Editorial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Sep 19, 2022; 12(9): 1115-1126
Published online Sep 19, 2022. doi: 10.5498/wjp.v12.i9.1115
Suicidal behavior-advances in clinical and neurobiological research and improvement of prevention strategies
Thomas Sobanski, Gregor Peikert, Ulrich W Kastner, Gerd Wagner
Thomas Sobanski, Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, THUERINGEN-Kliniken GmbH, Saalfeld 07318, Germany
Thomas Sobanski, Ulrich W Kastner, Gerd Wagner, Network for Suicide Prevention in Thuringia (NeST), Jena 07743, Germany
Gregor Peikert, Gerd Wagner, Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena 07743, Germany
Ulrich W Kastner, Department of Psychiatry and Psychotherapy, Helios Fachkliniken Hildburghausen, Hildburghausen 98646, Germany
Author contributions: Sobanski T, Peikert G, Kastner UW, and Wagner G contributed to this paper with conception, literature review and analysis, drafting and critical revision and editing, and approval of the final version.
Conflict-of-interest statement: Thomas Sobanski, Gregor Peikert, and Gerd Wagner have nothing to disclose. Ulrich W. Kastner owns shares in a healthcare company (Fresenius LTIP 2018, long-term incentive plan). However, this company is not active in the field of psychiatry or neuroscience. Thus, there is no content or technical reference.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thomas Sobanski, MD, Chief Doctor, Senior Lecturer, Senior Research Fellow, Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, THUERINGEN-Kliniken GmbH, 68 Rainweg, Saalfeld 07318, Germany. tsobanski@thueringen-kliniken.de
Received: April 13, 2022
Peer-review started: April 13, 2022
First decision: June 11, 2022
Revised: June 26, 2022
Accepted: August 15, 2022
Article in press: August 15, 2022
Published online: September 19, 2022
Processing time: 160 Days and 3.1 Hours
Abstract

Suicide is the 14th 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.