La inteligencia artificial en la prevención de conductas suicidas: aspectos técnicos y consideraciones ético-legales / La intelligència artificial en la prevenció de conductes suïcides: aspectes tècnics i consideracions ètico-legals / Artificial intelligence in the prevention of suicidal behaviour: Technical aspects and ethical-legal considerations

En este artículo reflexionamos sobre la potencialidad terapéutica de los nuevos desarrollos de la Inteligencia Artificial en el ámbito de la salud mental, en particular en la prevención de conductas suicidas. En primer lugar, analizamos los aspectos tecno-científicos más relevantes del Machine Learning en el entorno de las Redes Sociales, las aplicaciones móviles y los chatbots, así como las ventajas e inconvenientes de esta nueva Psiquiatría Computacional. A continuación, consideramos los límites y dificultades en el uso de estas tecnologías desde una perspectiva ética, además del marco legal para que estas aplicaciones preventivas sean garantistas en lo que a eficacia, seguridad, privacidad, transparencia, responsabilidad y equidad se refiere. Si bien las amenazas son considerables, concluimos que con una correcta identificación y gestión de las mismas el alcance terapéutico de estas herramientas se antoja alentador.(AU)

En aquest article reflexionem sobre la potencialitat terapèutica dels nous desenvolupaments de la Intel·ligència Artificial en l'àmbit de la salut mental, especialment en la prevenció de conductes suïcides. En primer lloc, analitzem els aspectes tecno-científics més rellevants de l'Aprenentatge Automàtic en l'entorn de les Xarxes Socials, les aplicacions mòbils i els chatbots, així com els avantatges i inconvenients d'aquesta nova Psiquiatria Computacional. A continuació, considerem els límits i les dificultats en l'ús d'aquestes tecnologies des d'una perspectiva ètica, a més del marc legal perquè aquestes aplicacions preventives siguin garantistes en qüestions d'eficàcia, seguretat, privadesa, transparència, responsabilitat i equitat. Toti que les amenaces són considerables, concloem que amb una correcta identificació i gestió d'aquestes, el potencial terapèutic d'aquestes eines sembla prometedor.(AU)

In this article we reflect on the therapeutic potential of the new developments of Artificial Intelligence in the field of mental health, particularly in the prevention of suicidal behavior. First, we analyze the most relevant techno-scientific aspects of Machine Learning in the environment of Social Networks, mobile applications and chatbots, as well as the advantages and disadvantages of this new computational psychiatry. Next, we consider the limits and difficulties in the use of these technologies from an ethical perspective, in addition to the legal framework so that these preventive applications are guarantees in terms of efficacy, security, privacy, transparency, responsibility and fairness. Although the threats are considerable, we conclude that with proper identification and management of them, the therapeutic scope of these tools seems encouraging.(AU)

State Firearm Laws and Firearm-Related Mortality and Morbidity.

This Viewpoint highlights the challenges to passing federal legislation that limits gun ownership and accessibility and summarizes some of the state laws used to successfully lower rates of firearm-related death and injury.

Examining the Impact of Firearm Safety Laws on Suicides.

This Medical News feature discusses what's known about the impact of firearm safety laws on suicide rates.

La influencia de las condiciones meteorológicas ambientales en la mortalidad por suicidio en la provincia de Córdoba / Influence of meteorological conditions on suicide rate in the province of Córdoba

INTRODUCCIÓN: La mortalidad por suicidio se ha incrementado en las últimas décadas. Existen múltiples factores que influyen en el riesgo de la conducta suicida (biológicos, cognitivos y relacionados con la personalidad) que pueden interactuar con los cambios meteorológicos ambientales. El objetivo del estudio fue conocer cómo influyen ciertas variables meteorológicas (temperatura, racha de viento y precipitaciones) en las muertes por suicidio en la provincia de Córdoba durante un período temporal concreto. MATERIAL Y MÉTODOS: Mediante un estudio observacional, analítico y retrospectivo se recogieron un total de 100 suicidios registrados en el Instituto de Medicina Legal y Ciencias Forenses de Córdoba, recopilando variables sociodemográficas, antecedentes patológicos, factores relacionados con el suicidio y variables meteorológicas obtenidas de la web de la Agencia Estatal de Meteorología. RESULTADOS: Se obtuvo significación estadística en cuanto al sexo y su relación con la racha de viento; demostrando asociación con rachas mayores de viento en suicidios de mujeres con respecto al de hombres (p = 0,043). Se observó también una asociación entre el sexo y las estaciones del año (p = 0,042) concluyendo que las mujeres cometen suicidios con más frecuencia durante la primavera (45,8%), mientras que los hombres llevan a cabo el acto suicida preferentemente durante el otoño (28,9%). CONCLUSIONES: Nuestro estudio indica que los suicidios se ven influenciados por las variables meteorológicas; en concreto aporta ciertas novedades en cuanto a la influencia de la velocidad de la racha de viento y el patrón estacional con el sexo

INTRODUCTION: Suicide mortality has increased in recent decades. There are multiple factors influencing the risk of suicidal behaviour (biological, cognitive and personality-related factors) that could interact with seasonal changes. The aim was to determine how certain meteorological factors (temperature, wind and rainfall) influenced suicides in the province of Córdoba committed over a specific time period. MATERIAL AND METHODS: A total of 100 suicides registered in the Institute of Legal Medicine of Forensic Sciences of the province of Córdoba were collected through an observational, analytical and retrospective study. We recorded sociodemographic variables, pathological background, factors related to suicide and meteorological variables according to the website of the State Meteorological Agency. RESULTS: Statistical significance was obtained regarding sex and its relationship with wind; showing an association of women's suicides with higher wind speed in comparison to men (P=.043). An association was also observed between sex and the seasons of the year (P=.042) concluding that women commit suicide more frequently during the spring (45.8%), while men commit suicide more often the autumn (28.9%). CONCLUSIONS: Our study suggests that suicides are influenced by meteorological variables; in particular it offers some new insights in relation to the influence of wind speed and seasonality according to sex

Accelerating Research on Suicide Risk and Prevention in Women Veterans Through Research-Operations Partnerships.

BACKGROUND: Suicide rates for women veterans are increasing faster than for nonveterans. The 2017 suicide rate for women veterans was more than double that for women nonveterans. However, research to inform improved suicide prevention for women veterans is scant. OBJECTIVES: To accelerate research on women veterans' unique risks and resiliencies for suicide, the Department of Veterans Affairs (VA) Women's Health Research Network launched a Women Veterans Suicide Prevention Research Work Group to target technical support for researchers, promote collaboration with national VA program offices, and ultimately increase dissemination and translation of research into clinical practice, public health strategies, and policies. The objective of this paper is to report on the process and outcomes of the Work Group's strategic planning efforts to identify and fill gaps in suicide prevention research among women veterans. METHODS: An in-person meeting of 20 researchers and operational leaders was convened to summarize existing research evidence and identify research priorities and challenges. RESULTS: Research priorities included civilian reintegration, community connections, psychosocial stressors (eg, social determinants of health) and trauma, risk assessment, clinical interventions, upstream prevention, and health care access. The importance of increasing evidence on gender differences and for women veterans not using VA health care was emphasized. CONCLUSIONS: Research to inform suicide prevention tailored to meet women veterans' needs is essential; however, many priorities and challenges remain unaddressed. Although Work Group efforts have achieved funding gains, further work to formalize, promote and meet the demands of a suicide prevention research agenda for women veterans requires is ongoing focus.

Aiding and Abetting Suicide: The Current Debate in Italy.

The article analyzes the recent ruling of the Italian Constitutional Court amending article 580 of the Italian Criminal Code, relating to aid and incitement to suicide. According to the first Assize Court of Milan, article 580, conceived in 1930, reflects the fascist culture of its author. The problem of the Constitutional Court was therefore to establish whether a democratic state can still place limits on aid for suicide and in what terms it can do so.

Subregistro de los suicidios en el Boletín Estadístico de Defunción Judicial en Málaga / Notification of suicides in the Statistical Bulletin of Judicial Death in Malaga (Spain)

El objetivo de este trabajo es confirmar, a partir de las Defunciones con Intervención Judicial (DIJ), si la causa de defunción fue un suicidio, según la información de la familia e identificar el porcentaje de los casos señalados como suicidio en el Boletín Estadístico de Defunción Judicial (BEDJ). Para ello se seleccionaron las DIJ de la base de datos del Parque Cementerio de Málaga en el año 2017. Se recabó información de las familias de las personas fallecidas a través del Gabinete Psicológico del Cementerio para confirmar o descartar el suicidio, y posteriormente se consultó el BEDJ para comprobar si los casos estaban identificados como suicidios. A través de los familiares se confirmaron 65 suicidios, de los que solo un 27% están identificados así en la sección correspondiente del BEDJ, documento que sirve de fuente de información para las estadísticas oficiales de suicidios. Se concluye que la familia puede ofrecer información complementaria que ayudaría a mejorar las estadísticas de suicidios

The objective of this study is to confirm from Deaths with Judicial Intervention (DIJ), whether cause of death was suicide, through family information and to establish the percentage of those identified as such in the Statistical Death Bulletin of Judicial Court (BEDJ). For this purpose, the DIJ were selected from the database of the Cementary Park of Málaga in 2017. Information was collected from the family of the deceased, through the Cementary's Psychological Cabinet to confirm or rule out suicide and the BEDJ was subsequently consulted to confirm whether these cases were identified as such. Relatives confirmed 65 suicides, of which only 27% are identified as such in the relevant section of the BEDJ, a document that serves as a source of information for official suicide statistics. From this study we concluded that the family can offer complementary information that would help improve suicide statistics

What is suicide? Classifying self-killings.

Although the most common understanding of suicide is intentional self-killing, this conception either rules out someone who lacks mental capacity being classed as a suicide or, if acting intentionally is meant to include this sort of case, then what it means to act intentionally is so weak that intention is not a necessary condition of suicide. This has implications in health care, and has a further bearing on issues such as assisted suicide and health insurance. In this paper, I argue that intention is not a necessary condition of suicide at all. Rather, I develop a novel approach that deploys the structure of a homicide taxonomy to classify and characterise suicides to arrive at a conceptually robust understanding of suicide. According to my analysis of suicide, an agent is the proximate cause of his death. Suicide is 'self-killing,' rather than 'intentional self-killing.' Adopting this understanding of suicide performs several functions: (1) We acquire an external standard to assess diverging analyses on specific cases by appealing to homologous homicides. (2) Following such a taxonomy differentiates types of suicides. (3) This approach has application in addressing negative connotations about suicide. (4) As a robust view, adding intention is an unnecessary complication. (5) It is more consistent with psychological and sociological assessments of suicide than 'intentional self-killing.' (6) It has useful applications in informing public policy. This paper's focus is on classifying types of suicides, rather than on the moral permissibility or on underlying causes of suicidal ideation and behaviour.

Means restriction for the prevention of suicide by jumping.

BACKGROUND: Jumping from a height is an uncommon but lethal means of suicide. Restricting access to means is an important universal or population-based approach to suicide prevention with clear evidence of its effectiveness. However, the evidence with respect to means restriction for the prevention of suicide by jumping is not well established. OBJECTIVES: To evaluate the effectiveness of interventions to restrict the availability of, or access to, means of suicide by jumping. These include the use of physical barriers, fencing or safety nets at frequently-used jumping sites, or restriction of access to these sites, such as by way of road closures. SEARCH METHODS: We searched the Cochrane Library, Embase, MEDLINE, PsycINFO, and Web of Science to May 2019. We conducted additional searches of the international trial registries including the World Health Organization International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov, to identify relevant unpublished and ongoing studies. We searched the reference lists of all included studies and relevant systematic reviews to identify additional studies and contacted authors and subject experts for information on unpublished or ongoing studies. We applied no restrictions on date, language or publication status to the searches. Two review authors independently assessed all citations from the searches and identified relevant titles and abstracts. Our main outcomes of interest were suicide, attempted suicide or self-harm, and cost-effectiveness of interventions. SELECTION CRITERIA: Eligible studies were randomised or quasi-randomised controlled trials, controlled intervention studies without randomisation, before-and-after studies, or studies using interrupted time series designs, which evaluated interventions to restrict the availability of, or access to, means of suicide by jumping. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion and three review authors extracted study data. We pooled studies that evaluated similar interventions and outcomes using a random-effects meta-analysis, and we synthesised data from other studies in a narrative summary. We summarised the quality of the evidence included in this review using the GRADE approach. MAIN RESULTS: We included 14 studies in this review. Thirteen were before-and-after studies and one was a cost-effectiveness analysis. Three studies each took place in Switzerland and the USA, while two studies each were from the UK, Canada, New Zealand, and Australia respectively. The majority of studies (10/14) assessed jumping means restriction interventions delivered in isolation, half of which were at bridges. Due to the observational nature of included studies, none compared comparator interventions or control conditions. During the pre- and postintervention period among the 13 before-and-after studies, a total of 742.3 suicides (5.5 suicides per year) occurred during the pre-intervention period (134.5 study years), while 70.6 suicides (0.8 suicides per year) occurred during the postintervention period (92.4 study years) - a 91% reduction in suicides. A meta-analysis of all studies assessing jumping means restriction interventions (delivered in isolation or in combination with other interventions) showed a directionality of effect in favour of the interventions, as evidenced by a reduction in the number of suicides at intervention sites (12 studies; incidence rate ratio (IRR) = 0.09, 95% confidence interval (CI) 0.03 to 0.27; P < 0.001; I2 = 88.40%). Similar findings were demonstrated for studies assessing jumping means restriction interventions delivered in isolation (9 studies; IRR = 0.05, 95% CI 0.01 to 0.16; P < 0.001; I2 = 73.67%), studies assessing jumping means restriction interventions delivered in combination with other interventions (3 studies; IRR = 0.54, 95% CI 0.31 to 0.93; P = 0.03; I2 = 40.8%), studies assessing the effectiveness of physical barriers (7 studies; IRR = 0.07, 95% CI 0.02 to 0.24; P < 0.001; I2 = 84.07%), and studies assessing the effectiveness of safety nets (2 studies; IRR = 0.09, 95% CI 0.01 to 1.30; P = 0.07; I2 = 29.3%). Data on suicide attempts were limited and none of the studies used self-harm as an outcome. There was considerable heterogeneity between studies for the primary outcome (suicide) in the majority of the analyses except those relating to jumping means restriction delivered in combination with other interventions, and safety nets. Nevertheless, every study included in the forest plots showed the same directional effects in favour of jumping means restriction. Due to methodological limitations of the included studies, we rated the quality of the evidence from these studies as low. A cost-effectiveness analysis suggested that the construction of a physical barrier on a bridge would be a highly cost-effective project in the long term as a result of overall reduced suicide mortality. AUTHORS' CONCLUSIONS: The findings from this review suggest that jumping means restriction interventions are capable of reducing the frequency of suicides by jumping. However, due to methodological limitations of included studies, this finding is based on low-quality evidence. Therefore, further well-designed high-quality studies are required to further evaluate the effectiveness of these interventions, as well as other measures at jumping sites. In addition, further research is required to investigate the potential for suicide method substitution and displacement effects in populations exposed to interventions to prevent suicide by jumping.

Medically Assisted Dying and Suicide: How Are They Different, and How Are They Similar?

The practice of medically assisted dying has long been contentious, and the question of what to call it has become increasingly contentious as well. Particularly among U.S. proponents of legalizing the practice, there has been a growing push away from calling it "physician-assisted suicide," with assertions that medically assisted dying is fundamentally different from suicide. Digging deeper into this claim about difference leads to an examination of the difference between two kinds of suffering-suffering from physical conditions and suffering from psychological conditions-and therefore leads also toward an examination of whether requests for medical assistance in dying by those suffering from psychological conditions and those suffering from physical conditions should be painted with the same brush. In this article, I aim both to illuminate some of the considerations that ought to be included in discussions related to medically assisted dying and to shed light on what the indirect effects of such discussions can be. I consider some of the reasons commonly given for holding that suicide and medically assisted dying differ fundamentally and then whether the conclusion that medically assisted dying should not be called "suicide" follows from the premises. I ask what else might justify the conclusion that the two acts ought to be called by different names, and I examine possible justifications for accepting this premise, as well as what justifications might exist for emphasizing how the acts are alike. Finally, I argue that we should be cautious before concluding that medically assisted dying should not be called "suicide." We need more evidence either that the two acts are fundamentally different or that emphasizing differences between them is not likely to do more harm than good.

Talking About Suicide: Trends in Christian and Socially Conservative Suicide Decedents.

This study examined the relationship between religious affiliation, social policy beliefs, and whether individuals spoke with anyone about suicide prior to suicide death. Two hundred sixty-seven suicide loss survivors reported on characteristics of suicide decedents. Binary logistic regressions found those who identified as socially liberal were more likely to have discussed suicide with the loss survivor or to have told someone else they were thinking about attempting suicide than were those who identified as socially conservative. Follow-up analyses indicated Christian affiliation was only associated with a lower likelihood of having discussed suicide with the loss survivor among older men. Results indicated that specific worldviews may serve as obstacles to suicidal individuals discussing their suicidal thoughts prior to death. As such, the findings indicate that public health approaches to suicide prevention that do not rely on open reporting of suicidal ideation may be vital within such communities.

The Impact of Suicide Prevention Act (2006) on Suicides in Japan.

Background: The Suicide Prevention Act was implemented in 2006 in Japan to promote various suicide prevention strategies. Aims: The present study examined the impact of the Suicide Prevention Act on recent suicide mortality rates in Japan. Method: Using an interrupted time-series design, we analyzed monthly mortality rates between January 1996 and December 2016. Death certificate data from vital statistics were obtained. Results: A total of 597,007 suicides (99.3% of all suicides) were analyzed. At the onset of the economic recession in 1998, a significant increase was observed in overall age-standardized mortality rates and sex-/age-specific populations, except for those aged 60 or older. The difference in trend between before and after implementation of the Suicide Prevention Act was not significant for overall or for any stratified populations. After the onset of the Tohoku earthquake and tsunami of 2011, mortality rates declined for overall and for sex-/age-specific populations. Limitations: No information was available on what could have led to each suicide. Conclusion: The decline in mortality rates may be due to a significant and recent natural disaster. Further studies are needed to clarify plausible mechanisms for the decline in suicide rates following the Tohoku disaster.

When is hastened death considered suicide? A systematically conducted literature review about palliative care professionals' experiences where assisted dying is legal.

BACKGROUND: Laws allowing assisted suicide and euthanasia have been implemented in many locations around the world but some individuals suffering with terminal illness receiving palliative care services are hastening death or die by suicide without assistance. This systematic review aims to summarise evidence of palliative care professionals' experiences of patients who died by suicide or hastened death in areas where assisted dying is legal and to understand when hastened death is considered to be a suicide. METHODS: AMED, CINAHL Complete, PsycINFO, PubMED, and Academic Search Ultimate were searched for articles from inception through June 2018. Quality assessment used the Hawker framework. RESULTS: A total of 1518 titles were screened resulting in thirty studies meeting eligibility criteria for this review. Published studies about professionals' experiences from areas with legalised assisted dying includes limited information about patients who hasten death outside legal guidelines, die by suicide without assistance, or if the law impacts suicide among palliative care patients. CONCLUSION: There are a range of experiences and emotions professionals' experience with patients who die by euthanasia, assisted suicide, or hasten death without assistance. The included literature suggests improved communication among professionals is needed but does not explicitly identify when a hastened death is deemed a suicide in areas where assisted dying is practiced. More research is needed to help clarify what hastened death means in a palliative care context and identify how and if assisted dying impacts issues of suicide in palliative care settings.

Physician Documentation of Access to Firearms in Suicidal Patients in the Emergency Department.

INTRODUCTION: Suicide is the 10th leading cause of death in the United States. An estimated 50% of these deaths are due to firearms. Suicidal ideation (SI) is a common complaint presenting to the emergency department (ED). Despite these facts, provider documentation on access to lethal means is lacking. Our primary aim was to quantify documentation of access to firearms in patients presenting to the ED with a chief complaint of SI. METHODS: This was a cross-sectional study of consecutive patients, nearly all of whom presented to an academic, urban ED with SI during July 2014. We collected data from all provider documentation in the electronic health record. Primary outcome assessed was whether the emergency physician (EP) team documented access to firearms. Secondary outcomes included demographic information, preexisting psychiatric diagnoses, and disposition. RESULTS: We reviewed 100 patient charts. The median age of patients was 38 years. The majority of patients had a psychiatric condition. EPs documented access to firearms in only 3% of patient charts. CONCLUSION: EPs do not adequately document access to firearms in patients with SI. There is a clear need for educational initiatives regarding risk-factor assessment and counseling against lethal means in this patient cohort.

State Gun Laws and Pediatric Firearm-Related Mortality.

BACKGROUND: Firearms are the second leading cause of pediatric death in the United States. There is significant variation in firearm legislation at the state level. Recently, 3 state laws were associated with a reduction in overall deaths from firearms: universal background checks for firearm purchases, universal background checks for ammunition purchases, and identification requirement for firearms. We sought to determine if stricter firearm legislation at the state level is associated with lower pediatric firearm-related mortality. METHODS: This was a cross-sectional study in which we used 2011-2015 Web-based Injury Statistics Query and Reporting System and Census data. We measured the association of the (1) strictness of firearm legislation (gun law score) and (2) presence of the 3 aforementioned gun laws with pediatric firearm-related mortality. We performed negative binomial regression accounting for differences in state-level characteristics (population-based race and ethnicity, education, income, and gun ownership) to derive mortality rate ratios associated with a 10-point change in each predictor and predicted mortality rates. RESULTS: A total of 21 241 children died of firearm-related injuries during the 5-year period. States with stricter gun laws had lower rates of firearm-related pediatric mortality (adjusted incident rate ratio 0.96 [0.93-0.99]). States with laws requiring universal background checks for firearm purchase in effect for ≥5 years had lower pediatric firearm-related mortality rates (adjusted incident rate ratio 0.65 [0.46-0.90]). CONCLUSIONS: In this 5-year analysis, states with stricter gun laws and laws requiring universal background checks for firearm purchase had lower firearm-related pediatric mortality rates. These findings support the need for further investigation to understand the impact of firearm legislation on pediatric mortality.

La eutanasia como antídoto del suicidio / Euthanasia as an antidote to suicide / L'eutanàsia com a antídot del suïcidi

Este trabajo comienza con una reflexión sobre la conciencia de mortalidad y la forma en que el ser humano puede situarse en la antesala de su propia muerte, refiriéndose algunas de las circunstancias y motivaciones en el suicidio. Por otra parte, se hace referencia a la formulación y postura filosófica de Cioran sobre el suicidio como recurso existencial para poder afrontar la vida en mejores condiciones. De manera semejante puede considerarse la eutanasia, observándose en su relación con el suicidio que la opción legal de acogerse a ella puede suponer para ciertas personas un alejamiento del suicidio mientras que su prohibición las puede precipitar a la autodestrucción definitiva para poder escapar así del sufrimiento insufrible

This paper begins by reflecting on people's awareness of mortality and how they lie in the antechamber of their own death. It refers to several specific circumstances and motivations which lead to suicide. On the other hand, reference is made to Cioran's ideas and philosophical stance on suicide as an existential resource which enables people to face life in better conditions. Similarly, euthanasia is considered, especially bearing in mind its close relationship to suicide, and it is observed as being the legal option of achieving that aim. This, however, can imply a flight from suicide for some sufferers while its prohibition can precipitate others towards definite self-destruction so as to escape from unbearable suffering. It is contrasted by using two illustrative cases

Aquest treball comença amb una reflexió sobre la consciència de mortalitat i la forma en què l'ésser humà pot situar-se en l'avantsala de la seva pròpia mort, referint-se algunes de les circumstàncies i motivacions en el suïcidi. D'altra banda, es fa referència a la formulació i postura filosòfica de Cioran sobre el suïcidi com a recurs existencial per a poder afrontar la vida en millors condicions. De manera semblant pot considerar-se l'eutanàsia, observant-se en la seva relació amb el suïcidi que l'opció legal d'acollir-se a ella pot suposar per a certes persones un allunyament del suïcidi mentre que la seva prohibició les pot precipitar a l'autodestrucció definitiva per a poder escapar així del sofriment insofrible, tal com apareix contrastat a través de dos casos il·lustratius