There is but one truly serious philosophical problem, and that is suicide.
Albert Camus, in The Myth of Sisyphus, draws attention to the absurdity of life and introduces important questions in order to understand suicide. This behavior, so difficult to explain and understand by those who continue to live, is perhaps one of the most important issues in psychiatry and other disciplines. From sociology, Emil Durkheim (1858–1917) has suggested several ways of understanding suicide and has proposed three types of it: the selfish, altruistic, and anomic suicide. More recently, Silverman et al.1,2 have revised the nomenclature for the study of suicide and suicidal behaviors. They are just a few of the authors who somehow and from different disciplines have contributed to the understanding of a phenomenon whose complexity requires different perspectives and interpretations.
Suicide is one of the major causes of death worldwide. It is estimated that between 1.2 and 1.5million people kill themselves annually around the world, which amounts to one death every 40s, a worldwide mortality rate of about 16 per 100,000 inhabitants; in Colombia, it is around 4–5 per 100,000. The global rate has increased 60% over the past 45 years. These data highlight the epidemiological importance of the issue and the need for research in this area in order to enable effective prevention and treatment.
The immediate precursors of suicide, such as suicidal ideation, plans and suicide attempts, have been little studied. A recent study by Nock et al.,3 which includes Colombia, found a prevalence of 9.2% for ideation, 3.1% for plans, and 2.7% for suicide attempts in various population samples. Based on these, it was estimated that gender and the presence of mental disorders might have a minor role in suicide in developing countries than in developed ones. Women, however, seem to be at a greater risk of suicidal ideation, plan or suicide attempt (OR=1.4). Similarly, all these aspects are inversely related to age, as they are more frequent in younger people.
Regarding the association between mental disorders and suicidal behavior, there is an increased association with mood disorders (OR=3.4–5.9), followed by disorders of impulse control (OR=3.3–6.5), anxiety disorders (OR=2.8–4.8), and substance abuse (OR=2.8–4.6).
This Supplement of the Colombian Journal of Psychiatry, which originates as a response to this problem, aims to provide some answers to the countless facets of suicide attempt and suicide in our country. Thus, it seeks to take a step toward understanding a phenomenon that, in most cases, remains silent.
Finally, Emil Kraepelin4, no stranger to this problem, wrote the poem entitled “Discord”, which reflects—between the lines—much of the suffering of a person who chooses not to be among us anymore. When life compels me its hard yoke to wear, A host of dazzling forms appear before me, Of thronging wishes, many-hued and fair: They spring and grow and seek dominion over me. Yet never comes the day when I may yield; I’m held, I know, a thousand fetters bind me. I strive for light, in freedom to be healed; Deep forces locked in struggle have confined me. The torment of this discord who can tell? How brims life's chalice oft with gall before me! And yet! my deepest nature loves it well, This rebel's strife! Without it I abhor me. How then the grayness of the day dispel- Did not the longing of my heart restore me?
