Sándor Kalmár, M.D., Ph.D.

There is no other complex physical, biological, somatic, mental, psychological, psychiatric, cultural, social and spiritual phenomenon like suicide. We can never be traced back to one single reason. There is always large number of biological, psychological-psychiatric, historical, social and cultural factors which play role in its development but the strongest suicide risk is an unrecognized and untreated mental disorder.

The victims of suicide are never healthy individuals. They always suffer from some psychiatric, mental, physical or somatic, cultural (social, historical, mythological) and spiritual disorders.Suicide risk and protective factors can occur (1) at the physical or biological-somatic level which includes physical circumstances, genetic and health, and diseases; (2) at the mental or psychological level, which includes mental health, self-esteem, and the ability to deal with difficult circumstances, manage emotions, or cope with stress; (3) at the cultural level or the broader life environment and it includes the social, political, environmental, and economic factors that contribute to available options and quality of life, and 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; (4) at the spiritual level, which includes faith, hope, charity, despair, salvation. 

According the risk and protective factors every suicide has at least four aspects: (1) Biological, abnormality in the body, (especially in the brain) (2) Psychological, psychiatric, (objective and subjective, abnormality in the mind) (3) Cultural and environmental, (mainly subjective, abnormality in the environment) (4) Spiritual aspect (subjective). This approach determines the possibilities of prevention. For example hopelessness is the most important spiritual risk factor. The HOPELESS SCALE (Beck) is a “user-friendly” tool for easy application in general practice. Some of the researchers not only abandoned the four aspects of suicide but took the duality of suicide out of consideration as well, which is partly based on biological abnormality (objective and can be examined with scientific methods, quantitative research), and partly on culture events (which are mostly subjective, social, spiritual, mythological, and can only be examined hermeneutically, indirectly, with qualitative methods).

Suicide among young people is one of the most serious public health problems in Hungary. Despite the great advances in the psychopharmacology and psychotherapy of mental disorders, suicides persist as major cause of mortality, especially among the 15-24, and 25-34 years old population. 1504 young people lost their lives due to suicide in the 24>age group (2000-2012: 1240 males and 264 females) and 3053 young people in the 25-34 years old group (2000-2012: 2587 males and 466 females). Among adolescents and youths (ages 15-24 and 25-34) suicide is the first leading cause of death. They should not have died. According to epidemiological studies 24.7% of children and adolescents suffer from some form of behavioral, conduct or other psychiatric disorders, but most of them never get appropriate psychiatric treatment.