The possibilities of suicide prevention in adolescents. A holistic approach to protective and risk factors.

There is no other such complex physical, biological, somatic, mental, psychological, psychiatric, cultural, social and spiritual phenomenon and general public health problem, so much unexplained, meaningless, so tragic, painful, and unreasonable, so difficult, contradictory and mystified like suicide. In spite of the several already identified background factors, we do not and we can not know the real reasons behind suicide, because suicide is multi-causal, and can never be traced back to one single cause, but there are always many biological, psychological-psychiatric, historical, social and cultural factors involved in its development. However, the strongest suicide risk factor is an unrecognized and untreated mental disorder. Suicide among young people is one of the most serious public health problems. In Hungary 1395 young people lost their lives due to suicide in the 24> age group between 2000-2010, 1150 males and 245 females. According to epidemiological studies, 24.7% of children and adolescents suffer from some form of behaviour-, conduct- or other psychiatric disorders. Among adolescents (aged 15-24) suicide was the first leading cause of death in 2010. Despite great advances in the psychopharmacology and psychotherapy of mental disorders, suicides persist as a major cause of mortality, especially among the 15-24-year old population. Victims of suicide are not healthy individuals. They always suffer from psychiatric or mental, physical or somatic, cultural (social, historical, mythological) and spiritual disorders. The author tries to classify suicide protective and risk factors according to physical-biological, mental-psychological, cultural-social, and spiritual aspects. However, it must be remembered that these factors are not necessarily present in each and every case and may vary from one country to another, one person to another, depending on cultural, political, (spiritual) and economical features. Risk and protective factors can occur (1) at the physical or biological-somatic level which includes physical circumstances, genetics, health, and diseases; (2) at the mental or psychological level, which includes mental health, self-esteem, and ability to deal with difficult circumstances, manage emotions, or cope with stress; (3) at the cultural level or the broader life environment, and this includes social, political, environmental, and economic factors that contribute to available options and quality of life; (4) at the social level, which includes relationships and involvement with others such as family, friends, workmates, the wider community and the person's sense of belonging; (5) at the spiritual level, which includes faith, hope, charity, despair, salvation. Children and adolescents spend a lot of time at school, so teachers must be educated to notice any warning signs of suicide, but the majority of pedagogues not only do not know the most important mental and psychosomatic symptoms, but do not recognize them in children and do not know how to handle them either. Hopelessness is the most important spiritual risk factor. The Beck Hopelessness Scale is a tool for easy application in general practice. The author lists some important symptoms and signs that neither parents nor teachers are able to recognize and handle, and provides useful advice for prevention.