Protective factors are those that decrease the risk of suicidal behaviour, such as personal resilience, tolerance for frustration, self-mastery, adaptive coping skills, positive expectations for the future, sense of humour, having good social supports and particularly having at least one positive healthy relationship with a confident.
Prevention and Recovery
Using the framework described above16, suicide
prevention programs must address the predisposing, precipitating, contributing and protective factors for suicidal behaviour:
• Early identification and treatment programs address the predisposing factors.
• Crisis intervention addresses the precipitating factors.
• Treatment programs address the contributing factors.
• Mental health promotion programs address the protective factors.
• For Aboriginal communities, ceremonies and community control and ownership of
education, housing, employment and health are protective factors. They also address
predisposing factors.17
Many provinces, territories and communities have developed suicide prevention programs. Programs need to be both population-wide and targeted toward those who are at higher risk. A comprehensive program has a framework, goals and objectives and a commitment to adequate funding. Promotion of good mental health of the entire Canadian population, reduction of risk factors, early recognition of those at risk for suicidal behaviour, and
A comprehensive program has the following strategies.19
1. Promote awareness in every part of Canada that suicide is a preventable problem.
2. Develop broad-based support for suicide prevention and intervention.
3. Develop and implement a strategy to reduce stigma, to be associated with all suicide prevention, intervention and bereavement activities.
4. Increase media knowledge regarding suicide.
5. Develop, implement and sustain community-based suicide prevention programs, respecting diversity and culture at local, regional, and provincial/territorial levels.
6. Reduce the availability and lethality of suicide methods. Since suicidal behaviour is impulsive and often occurs during a transitory crisis, restricting access to lethal means can substantially reduce the risk of
the completion of a suicide attempt.20 This
includes reducing access to firearms, bridges and dangerous sites, and restricting the quantity of common over-
7. Increase training for recognition of risk factors, warning signs and at-risk behaviours and for provision of effective intervention, targeting key gatekeepers, volunteers and professionals.
8. Develop and promote effective clinical and professional practice (effective strategies, standards of care) to support clients, families and communities.
9. Improve access and integration with strong linkages between the continuum-of-care components/services/families.
10. Prioritize intervention and service delivery for high-risk groups while respecting local, regional and provincial/territorial
uniqueness.
11. Increase crisis intervention and support. 12. Increase services and support to those
bereaved by suicide.
13. Conduct research and evaluation to inform the development of effective suicide prevention programs. These research efforts need to address the causes of suicidal behaviours, factors that increase risks for these behaviours, and factors that are protective and that may facilitate resiliency in vulnerable persons. Research must also evaluate the effectiveness of suicide prevention programs.
Older adults are not generally considered at risk for suicide and, as a result, warning signs are often missed. The Canadian Coalition for Seniors Mental Health will soon be releasing national guidelines on the prevention and
assessment of suicide among seniors.21
Endnotes
1 Bland RD, Dyck RJ, Newman SC, Orn H. Attempted suicide in Edmonton. In: Leenaars AA,
Wenckstern S, Sakinofsky I, Dyck RJ, Kral MJ, Bland RC, editors. Suicide in Canada. Toronto: University of Toronto Press; 1998. p. 136.
2 Langlois S, Morrison P. Suicide deaths and suicide attempts. Health Reports. 2002;13:2:9–22.
Statistics Canada Catalogue 83-003.
3 Langlois et al.
4 Canetto SS, Sakinofsky I. The gender paradox in suicide. Suicide and Life and Life Threatening
Behavior. 1998;28:1:1–23.
5 White J. Comprehensive youth suicide prevention: a model for understanding. In: Leenaars AA,
Wenckstern S, Sakinofsky I, Dyck RJ, Kral MJ, Bland RC, editors. Suicide in Canada. Toronto: University of Toronto Press; 1998. p. 165–226.
6 Prévill M, Boyer R, Hébert R, Bravo G, Séguin M. Etude des facteurs psychologiques, sociaux et de
santé reliés au suicide chez les personnes âgées. Centre de recherce sur le vieillissement/Research Centre on Aging; November 2003.
7 White J.
8 Health Canada. Acting on what we know: preventing suicide in First Nations youth. Suicide Prevention
Advisory Group. Ottawa: Health Canada; 2003.
9 Kral MJ et al. Unikkaartuit: meanings of well-being, sadness, suicide, and change in two Innuit
communities. Final report in to the National Health Research and Development Program, Health Canada; 2003.
14 White J.
15 Leenaars AA. Suicide, euthanasia, and assisted suicide. In: Leenaars AA, Wenckstern S, Sakinofsky
I, Dyck RJ, Kral MJ, Bland RC, editors. Suicide in Canada. Toronto: University of Toronto Press; 1998. p. 460–61.
16 White J.
17 Chandler M., Lalonde C. Cultural continuity as a hedge against suicide in Canada's First Nations.
Transcultural Psychiatry. 1998;35:191–219.
18 Dyck RJ, White J. Suicide Prevention in Canada: Work in Progress. In: Leenaars AA, Wenckstern S,
Sakinofsky I, Dyck RJ, Kral MJ, Bland RC, editors. Suicide in Canada. Toronto: University of Toronto Press; 1998. p. 256-271.
19 Canadian Association for Suicide Prevention. Blueprint for a Canadian National Suicide Prevention
Strategy. 2004 Available from: http://www.suicideprevention.ca/
20 Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the
National Comorbidity Survey. Archives of General Psychiatry. 1999;56:617–26.