Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment

Abstract

Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissã o de Emergê ncias Psiquiá tricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517

The Management of Psychiatric Emergencies in Situations of Public Calamity

“…The secondary consequences of social distancing may increase the risk of suicide. It is important to consider changes in a variety of economic, psychosocial, and health-associated risk factors ( 19 , 21 , 38 , 39 ).…”

“…The therapeutic approach to suicidal behavior, both ideation or attempts, must include the assessment of risk and protective factors associated with intervention measures (called the safety plan) ( 38 , 39 , 51 , 52 ). For cases involving a high risk of suicide, strict observation of the individual is required, so they must stay in the emergency department or undergo hospitalization or home care.…”

“…According to Weber et al ( 54 ), the patient assessment should include the identification of the present level of risk and the modifiable and fixed risk factors related to the intention. The risk (e.g., previous suicide attempt, psychiatric illness, substance dependence) and protective factors (e.g., interpersonal support, positive coping skills) should also be identified ( 38 , 39 ).…”

“…In emergency service centers, patients at risk of suicide must first receive any general health care. Many suicide attempts are associated with severe trauma or intoxication, and such emergencies should not be neglected to assess psychiatric emergencies (they must be carried out together) ( 38 , 39 ).…”

“…Therefore, the public sector must be prepared to address such situations using the prevention and intervention measures mentioned above. Within this context, the application of guidelines through evidence-based medicine is essential [i.e., ( 13 , 30 , 38 , 39 , 57 , 59 – 61 )].…”