RAMB - JULHO 2017

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Many reasons to talk about suicide
Rev Assoc Med B ras 2017; 63(7):557-558 557
EDITORIAL
Many reasons to talk about suicide
Muitas razões para falarmos sobre suicídio
Guilherme V. Polanczyk1*
1Associate Professor, Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP). Head of the Inpatient Unit, Child and Adolescent Psychiatry Division, Institute of Psychiatry,
Hospital das Clínicas, USP, São Paulo, SP, Brazil
*Correspondence:
Instituto de Psiquiatria, Hospital das Clínicas
Address: Rua Dr. Ovídio Pires de Campos, 785
São Paulo, SP – Brazil
Postal code: 05403-010
Approximately 1 million people die each year from suicide
worldwide.1 This is the second leading cause of death among
adolescents and young adults.1 Although recognized by
the World Health Organization as a public health priority,
mental disorders and suicide are beset by ignorance and
stigma, which hinders proper treatment and prevention.
Recently, teenage suicide has been the subject of news
because of a supposed online challenge called “Blue Whale,”
probably originating in Russia, which would encourage
risky behavior among participants and ultimately suicide.
It has also been widely discussed after being portrayed in
an American drama series, 13 Reasons Why , which has been
watched by many young people in Brazil and the world.
Both the online challenge and the television drama pose
risks, but the community’s interest in the subject is an
important opportunity to educate people about suicide.
The online challenge, in line with many websites,
blogs and messaging lists that encourage other risky
behaviors (such as self-mutilation and restrictive eating
behavior) found its way in the lives of fragile adolescents
who often already suffer from mental illnesses. Associ-
ated with psychopathology, these adolescents frequent-
ly face social isolation and are part of families that are
unable to identify and deal with their difficulties. While
using digital tools, adolescents somehow feel understood
and belonging to a social group. Dysfunctional symptoms
and behaviors are thus justified and encouraged, and
ultimately intensified.
The drama series, on the other hand, has a less explic-
it potential to stimulate suicidal behavior, even though
its producers advocate a positive effect on young people.
The plot portrays suicide as a glamorized act that is the
consequence of specific events and cannot be prevented,
achieving specific functions successfully, which is main-
ly revenge. Also, suicide is shown explicitly, emotionally
impacting any viewer, especially the most fragile ones. In
view of these characteristics,2 the experience of a fiction
narrative such as these for those who already have risk
factors for suicide, including depression, family history
of suicide, previous suicide attempts or previous self-in-
jury, suicidal ideation and lack of social support, can
actually represent encouragement for suicidal behavior,
especially in the presence of other triggers, such as access
to lethal methods, impulsivity, substance abuse and acute
stress events. 3
Suicide is still marked by ignorance and stigma not
only in society as a whole, but also within the medical
community, both in relation to the suicide of patients
and the physicians themselves. It is estimated that 45%
of people who commit suicide consulted a physician in
the month prior to their death, and there is rarely any
documentation of suicide risk assessment.4 Many doctors
mistakenly think that those who talk about suicide do
not really want to kill themselves, that asking about
suicidal intent and plan for those who feel depressed
may encourage suicide, or that people do not want to
talk about their thoughts about death. These are all
myths that interfere with proper evaluation and man-
agement of the cases.
As for physician suicide, male doctors have a 1.41 times
higher rate than the general male population, while female
doctors have a 2.27 times higher rate than that observed
in the general female population.5 Surprisingly, despite
substantially higher rates of depression6 compared to the
general population, and also suicide,5 depressed students
and physicians6 and suicide victims7 have lower treatment
rates. Among the reasons for not seeking treatment, stigma
and self-stigma, denial of the presence of depression and
fear of the negative impact that psychiatric treatment may
have on performance and professional image in an extreme-
ly competitive environment have a strong effect. In addition
to depression, suicide risk factors among medical students