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Suicide is a common cause of death. Around one million people die by suicide every year worldwide. In our country, suicide has remained the leading cause of external death (INE, 2017). It is estimated that suicide attempts (SA) occur 10–20 times more frequently than suicide. Within the broad spectrum of suicidal behavior, there are high‑lethality suicide attempts (HL‑SA), which are the closest to completed suicide.
Medically serious suicide attempts (MSSA) or high‑lethality suicide attempts (HLSA) are defined as those involving severe organic compromise, regardless of their psychiatric severity.
Within the wide spectrum of suicidal behavior, MSSA are the closest to completed suicide, and the two groups overlap substantially, sharing common characteristics. In addition, MSSA carry a higher risk of subsequent death by suicide compared with low‑lethality suicide attempts.
An important aspect to consider is that evaluating survivors of a severe suicidal act allows direct information to be obtained from the survivor, unlike completed suicides, in which assessment is carried out indirectly through third parties (psychological autopsy). Being able to assess individuals who have come so close to suicide is of great value for understanding the psychological mechanisms behind severe suicidal behavior and for identifying warning signs to prevent suicide.
A considerable percentage of these cases show underlying psychiatric disorders, mainly affective disorders (Depression), followed by Personality Disorders and other Substance‑related Disorders. Other non‑psychiatric and socio‑environmental risk factors must also be assessed: the presence of severe or chronic medical conditions, functional limitations and their impact (such as in people with physical disabilities or older adults), and social support.
Most patients present depressive symptoms that do not always coincide with a recent stressful event. They often have a history of previous suicide attempts. Prior to the MSSA, they typically experience thoughts of wanting to die or a more structured suicidal ideation.
People with an unstable or untreated psychiatric disorder—particularly unipolar affective disorders (Depression)—may be more predisposed to suicidal behavior.
In the event of an MSSA, it is essential to assess and treat any underlying psychiatric disorder.
Once the patient has recovered from the life‑threatening situation, a comprehensive approach is required, addressing both clinical and socio‑environmental aspects. Clinically, it is crucial to evaluate and treat any psychiatric condition. After medical discharge, referral to the mental health network is important, as well as activation of the Suicide Risk Code, which ensures follow‑up after hospital discharge.
Medical‑psychiatric history and psychological evaluation.
Combat myths that perpetuate the social stigma surrounding suicide and assess suicidal ideation in individuals with clinical and sociodemographic risk factors.
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