EPA Suicidology section’s meeting

Monday 27th at 4:30, Room 123M 

1.Introduction and short summary of past and future activities (10 minutes):

– Welcome (Philippe Courtet)

– MOOC and Summer school (Emilie Olie and Jorge Lopez-Castroman)

– Delphi study (Aisté Lengvenytė)

– New website (Aisté Lengvenytė, Patrizia Zeppegno / Carla Gramaglia) 

2. Election

3. Task force on National Helplines (45 min) :

– Introduction (Philippe Courtet)

– Brief review of helplines in Europe (Miriam Iosue)

– French national helplines (Lucie SHARKEY PLANTIN)

– Spain complementary numbers: 024, Esperanza and 061-emergencies (Diego J. Palao)

– Discussion of future activities

Recommended papers in suicide research, 2023

By Nathan Risch, PhD student in Montpellier

Research on suicide aims to identify what distinguishes patients who attempt suicide (i.e. suicide attempters) from those who won’t. This systematic review shows that decision-making is impaired in suicidal attempters, especially in social contexts with other human beings. Suicidal attempters are less sensitive to social reward and punishment and can persist longer in the aversive task.

Rzeszutek, M. J., DeFulio, A., & Sylvester, G. E. (2022). A systematic review of behaviour – outcome psychological assessments as correlates of suicidality. Archives of suicide research, 26(4), 1757-1793.

Psychological pain leads to suicide, but not for all patients. In this study, the authors wish to identify which feature of psychological pain distinguishes depressed patients who have attempted suicide (i.e. suicide attempters) from those who haven’t. Depressed suicidal attempters have a stronger motivation for pain avoidance. Pain avoidance could be one of the most important features of psychological pain to predict future suicidal attempt.

Sun, X., Li, H., Song, W., Jiang, S., Shen, C., & Wang, X. (2020). ROC analysis of three-dimensional psychological pain in suicide ideation and suicide attempt among patients with major depressive disorder. Journal of Clinical Psychology, 76(1), 210-227.

Ideation to action theories

By Nathan Risch, PhD student, Montpellier, France

In the last decade, ideation-to-action theories of suicide have been very popular among researchers. Those theories posit that suicidal ideation and attempt are two distinct processes.
Suicidal ideation would emerge from:
– Thwarted belongingness and perceived burdensomeness for the interpersonal theory of suicide (Van Orden et al., 2010) ,
– Humiliation, defeat, and entrapment for the integrated motivational-volitional (O’Connor, 2011) ,
– Psychological pain and hopelessness for the three-step theory (Klonsky & May, 2015).

When patients have suicidal ideation, only those who have the acquired capability of suicide and the practical capacity of suicide will attempt suicide. Acquired capability refers to fearlessness about death and higher physical pain tolerance (Van Orden et al., 2010).

Fearlessness about death facilitates suicide attempts, whereas higher pain tolerance allows one to endure pain during the suicidal act and not stop during this aversive action. Meta-analysis reported higher acquired capability in past suicidal attempters compared to non-attempters (Chu et al., 2017) .

Practical capacity refers to access to lethal means, knowledge and familiarity with suicide methods (Klonsky et al., 2021). For example, patients who have access to lethal means such as fire guns are at higher risk of death (Conner et al., 2019). Patients who know how to attempt properly are at risk of death such as doctors, veterinarians or military (Hawton, 2000; Tomasi et al., 2019; Anestis & Bryan, 2013). Patients who practice non-suicidal self-injury have a familiarity with lethal means and could be prone to use lethal means. To date, reducing access to lethal means is one of the best way to prevent suicide (Mann et al., 2005) .


Anestis, M. D., & Bryan, C. J. (2013). Means and capacity for suicidal behavior: A
comparison of the ratio of suicide attempts and deaths by suicide in the US military and
general population. Journal of Affective Disorders, 148(1), 42–47.

Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R.,
Rogers, M. L., Podlogar, M. C., Chiurliza, B., Ringer, F. B., Michaels, M. S., Patros, C. H.
G., & Joiner, T. E. (2017). The interpersonal theory of suicide: A systematic review and meta-
analysis of a decade of cross-national research. Psychological Bulletin, 143(12), 1313–1345.

Conner, A., Azrael, D., & Miller, M. (2019). Suicide Case-Fatality Rates in the United States,
2007 to 2014: A Nationwide Population-Based Study. Annals of Internal Medicine, 171(12), 885 https://doi.org/10.7326/M19-1324

Hawton, K. (2000). Doctors who kill themselves: A study of the methods used for suicide. QJM, 93(6), 351–357. https://doi.org/10.1093/qjmed/93.6.351

Klonsky, E. D., & May, A. M. (2015). The Three-Step Theory (3ST): A New Theory of
Suicide Rooted in the “Ideation-to-Action” Framework. International Journal of Cognitive
Therapy, 8(2), 114–129. https://doi.org/10.1521/ijct.2015.8.2.114

Klonsky, E. D., Pachkowski, M. C., Shahnaz, A., & May, A. M. (2021). The three-step theory
of suicide: Description, evidence, and some useful points of clarification. Preventive
Medicine, 152, 106549. https://doi.org/10.1016/j.ypmed.2021.106549885

Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., Hegerl, U.,
Lonnqvist, J., Malone, K., Marusic, A., Mehlum, L., Patton, G., Phillips, M., Rutz, W.,
Rihmer, Z., Schmidtke, A., Shaffer, D., Silverman, M., Takahashi, Y., … Hendin, H. (2005).
Suicide Prevention Strategies: A Systematic Review. JAMA, 294(16), 2064.

O’Connor, R. C. (2011). The Integrated Motivational-Volitional Model of Suicidal Behavior.
Crisis, 32(6), 295–298. https://doi.org/10.1027/0227-5910/a000120

Tomasi, S. E., Fechter-Leggett, E. D., Edwards, N. T., Reddish, A. D., Crosby, A. E., & Nett,
R. J. (2019). Suicide among veterinarians in the United States from 1979 through 2015.
Journal of the American Veterinary Medical Association, 254(1), 104–112.

Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner,
T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600.

Recent European papers from The Journal of Clinical Psychiatry, 2023

By Pr Philippe Courtet, Montpellier

Monitoring suicide attempters with their smartphone could be useful for detecting the short-term risk of reattempt !

Porras-Segovia A et al. Six-Month Clinical and Ecological Momentary Assessment Follow-Up of Patients at  High Risk of Suicide: A Survival Analysis. J Clin Psychiatry. 2022 Dec 14;84(1):22m14411. doi: 10.4088/JCP.22m14411.


In this innovative study, Alejandro Porras-Segovia and colleagues reported that Ecological momentary assessment (daily smartphones questionnaires that are completed by patients) may help to detect the risk of suicide reattempt during the 2 months following the index suicide attempt.

Depressed mood is an important risk factor of imminent suicide !

Fredriksen et al. Imminent and Short-Term Risk of Death by Suicide in 7,000 Acutely Admitted  Psychiatric Inpatients. J Clin Psychiatry. 2022 Dec 12;84(1):22m14460. doi: 10.4088/JCP.22m14460.


Fredriksen et al used a large prospective cohort of Norwegian psychiatric patients to find that during the first week following admission severely depressed mood, including self-blame and guilt was the only predictor of suicide.

How are dreaming our patients may help to identify prodromal signs of suicide !

Geoffroy et al. Bad Dreams and Nightmares Preceding Suicidal Behaviors. J Clin Psychiatry. 2022 Nov 23;84(1):22m14448. doi: 10.4088/JCP.22m14448.


Geoffroy et al. extensively assessed suicidal patients about their dreams and nightmares. A progression in dream content alterations could predict imminent risk of suicide : bad dreams-nightmares-dreaming of suicide.

COVID-19, burnout and suicide

 In February 2020, on Jama Psychiatry, it was published the article “The Loss of Social Connectedness as a Major Contributor to Physician Burnout – Applying Organizational and Teamwork Principles for Prevention and Recovery” (LINK HERE). 

In this period, in which medical teams from all over the world are engaged to fight against COVID-19 pandemic, the necessity for psychological support is a hot topic. 

Physicians are called to work many hours everyday, with a huge number of unknown patients, with individual protections and, when they come back home, they prefer to stay alone to protect their families. All of these factors can produce feelings of loneliness, sadness and tiredness. Moreover, everyday they could face off with death and feelings of impotence against a disease still not well known. All these feelings may enhance the risk of anxiety, depression, burnout and suicide. 

The study published on Jama stresses the association between burnout, loneliness and social isolation; inadequate support from colleagues and leaders, community and so on.  

During this pandemic it is essential not to forget that in order to reduce burnout and permit professionists to give their best it is essential to prioritize human connections and teamwork so they can give optimal patient care. 

  • Southwick SM, Southwick FS. The Loss of Social Connectedness as a Major Contributor to Physician BurnoutApplying Organizational and Teamwork Principles for Prevention and RecoveryJAMA Psychiatry. 2020;77(5):449–450. doi:10.1001/jamapsychiatry.2019.4800

A Star Is Born

Film: A Star Is Born
Directed by: Bradley Cooper
Year: 2018
Running time: 136 minutes

Plot: Cinematography has often dealt with the theme of suicidality in many different ways, and also some recent movies talk about this topic using a modern language and approach. An example is the notorious “A Star Is born”, a movie focused on a beautiful love story set in the music business world. In this movie the main character is a successful rock star named Jackson Maine (Bradley Cooper), who accidentally meets a young unknown singer named Ally (Lady Gaga), while she’s exhibiting in a night club. He isimmediately very impressed by this girl: and invites her to his concert the day after, where she sings a song with him overcoming her early shyness. Since that moment, Ally begins a new career as singer, supported by Jackson, and the two fall in love. In a short time, Ally reaches success in music business world, but important private relational problems start to emerge. Jackson has a long-standing alcohol abuse problem, which has heavy consequences on their relationship. Moreover, Ally starts a collaboration with a music manager that changes radically her initial music style, making Jackson feel confused and useless in some way. Jackson decides to go to rehab, and when he comes back home he wants to start again, but the sense of uselessness and frustration are unbearable so he decide to commit suicide. Ally appears devastated by this tragedy, showing the incredible burden of surviving a suicide.


Social Network and Suicide

An increasingly interesting research topic of the recent literature on suicide is about the relationship between use of social network and suicide rates among young people. A recent narrative review published online by Nassir Ghaemi, “Digital Depression: A New Disease of the Millennium?” (Ghaemi, 2020) has reviewed the last data about this subject, finding that in the last decade there has been a rise of suicide rates among teenagers and young adults, correlated with the massive use of smartphones and social networks. Author reports that in this last period depressive symptoms have risen, and suicide has become more frequent especially among teenage girls in the USA. The specific correlation between suicidality and use of social networks has been investigated by studies that tested depressive symptoms in college students and observed a decrease of these symptoms in students that accepted a reduction of social media use. On this track many works identified a correlation between these two phenomena, for example a review published on Current Opinion in Psychiatry in November 2019 titled “Social media, internet use and suicide attempts in adolescents”, found an independent direct association between problematic social media use and suicide attempts in young people. These findings suggest the importance of further studies on this problem, in order to create suicide preventive programs that consider this correlation. Another interesting fact is that the role of social media has shown to be also protective in some cases, because adolescents frequently use this media to communicate suffering and distress as shown by other recent studies (Marchant et al, 2017). 

  • Ghaemi SN (2020) Digital depression: a new disease of the millennium? Acta Psychiatr Scand. 2020 Jan 18. doi: 10.1111/acps.13151.
  • Marchant A, Hawton K, Stewart A, Montgomery P, Singaravelu V, Lloyd K, et al. (2017) A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown. PLoS ONE 12(8): e0181722. https://doi.org/10.1371/journal.pone.0181722 pmid:28813437

UNICEF: “An open letter to the world’s children”

Henrietta H. Fore, the UNICEF Executive Director, in her recent “An open letter to the world’s children”, described the 8 reasons why she’s worried, and hopeful, about the next generation. In the third place (after the need of clean water, air and safe climate, life in conflict and disaster zone) it is listed the need to talk about mental health and, more specifically, about the vulnerability of young people, the high risk of depression, self harm and suicide. “The World Health Organization (WHO) estimates that 62,000 adolescents died in 2016 because of self-harm, which is now the third leading cause of death for adolescents aged 15 –19. This is not just a rich country problem – WHO estimates that more than 90 per cent of adolescent suicides in 2016 were in low or middle-income countries. And while young people with severe mental disorders in lower-income countries often miss out on treatment and support, there is no country in the world that can claim to have conquered this challenge. To quote the WHO’s mental health expert Shekhar Saxena, “when it comes to mental health, all countries are developing countries.” 

The Kazakhstan experience in suicide prevention is then described: “For example, in Kazakhstan, which has one of the highest suicide rates among adolescents worldwide, UNICEF stepped up efforts to improve the mental well-being of adolescents through a large-scale pilot programme in over 450 schools. The programme raised awareness, trained staff to identify high-risk cases, and ensured referral of vulnerable adolescents to health specialists. Nearly 50,000 young people participated in the pilot with many significant improvements in well-being. The programme has since been scaled up to over 3,000 schools”. 

We are proud to remind that the UNICEF programme involved the EPA-SSSP Chair, Marco Sarchiapone (LINK)


World Mental Health Day

On 10 October 2019, every year, the World Mental Health Day is celebrated to raise awareness about mental health issues around the world and to foster efforts in support of mental health. This year the main theme of the World Mental Health Day is suicide prevention. 

Our section, represented by the Section Chair Marco Sarchiapone, participated in drafting the EPA statement for both the World Suicide Prevention Day and the World Mental Health Day 2019. These statements will be circulated to the NPAs, which will be invited to inform the EPA offices about their activities and initiatives for October 10th, in order to develop a communication strategy to raise visibility and support them.


Link: https://www.who.int/news-room/events/detail/2019/10/10/default-calendar/world-mental-health-day-2019-focus-on-suicide-prevention


Activities World Suicide Prevention Day 2019

In alphabetical order, for country:

Federico Daray wrote us from Argentina about their initiative, called CALMA: “This September 10 we have lanced CALMA. CALMA is the first Spanish tool-based mobile app for smartphones, which interacts with the user providing tools based on dialectical behavioral therapy (DBT) for the management of crisis situations and thus preventing suicide among adolescents and young people. CALMA also provides information, promoting activities aimed to reduce one’s vulnerability in order to prevent new crises and psychoeducational content about suicide and its prevention. The app was designed for teenagers and young people. It is available for free and works with Android and iOS. We have a small trial under review analyzing its effectiveness. This has a great impact on the media.

For now, we only have it in Spanish but we are searching the way to translate it into other languages. Maybe circulating this info through the EPA network could help to translate it into other languages, even to improve the app or do research projects to prove its effectiveness.

The project has no economic purpose, it has no financing, and the app is free”.

Here is the web site: https://www.appcalma.com/ 

Daniel Banos Illan from Australia wrote us a couple of things they do for suicide prevention: 

  • RUOK? Day  – This is a suicide prevention charity in Australia, reminding people that having meaningful conversations is important and encouraging to meaningfully ask “Are you ok?”. I am a local RUOK champion promoting this initiative. Info here: https://www.ruok.org.au/join-r-u-ok-day
  • Out of the Shadows – This is a national suicide prevention walk here in Australia, and is held to coincide with World Suicide Prevention Day. More info here https://www.outoftheshadows.org.au/

Moreover, Daniel on the 20th September 2019 delivered a suicide prevention TEDx talk in Bundaberg, Queensland in Australia about the link of spirituality and hopeful living. 

Sergey Igumnov shared with us the text of his popular article which is planning for publishing in Belarusian Newspaper “Vecherny Minsk” (Minsk Evening) on October 10, 2019 and devoted to suicide prevention (original is in Russian). LINK

Alexandr Kasal, who is now coordinating most of the suicide prevention-related agenda of Czech National Institute of Mental Health, supervised by Dr Winkler, told us: “On WSPD 10th September we held a press conference on the Ministry of Health to introduce that Czechia is preparing the National Action Plan for Suicide Prevention. It is the first strategical document on this topic in our country. Attending were among others the Minister of Health, the director WHO country office and representatives of relevant institutions” press release, video and other materials are accessible on the following link: https://www.mzcr.cz/dokumenty/ministerstvo-zdravotnictvi-predstavilo-narodni-akcni-plan-prevence-sebevrazd_17776_3970_1.html

Moreover, Kasal informed us about the activities they are organizing for the WMHD: “On World Mental Health Day 10th October we will release collaborative publication of National Institute of Mental Health, Ministry of Health and WHO country office in both Czech and English called Situational Analysis of Suicide Prevention in the Czech Republic. It covers epidemiology of the suicide and self-harm in our country as well as the results of interviews with relevant actors with identification of both opportunities and threats in the public health care and identification of promising interventions for the Czech context. It is background document for the previously mentioned action plan, and it may serve as inspiration for other states of the CEE region”.

Nicoletta Lekka from England sent us an update about a recent symposium on Suicide Prevention in Sport, as well as World Mental Health Day activities organised by the Mental Health Foundation and by One Dance UK.

  • On September 20th 2019, the Sport and Exercise Special Interest Group of the Royal College  of Psychiatrists organised a Symposium about Suicide Prevention in Sport, during the Autumn Conference in London. The speakers were Dr Tom McCabe who has published about suicide in sport, and Dr Allan Johnston who has chaired the Derbyshire Suicide Prevention Strategy Group from 2013-2018.
  • For World Mental Health Day 2019, the Mental Health Foundation (https://www.mentalhealth.org.uk) created the advice ‘WAIT’, a good way to remember how to support another person who may be suicidal.  It stands for:
    • Watch out for signs of distress and uncharacteristic behaviour e.g. social withdrawal, excessive quietness, irritability, uncharacteristic outburst, talking about death or suicide
    • Ask “are you having suicidal thoughts?” Asking about suicide does not encourage it, nor does it lead a person to start thinking about it; in fact it may help prevent it, and can start a potentially life-saving conversation
    • It will pass – assure your loved one that, with help, their suicidal feelings will pass with time
    • Talk to others – encourage your loved one to seek help from a GP or health professional

https://www.mentalhealth.org.uk › publications › suicide-prevention-wait

  • On World Mental Health Day (October 10th), OneDanceUK and the National Institute of Dance Medicine and Science (NIDMS) plan to create a social media discussion about Suicide Prevention in Dance. The key focus will be on sharing information about suicide prevention (e.g. risk and protective factors for suicide among dancers), signposting to support and resources, and getting people to engage with the question ‘What do you think needs to be discussed in suicide prevention in dance?’

Philippe Courtet from France informed us that on September 10th, they launched a prevention programme for students of the University of Montpellier. On October 10th, with Fondamental Foundation, they organize a press meeting in which he will present the project of an app of monitoring and suicide prevention “Emma”, they are currently developing. 

Hannah Müller-Pein from Universität Kassel in Germany informed us about their WSPD-related activities, which can be found here: https://suizidpraevention.wordpress.com/category/veranstaltungen-2019/, taken the opportunity to have a month of Suicide Prevention between WSPD and WMHD. (https://suizidpraevention.wordpress.com/category/monat-der-suizidpraevention/).

Zoltan Rhimer from Hungary shared with us activities in which he was recently involved in:  

  • 17 September. Chairmanship at Keynote Lecture on suicide at International Symposium on Suicidology and Public Health, Rome, Sapienza University
  • 20 September: Lecture on suicide in young persons at Scientific Congress  (Forum for Young People, Baja city, Hungary)
  • 21 September: Lecture about Recognition of suicide risk tz meeting in the village Szihalom (Hungary).
  • 10 OctOber: Lecture on Prevention of suicide in the frame of World Day of Mental Health, Eötvös Lóránd University, Budapest

Judit Balazs from Hungary wrote us as follows: “In Hungary, the Hungarian Psychiatric Association, where I’m the president-elect, jointly with Eötvös Lóránd University Faculty of Education and Psychology have organized an event on the WMHD focusing on prevention of suicide among youth. The WHO Country Office leader and the representative of the Hungarian Government will also be present. Prof Rihmer will present on suicide prevention, my PhD student, Lili Olga Horvath will present on school-based prevention programs, including YAM and I will present on youth mental health.  There will be a round-table as well with several experts”.

PROGRAM (Hungarian): HERE 

On the occasion of the XVII edition of World Suicide Prevention Day, Maurizio Pompili from the Sapienza University of Rome (Italy) organized the XVII edition of the International Symposium on Suicidology and Public Health which took place in Rome on September 17-18, 2019; the main theme was “World Suicide Prevention Day: Working Together to Prevent Suicide”. 

During the symposium, many specialists gathered to discuss the most up-to-date suicide-related topics. The high scientific level of the meeting was granted by the participation of italian and international speakers and opinion leaders including some of the most important experts in the field of suicidology worldwide. 

Several of our Section members attended the congress, either as presenters or participants. You can find more here:

Our member Agnieszka Gmitrowicz, President of Scientific Section of Suicidology of Polish Psychiatric Association sent us this small summary of Polish activities for suicide prevention:

“ Recent months have proved extremely important for Polish Suicidological Society (PSS). On September 10, we celebrated the World Suicide Prevention Day. As part of the campaign “Life is worth a conversation’ the PSS in co-operation with the Institute of Psychiatry and Neurology and the University of Warsaw organized Open Lectures addressing both theory of suicidology and practical issues of suicide prevention and postvention. The event proved to be quite popular – not only a large group of people have gathered in the Library of the University of Warsaw to listen to the lecturers, but there has been also a substantial media response. During the event specialists were available for consultations. A video spot „Manly thing” has been presented, addressing the issue of suicide among men, who are an 80% majority among suicide victims in Poland.

Since September 2019 as a part of the EU program ERASMUS+ an e-learning platform is being developed, whose objective is to popularize the ideas of suicide prevention among students and university teachers and improve their knowledge in this area. The project is to be carried out for the next three years.

Still active and available are helplines for adults, children and adolescents in crisis.

A guideline for journalists on how to inform the public about suicide has been issued earlier this year. It is available free of charge, both in print and on the website www.poradnikdlamediow.pl.

Thanks to this action, some newspapers and web portals have already changed the way of reporting suicide deaths. They also publish – at the end of each such article – information on how to deal with suicidal ideations and where to find help.

Another extremely important issue is the accession of the Polish Suicidological Society to the international program ELLIPSE. This project is first such initiative in Poland. Polish Suicidological Society consider access to this program a milestone on the road to suicide prevention in our country. In addition, it should be emphasized that we succeeded to join forces of our Society with representatives of foreign organizations dealing with suicide prevention. Thanks to such actions undertaken on a large, international scale we can speak louder and louder that suicide can be prevented! Our common effort helps not only break stereotypes, but also save lives!”.