Van Orden et al(2010年)認為企圖自殺有二個主要因素,第一個主要因素是想要自殺或是死亡的慾望(desire for death),另一個主要因素是完成自殺行為的能力(acquired capability)。死亡慾望一般會是挫败的侵入性想法(英语:Intrusive thought),包括归属受挫(thwarted belongingness,也就是和其他人有情感上的疏離)以及自我累赘感知(perceived burdensomeness,認為自身不稱職,是其他人的累赘)[4]。此處用到完成能力的概念,因為一般人恐懼死亡以及疼痛的經驗。執行自殺意圖的能力一般是經由情感以及身體上的痛苦以及認知障礙持續狀態來形成,透過以往的企圖自殺(自我暴力)、通过行为或图像排练自殺,或是利用其他方式習慣疼痛或危險的經驗來達到。
美國的《國家預防自殺戰略》(NSSP)曾建議媒體避免對負面情緒浪漫化,也避免一些會造成替代性創傷的適應方式。美國疾病預防控制中心(1994年研討會)和美國自殺預防基金會(1999年)曾建議電視節目及新聞媒體可以用此方式來預防自殺:將自殺和自殺的結果(例如自殺的痛苦以及自殺遺族的傷痛等)相連結,讓社會大眾可以選擇自殺以外的方式來解決他們生命中的問題,另外也建議電視節目及新聞媒體避免提到自殺流行(英语:suicide epidemic)、避免把權威人士或是有同理心的一般人成為自殺合理性(英语:reasonableness of suicide)的代言人[37]。
策略
因為有必要針對自殺采取全面的预防方法,在證據的支持下已經發展了不同的防治策略。傳統的研究是識別會導致自殺或是自我傷害的危險因子,不過有元分析指出自殺風險評估不一定有效[38]。2001年美国卫生及公共服务部出版了《国家预防自杀战略》(National Strategy for Suicide Prevention),為美國建立了自殺預防的框架,呼籲用公共衛生的方式來防止自殺,重點是在群體中識別出自殺模式以及自殺意念(英语:suicidal ideation)的模式,(而不是去探索可能导致个人自杀的历史和健康状况)[39]。
有許多有關自殺預防的非營利團體,例如美國的美國自殺防治基金會(英语:American Foundation for Suicide Prevention),有提供危機熱線,此基金會受益於一個以上的众包計劃[55]。第一個有記錄,針對自殺防治的計劃是在1906年紐約發起的Save-A-Life League,以及倫敦的Suicide Prevention Department of the Salvation Army[56]。自殺是美國第十大最常的死因,根據2012年疾病預防控制中心的調查,有0.5%的成年人曾試圖自殺[57]。美國衛生及公共服務部在2001年發布美國國家自殺預防戰略(U.S. National Strategy for Suicide Prevention),許多自殺預防的成果和此戰略有關[39]。
^Office of the Surgeon General:The Surgeon General's Call To Action To Prevent Suicide 1999 [1] (页面存档备份,存于互联网档案馆)
^Rory C. O'Connor, Stephen Platt, Jacki Gordon: International Handbook of Suicide Prevention: Research, Policy and Practice, p. 510 [2] (页面存档备份,存于互联网档案馆)
^Rory C. O'Connor, Stephen Platt, Jacki Gordon, International Handbook of Suicide Prevention: Research, Policy and Practice, p.361; Wiley-Blackwell (2011), ISBN0-470-68384-8
^Alan F. Schatzberg: The American Psychiatric Publishing textbook of mood disorders, p. 503: American Psychiatric Publishing; (2005) ISBN1-58562-151-X
^Crawford, MJ; Thana, L; Methuen, C; Ghosh, P; Stanley, SV; Ross, J; Gordon, F; Blair, G; Bajaj, P. Impact of screening for risk of suicide: randomised controlled trial.. The British Journal of Psychiatry. May 2011, 198 (5): 379–84. PMID 21525521. doi:10.1192/bjp.bp.110.083592.
^Pirkis J, Burgess P. Suicide and recency of health care contacts. A systematic review. The British Journal of Psychiatry. December 1998, 173 (6): 462–74. PMID 9926074. doi:10.1192/bjp.173.6.462.
^Mann, J. John; Michel, Christina A. Prevention of Firearm Suicide in the United States: What Works and What Is Possible. American Journal of Psychiatry. 22 July 2016, 173: appi.ajp.2016.1. PMID 27444796. doi:10.1176/appi.ajp.2016.16010069.
^Sakinofsky I. The current evidence base for the clinical care of suicidal patients: strengths and weaknesses. Canadian Journal of Psychiatry. June 2007, 52 (6 Suppl 1): 7S–20S. PMID 17824349. Other suicide prevention strategies that have been considered are crisis centres and hotlines, method control, and media education... There is minimal research on these strategies. Even though crisis centres and hotlines are used by suicidal youth, information about their impact on suicidal behaviour is lacking.
^Summary of the Practice Parameters for the Assessment and Treatment of Children and Adolescents With Suicidal Behavior. Journal of the American Academy of Child & Adolescent Psychiatry. 2001, 40 (4): 495–499. ISSN 0890-8567. doi:10.1097/00004583-200104000-00024.
^Randolph B. Schiffer, Stephen M. Rao, Barry S. Fogel, Neuropsychiatry: Neuropsychiatry of suicide, pp. 706-713, (2003)ISBN0781726557
^Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch. Gen. Psychiatry. July 2006, 63 (7): 757–66. PMID 16818865. doi:10.1001/archpsyc.63.7.757.
^Marasinghe RB, Edirippulige S, Kavanagh D, Smith A, Jiffry MT. "Telehealth approaches to suicide prevention: a review of evidences." eHealth Sri Lanka 2010 2010,1(suppl.1):S8
^Hall RC, Popkin MK, Devaul RA, Faillace LA, Stickney SK. Physical illness presenting as psychiatric disease. Arch. Gen. Psychiatry. November 1978, 35 (11): 1315–20. PMID 568461. doi:10.1001/archpsyc.1978.01770350041003.
^Andreas P. Otte, Kurt Audenaert, Kathelijne Peremans, Nuclear Medicine in Psychiatry: Functional Imaging of Suicidal Behavior, pp.475–483, Springer (2004);ISBN3-540-00683-4
^Patricia D. Barry, Suzette Farmer; Mental health & mental illness, p. 282, Lippincott Williams & Wilkins;(2002) ISBN0-7817-3138-0
^Baldessarini RJ, Tondo L, Hennen J. Lithium treatment and suicide risk in major affective disorders: update and new findings. J Clin Psychiatry. 2003,. 64 Suppl 5: 44–52. PMID 12720484.
^Coppen A. Lithium in unipolar depression and the prevention of suicide. J Clin Psychiatry. 2000,. 61 Suppl 9: 52–6. PMID 10826662.
^Heath N. L.; Baxter A. L.; Toste J. R.; McLouth R. Adolescents' willingness to access school-based support for non-suicidal self-injury. Canadian Journal of School Psychology. 2010, 25 (3): 260–276. doi:10.1177/0829573510377979.