Where is the social in the biopsychosocial model of suicide prevention?

BACKGROUND: Each year, around 800,000 people die by suicide. The prevalence of suicidal behaviors is much higher when suicidal attempts and persistent self-injurious ideation are included. Therefore, suicide is a public health concern. Research has been sensitive to this problem, deepening the study of risk factors and the development of theoretical frameworks of suicidal behavior, with the aim of generating effective suicide prevention policies around the biopsychosocial model. AIM: We aimed to explore the role of relational, community, and social factors in current suicide prevention strategies. METHOD: Studies of risk and protective factors for suicidal behavior and the consequent development of theoretical frameworks were reviewed to verify if this knowledge was really used in suicide prevention policies. RESULTS: Studies of risk and protective factors focus mainly on the individual, while theoretical frameworks emphasize the role of the relational, community, and social. Suicide prevention strategies more closely follow individual models derived from studies of risk factors. CONCLUSIONS: Suicide prevention strategies should broaden their individual narrative to include relational, community, and social interventions as anti-suicide measures.

Ecofenotipos en la depresión mayor: el papel del maltrato físico en la infancia / Ecophenotypes in major depression: the role of child physical abuse

La depresión mayor puede derivarse de distintos factores de riesgo, entre los cuales se han destacado las experiencias de adversidad a lo largo de los años de desarrollo. En la presente investigación, nos preguntamos si la experiencia de maltrato físico, uno de los factores de riesgo documentados, se asocia a características clínicas diferenciales en los pacientes con depresión mayor. En el estudio, con un diseño transversal, comparamos dos grupos de pacientes que cumplían criterios diagnósticos DSM-IV para depresión mayor. El primer grupo estaba formado por 20 pacientes que refirieron maltrato físico en la infancia y el segundo, por otros 52 pacientes que no refirieron maltrato físico u otras formas de maltrato. Los resultados indican características clínicas diferenciales. En concreto, el maltrato se asocia a una mayor frecuencia de episodios depresivos previos al actual, a mayor intensidad de la sintomatología depresiva, tendencia a la autodevaluación, conducta suicida a lo largo de la vida, rasgos disfuncionales de la personalidad, funcionamiento académico/laboral más afectado, disfunciones cognitivas sutiles, paranoidismo y dificultades en la interacción social. Se discuten las posibles vías a través de las cuales la adversidad en la infancia puede ejercer su impacto en este ecofenotipo clínico, así como algunas implicaciones terapéuticas

Major depression can be derived from different risk factors, among which experiences of adversity throughout the years of development have been highlighted. In the present work, we investigated whether the experience of physical abuse, one of the documented risk factors, is associated with distinct clinical characteristics among patients with major depression. In the study, with a cross-sectional design, we compared two groups of patients with major depression according to DSM-IV. One group consisted of 20 patients who reported child physical abuse and the other consisted of 52 patients who did not report child physical abuse or other forms of child abuse. Our results showed differential clinical features. In particular, child physical abuse was associated with a higher number of previous depressive episodes, higher levels of depressive symptoms, self-deprecation, suicidal behavior throughout the life span, dysfunctional personality traits, impaired academic/work performance, subtle cognitive dysfunctions, paranoidism, and difficulties in social relationships. The pathways through which childhood adversity may have an impact on this clinical ecophenotype and some therapeutic implications are discussed