various factors that can contribute to a suicidal crisis is extremely important to help the person and assist them in getting help. The presence of thoughts of death, such as threatening or talking about wanting to hurt or kill oneself; searching the internet for information about death, dying, or suicide, especially when these actions are out of the ordinary or if the person has previously thought or talked about suicide; expressing, more or less openly, feelings of hopelessness, helplessness, despair, a sense of having no way out, anxiety, agitation, anger, or aggression. Also, sudden changes in behavior or mood, increased alcohol or drug use, neglected appearance, social isolation, self-harm, job loss, or significant financial loss, and traumas such as bereavement, separation, or illness.
What is meant by suicide prevention?
Suicide represents the final act of a series of preparatory behaviors: suicidal ideation, putting the plan into action, attempted suicide, and completed suicide.
Recognizing the ideation and planning of this extreme act is therefore fundamental in preventing it. The first objective of suicide prevention is to recognize the warning signs.
If you notice a change that worries you, it can be an opportunity to ask someone how they are and a chance to openly discuss suicidal and self-harm thoughts.
It is possible to support family and friends with mental health disorders and substance abuse issues. Encourage them to seek help before a suicidal crisis occurs.
Other key aspects of prevention are reducing risk factors and increasing protective factors.
Some international studies highlight that suicidal risk is often not recognized in clinical settings: 45% of those who take their own lives had at least one contact with their general practitioner in the month prior to death. It is therefore crucial to improve the diagnostic efficiency of psychiatric disorders.
“Protective factors” include the presence of an effective family and social network, dedicating time to hobbies and recreational activities, consistently engaging in physical activity or sports, and avoiding overloading oneself at work, thus preventing burnout. Moreover, it would be important to implement campaigns to reduce the stigma of suicide, increase resources to create meeting places and promote physical activity, especially among young people, and undertake measures to increase job opportunities and the availability of decent housing for those who are socially and economically disadvantaged.
At UPMC Salvator Mundi International Hospital, a center dedicated to the diagnosis and treatment of depressive disorders and all their consequences on physical and mental health is active.
If you or someone you know is at risk of suicide, seek help from a qualified professional.
Useful Numbers:
- Emergency Number (in Italy and Europe): 112
- Medical or Psychiatric Emergency: 118
- Telefono Azzurro (for children and adolescents): 196 96
- Anti-Violence and Stalking Number: 15 22
- Telefono Amico: 02 2327 2327
- Samaritans (Suicide Prevention): 06 77208977