Headnote

Summary

The World Organization of the Health defines the suicide like the deliberate act of
taking off the life, being caused a lesion, with a variable grade in the intention of dying.
The suicide is the fourth form of violent death in Colombia (Cifuentes 2013). In the
2014 4,33 cases were reported by 1 00.000 inhabitants, being the groups etarios from 20
to 24 and from 70 to 74 years those that presented bigger rates at national level
(Ramírez & Orange tree 2014). The literature reports that in 90% of cases of
suicide he/she is some dysfunction mental associate, what is constituted in a problem of
public health. This revision article intends to describe the relationship between mental
dysfunctions and suicidal behavior, with the purpose of to contribute to the
understanding of the phenomenon and to stand out the necessity to create and to
implement strategies of early attention.

Words Key: Suicide, Ideación Commits Suicide, Mental Health, Public Health,
Psicopatología, Mental Dysfunction.

Abstract

The World Health Organization defines he/she commits suicide ace the act of
deliberately killing oneself, causing injury or damage, with varying degrees of intention
to die. Commit suicide is the fourth form of violent death in Colombia. In 2014 4.33
marry per 1 00,000 inhabitants were reported; the target age groups, with the higher
rates nationwide, consisted of 20-24 and 70-74 years old. Papers reported that 90% of
commits suicide it plows associated with mental disorder therefore, it should be
considered to public health problem. This study aims to review scientific literature to
describes the relationship between mental disorders and suicidal behavior, highlighting
the need to establish and implement strategies for early intervention in populations at
he/she commits suicide risk.

Keywords: Commit Suicide, Suicidal Ideation, Mental Disorders, Mental Health, Public
Health, Psychopathology.

Introduction

The World Organization of the Health (OMS) defines the suicide like "the deliberate act
of taking off the life" (2012a, p. 75). The behavior commits suicide it can express as a
continuous one that goes from the ideación, planeación and tentative to the
accomplished suicide (Ministry of Health and Social Protection 2014). From 1970 OMS
identified the suicidal act as a problem of public health, and in the 2013 he/she carried
out an epidemic study finding that in the world 9.000 people try to commit suicide daily
and every year they are made around a million suicides; this means a death every 40
seconds, locating at suicide among tas first three causes of death in people from 15 to 44
years (OMS 2013). He/she is also considered that it stops et year 2020, approximately
1,53 mittones of people will die for suicide, to that represents an average of a death
every 20 seconds and an intent every 1-2 seconds (Bertotote & Fteischmann 2002).

As an intent of measured preventive consensuar, in et year 2012 ta OMS creó et

Program of Prevention det Suicide (SUPRE) (2012b). To this effort they have united
atgunos countries to nivet tatinoamericano and mundiat, reatizando diverse studies and
boarding proposals like, for ejempto, ta Association Internacionat det ta Tetéfono
Esperanza (ASITES) whose mission is to promote ta satud emocionat of tas people in
gratuitous crisis mediating nets of preventive help of character.

A Potítica of Satud has existed in Cotombia Mentat almost for 20 years (Ministry of
Satud Repúbtica of Cotombia, 1998, Resotución N° 2358) that it dictates tas norms
scientific, technical and administrative regutadoras of ta catidad of services for this area
of ta satud, and they have left improving tas conditions through proposals as cough
Limits of Potítica of Satud Mentat for Cotombia det Ministry of ta Protection Sociat and
ta Foundation FAITHS Sociat (2005), et Modeto of Operative Management for
Component et of Satud Mentat in Primary Attention in Satud (King Sarmiento 2009)
and et Observatory Nacionat of Satud Mentat (Ministry of Satud and Protection Sociat
Repúbtica of Cotombia 2011).

In et year 2013 ta Law was sent 1616 of Satud Mentat, (+) by means of ta cuat it is
looked for to guarantee et exercise right det to ta satud mentat, you estabtecen cough
regtamentos for ta promotion and benefit of services integrates. In et 2014 you pubticó
et Document Proposal of ta Adjustment Potítica Nacionat of Satud Mentat for Cotombia
(Ministry of Satud and Protection Sociat - Pan-American Organization of ta Satud -
OPS - / OMS 2014). That year et same Ministry recognized important restrictions in ta
apticación and resuttados det System of Satud of Cotombia, resattando that ta attention
in satud mentat is timitada in its opportune handling and early of tas necessities of ta
pobtación, it presents catidad probtemas and it is based on a modeto hospitatario of
benefit of services, and it proposes et it Programs Nacionat of Satud and Medicine
Famitiar and Community for fortatecer ta formation, competitions and
interdisciptinariedad of cough different profesionates of ta satud.

In et year 2015, ta fourth Nacionat of Satud Interviews Mentat in et country,

desarrottada for et Ministry of Satud and Protection Sociat, COLCIENCIAS, ta Papal
University Javeriana and Data, Processes and Tecnotogía S.To.S., it presented data
epidemiotógicos retacionados with ta subjective perception of well-being and retaciones
interpersonates, support sociat, estrés, viotencia, etc., with et end that they were kept in
mind in cough ptanes of promotion of ta satud mentat and opportune prevention of
probtemas and dysfunctions mentates, for ejempto, by means of strategies of
fortatecimiento of ta empathy, recognition and participation sociat. In January det 2016
you pubticó ta Potítica of Attention Integrat in Satud (+) to assure et access to services
fundamentates to inclination det improvement of ta same catidad of cough,
fortateciendo ta infrastructure hospitataria, ta financial sostenibitidad, tas preventive
strategies with focus famitiar, community and intercutturat, et human tatento and ta
incorporation of Tetesatud (promotion activities, prevention, diagnosis, treatment and
rehabititación mediating ta utitización of tecnotogías of information and
communication, for facititar et pobtación access that he/she lives in remote tugares).

In Colombia, the suicide is the fourth form of death violenta1 (Cifuentes 2013). In 2014
4,33 cases were reported for 100.000 inhabitants, being the groups etarios from 20 to 24
and from 70 to 74 years those of more rates (650) at national level. The group with
more cases is that of men among 20 and 29 years continued by that of women between
15 and 17 years. Some psychosocial factors associated to the suicide are bereavements,
family difficulties or of couple, unemployment, jubilation, divorce or widowhood,
diagnoses of serious illnesses, I overturn mental, abuse of substances psicoactivas and
alcohol (Ramírez & Orange tree 2014).
The consequences are devastating point for people that suicidal acts and their relatives
carry out as for the State, due to the physical lesions, emotional and mental traumas,
hospitalizations and high investment that it implies a treatment for the integral recovery.
Also, the suicide generates an economic impact due to population's loss in productive
ages. In Colombia he/she is considered that, in the year 2006, the lost years because of
the suicide were 57.078 per year, of those which 19.590 corresponded people in ages
between 18 and 24 years (Rodríguez 2007).

On the other hand, people with mental dysfunctions constitute a population with high
grade of affectations (Of Hert et to the one., 2011), among them the suicide. The mental
dysfunctions are an important factor of risk, since near 90% of people that make suicide
they present a psychiatric diagnosis (Phillips, 2010; Windfuhr & Kapur 2011) and
when these are increased he/she usually shows up bigger mortality for suicide, as they
report psychological autopsies (Cavanagh, Carson, Sharpe, & Lawrie, 2003; Saha,
Chant, & McGrath 2007). The suicide is, then, superior in this population, what
represents a very expensive outcome for the families and the society (Ajetunmobi,
Taylor, Stockton, & Wood, 2013; Whiteford et to the one., 2013).

It is common that people with this type of diagnoses attend services of primary attention
(Cohen 2006) and professionals of health consult during the previous year to the suicide
(Borges et to the one., 2005; Espinosa, Blum Grynberg, & Romero Mendoza,
2009; Hunt et to the one., 2006a; Luoma, Martin, & Pearson 2002), and the
quantity of necessities not satisfied in this population the social load, the same cost of
the illness and the human losses they increase (Wittchenet to the one., 2011). It exists in
the population with mental dysfunctions a hospital suicide risk related with the high one
after a crisis characteristic of the dysfunction or a suicide intent: it has been reported
that the period of more risk is the first four weeks after the high one (Goldacre,
Seagroatt, & Hawton 1993), what could be explained by a perception of support
loss, smaller supervision, relapse to the one turns again exposed to problems in the
habitual mean, I abandon of the treatment, or that they are not simply completely
recovered, with that which is justified the importance of the maintenance of the
treatment with medication prophylaxis in people with episodes community recurrent,
appropriate support, special attention to the precocious signs of relapse and design of
plans that mitigate the risk.

Keeping in mind this general panorama, this article intends to describe the narrow
relationship between mental dysfunctions and the suicidal behavior, with the purpose of
to contribute to the understanding of the phenomenon and to justify the urgency of to
recognize and to not only act by means of treatments and interventions on the
difficulties and pathologies, but also through plans and activities of prevention and early
attention as one of the main objectives of the public health (OMS, 2013; Pérez 2011).

The present revision you mediating reatizó a bibliographical search of articles, books,
political and teyes, using cough taken terms of ta virtual Library in satud DeCS
(Describers in ta Sciences Satud) and det Thesaurus MeSH (Medicat Sucject Headings):
"suicide, suicidal ideación, suicidal spectrum, illness mentat, dysfunction mentat,
psicopatotogía, suicide and dysfunction mentat, suicide and psicopatotogía, suicide and
illness mentat, factors of risk, satud púbtica"; in tas following databases: Science Direct,
PubMed, Ovid, Scieto, Psicodoc and Academic Googte.

Implications in the Colombian Context

According to ta OPS (2003), dysfunctions mentates like ta depression, dysfunctions for
atcohot consumption and abuse of substances, ta viotencia, tas wars, cough disasters, ta
acutturación2 (of indigenous puebtos or people desptazadas, among other), ta
discrimination, et aistamiento, tas losses and diverse environments sociates, constitute
factors of suicide risk, as well as tas dificuttades to consent to ta attention in satud, ta
disponibitidad of cough resources to commit suicide and et sensacionatismo of atgunos
massive means of communication when they inform on cough happened cases of
suicide.

During more than 50 years Cotombia has suffered múttiptes conflicts sociates and
politicians generating forced desptazamientos, kidnappings, tortures, massacres,
disappearances, homicides, viotencia intrafamitiar and of gender, mattratos, abuses
sexuates, exptotación, atcohot abuse and substances psicoactivas, etc. (I Center
Nacionat by heart Historical 2013), unchaining estrés situations, self-destructing
behaviors (Cervantes & I Put Hernández 2008) and dysfunctions mentates. Among
tas direct causes of cough dysfunctions mentates they are cough probtemas
psicosociates and ta decomposition det núcteo famitiar, and among tas indirect et
deterioration of ta situation sociat and economic of ta pobtación, as well as et low nivet
of catidad of life. For another tado, atgunos direct effects of cough dysfunctions
mentates is et increase of promotion costs, prevention and treatment, and ta decrease of
ta capacity taborat and productive; and among indirect cough they are et increase of
cases of viotencia intrafamitiar, viotencia sexuat and of gender, etevado consumption of
substances psicoactivas, deterioration sociat and economic (Project of Ordinance N°
040 by means of ta cuat you estabtecen cough ta Limits Potítica Púbtica in Satud Mentat
and Coexistence Sociat det Department of Santander 2014). All these phenomena, like
one can observe, they constitute a vicious círcuto in et that stay and tas affectations and
consequences increase.

Association between Suicide and Mental Dysfunction

The dysfunctions more frequent mentates in aduttos that they have reatizado suicide
intents are depression, distimia, bipotaridad, personatidad dysfunction, anxiety,
agoraphobia, abuse of substances (you drug psicoactivas, atcohot and tobacco),
schizophrenia, somatización and dysfunctions atimentarios like ta nervous anorexy
(Bathara & Verma, 2012; Chesney, Goodwin, & Fazet, 2014; Rodríguez
& Guerrero, 2005; Sitva, Vicente, Satdivia, & Kohn, 2013; Sotoff, Fabio,
Ketty, Matone, & Mann 2005). In adotescentes they are behavior dysfunctions,
depression, phobias simptes and anxiety generatizada (Petkonen & Marttunen
2003). Retación also exists between suicide and atimentación dysfunctions in
adotescentes women, behavior dysfunctions in men (tímite and sociópata) and abuse of
substances in both sexes (Bhatia & Bhatia 2007).

Bigger suicide risk exists in the first months after being diagnosed with some affective
dysfunction (Castro-Díazet to the one.. 2013), depression psicótica and bipolar
dysfunction (Steele & Doey 2007). The risk increases since in the first days or
weeks of beginning of a pharmacological treatment in this period it usually worsens the
sintomatología (Healy & Alfred. 2005; Perlis et to the one.. 2007). and in the
following days to the high one hospital. mainly in those that consult in urgencies
(Gairin, House. & Owens. 2003; Hansagi. Olsson. Hussain. & Onlén. 2008). reporting a
risk 100 times adult (Ho. 2003) between the three days and the week after leaving the
hospital (Hunt et to the one.. 2009).
He/she has also been evidence that to more number of dysfunctions mental comórbidos
it is bigger the suicide risk. being those that one writes down the main ones next:

Depression. According to the Diagnostic and Statistical Manual of the Mental

Dysfunctions [DSM-V] (American Psychiatric Association - APA. 2013). the
depression is one period in which shows up a change of the previous operation. state of
decayed spirit. loss of interest or pleasure. appetite changes. dream. activity motorboat.
feeling of uselessness or it accuses. difficulty to concentrate and recurrent (not only fear
to die) "thoughts of death. you devise recurrent suicides without a certain plan. suicide
intent or a specific plan to carry out it" (p. 105).

At level sintomatológico a relationship exists between depression and suicide

(Aristizábal. González. Palacio. García. & López. 2009; Bolton. Belik. Enns. Cox. &
Sareen. 2008; González & Camejo. 2014; Harwitz & Ravizza. 2000; Nock et
to the one.. 2008; Palacio et to the one.. 2007). He/she is considered that the depression
by itself the suicide risk increases (Kessler. Berglund. Borges. Nock. & Wang. 2005); in
this respect Hagnell. Lanke. Rorsman and Ojesjo (1 982. mentioned by Hernández.
González-Elías. & López. 2013) they sustain that depressed people present suicide rates
44 times superiors to people without depression. and 8 times superiors to the rest of the
psychiatric patients. In the suicide tentative. the depression plays a decisive role and it
affects the adolescents mainly (Goat. Infante. & Sossa. 2010; Bull. Paniagua. González.
& Montoya. 2009).

In people with depressive dysfunction 27% has had a suicide intent at least throughout
its lives (Nemeroff. Compton. & Berger. 2001). The depression can increase up to 12
times the suicide risk when the despair prevails. associated with premeditation and high
letalidad (Aliaga. Rodríguez. Ponce. Fristancho. & Vereau. 2006). The vivencia of
suffering in the depression. evident in people's letters that you/they have carried out
suicidal acts. he/she has been related most often and ideación intensity and suicidal
behaviors (Olié. Guillaume. Jaussent. Courtet. & Jollant. 2010).

Anxiety. According to DSM-V (APA. 2013) the dysfunctions of anxiety are

characterized by excessive fear before real or perceived threats and anxiety like
anticipation of future threats. He/she has met association of several dysfunctions of
anxiety with ideación and suicidal" intents (p. 193). and people with specific phobias
"have 60% more than probability of suicide intents that people without the diagnosis.
However. this high rate can be due to the comorbilidad with dysfunctions of personality
and other dysfunctions of anxiety" (p. 201). He/she has also been that "the presence of
wonderful attacks and diagnosis of wonderful dysfunction in the last 12 months are
related with a bigger rate of intents and suicidal ideación, even when they are kept in
mind the comorbitidad, a history of infantile abuse and other factors of suicide" risk (p.
212).

Other studies have shown that the dysfunction of anxiety increases the ideación risk and
suicidal intent (Bartels et at., 2002; Norton, Tempte, & Pettit, 2008; Sareen et at
2005). Almost et 20% of cough patients with a dysfunction of crisis of anxiety and
phobia sociat makes fruitless suicide intents (Caycedo et at., 2010). They are considered
factors of risk of suicide cough dysfunctions of anxiety moderately severe, react
transitory of adjustment, anxiety like personatidad feature and characteristic obsessive
(Chioqueta & Stites, 2003; Joiner, Brown, & Wingate 2005), for to that ta
vatoración of ta graveness of ta anxiety would help to identify patient in suicide risk
(Sharma 2003).

In a study reatizado for Luggage rack and Aroca (2014) it was found that who presented
anxiety and depression they were more imputsivos, reatizaron suicidal more intents, and
they had antecedent famitiares of suicidal behavior, abuse sexuat and emocionat in ta
childhood.

I Overturn Bipolar. According to et DSM-V (APA 2013), et overturns bipotar imptica

maniac, followed episodes or preceded by episodes hipomaníacos or of more
depression. Between et 10% and 15% of people with dysfunction bipotar consummate
et suicide, usuatmente at beginning of ta illness (Goodwin & Jaminson 2007) and
in tas depressive phases (Post 2005). Strakowski, McEtroy, Keck and West (1996) they
identified in patient with dysfunction bipotar until 90% of tendency at suicide, and attas
punctuations in a depression escata like et more aggravating factor; there is also you
estabtecido that et suicide risk is 22 times adult in patients diagnosed with dysfunction
bipotar that in pobtación generat (Tondo, Hennen, & Batdessarini 2001).

Abuse of substances psicoativas. According to et DSM-V (APA 2013) tas conditions

ctasificadas like induced by use or abuse of substances they are: "intoxication,
abstinence and other dysfunctions (psicóticos, bipotar and retacionados, depressive, of
anxiety, obsessive-computsivos and retacionados, det dream, disfunciones sexuates,
detirio, and neurocognitivos)" (p. 481). In generat, et risk for all cough dysfunctions
retacionados with substances associates with overdose accidentates and detiberadas.
"The repeated intoxication and abstinence can be associated with depressions
sufficiently intense severe to as to give tugar to intents and suicides. However, cough
data disponibtes suggests that they should not made a mistake overdose accidentates
non fatates with suicide" intents (p. 544).

Et abuse of substances presents attos comorbitidad nivetes with other dysfunctions

mentates (Davis, Uezato, Newett, & Frazier, 2008; Dougherty, Mathias, Marsh,
Moetter, & Swann, 2004; Bread et at., 2012; Park, Scheep, Jang, & Koo
2006), increasing their incidence from 19% to 45% (Bakken & Vagtum 2007). It
fences det 50% of those who commit suicide they are intoxicated and et 18% of tas
people with atcohotismo diagnosis commits suicide (Maris 2002).

Et atcohot abuse and substances psicoactivas retacionado with deaths for suicide
fluctuate among 5% and 27%, and et suicide risk for tas people with atcohotismo
diagnosis to targo of their life atrededor det 15% it is located (Mites, 1 997). Et abuse of
substances and atcohot are an important suicide predictor (Ocampo, Bojorquez, &
Cortés 2009) and depression (Lecrubier 2002). The frequent comorbitidad between
depressive dysfunction and consumption of substances is almost higher three times that
in general population (Agosti & Levin 2006), and in the case of dependence of
alcohol there are up to two thirds more than association (Beghi, Rosenbaum, Cerri,
& Cornaggia, 2013; Santamarina, Churches, & Alonso 2004).

The suicide risk in people that consume substances increases 2.6 times. The alcohol
(72,9%), the cannabis and the sedative (6,8%) ones, the stimulants (9,6%), the opioides
(Borges, Walter, & Kessler 2000) and the prescription fármacos is those more used
to carry out suicidal acts (Agosti & Levin, 2006; Preuss et to the one., 2002). Also,
the abuse / dependence of cocaine has a prevatencia of 40,5% in cases of suicidal
ideación and 39, 2% of intents (Garlow, Purselle, & D'Orio 2003).

Some authors explain the association between consumption of substances and suicide
(Bernal et to the one., 2007; Borges et to the one., 2000) intending that the intoxication
can reduce the inhibition and to increase the risk of an act of impulsive suicide, to alter
the trial capacity and to develop the disforia (Santamarina et to the one., 2004), to
generate cerebral disfunción, changes neuropsicotógicos, change in state of spirit and
violent behavior that are developed when he/she wastes away more than a substance
(Conner, Beautrias, & Conwell 2003).

Dysfunctions of personality. Defined by DSM-V (APA 2013) as a lasting and inflexible

pattern "of internal experience and behavior that he/she turns notably off the
expectations of the individual's culture, and it is manifested in the knowledge,
affectivity, interpersonal operation and control of impulses" (p. 359). These
dysfunctions show up until in 70% in suicidal people (Mejía, Sanhueza, &
González 2011), and features like poor self-esteem are implied, impulsiveness, anger
and aggressiveness (Guo & Harstall 2002), being the dimensions of emotional
desregutación and the impulsiveness those that bigger prevatencia has presented in
retrospective studies (Cold Ibañez, Vázquez Costa, of Real Peña, & Sánchez of the
Castle 2012).

People that suffer personatidad dysfunctions have bigger suicide risk (Echávarri et to
the one., 2015; Matschnig, Fruhwald, & Frottier 2006). There is special evidence
for the dysfunctions limit of personality (Samuels, Nestadt, Romanoski, Folstein,
& McHugh 1994), narcisista and histrionic (Mardomingo 2000), antisocial
(Verona, Patrick, & Joiner 2001) and esquizotípico (Sollof, Lynch, & Kelly
2002). 56% of people that you/they commit suicide presents this dysfunctions in
comorbitidad with abuse of drugs and alcohol (there am, Felthous, Holzer, Nathan,
& Veasey 2001), the same as 65% of who you/they attempt it (Arbanas, Bicanic,
Grba-Bujevic, & Mlinac-Lucijanic, 2006; Lejoyeux & Marinescu 2006).

The suicide intent is considered a diagnostic approach of dysfunction of the personality

type limit (TPL) (LeGris & Reekum, 2006 goes; Yoshida et to the one., 2006). In
people with this dysfunction has been a prevatencia of 60% to 80% of prejudicial
behaviors car (Mendieta 1997) and 10% of suicides consummated in smaller than 30
years (Sotoff et to the one., 2002), in their majority women (Qin 2011), since in TPL a
strong presence of emotional uncertainty exists (Yen et to the one., 2004) self-
destructing and impulsive behaviors (Hawton & Van Heeringen, 2009; Swann,
Liiffiit, Lane, Steinberg, & Moeller 2009) as rash conduction, expenses, robberies,
gorging and purges, abuse of substances, sexual encounters without protection, car
mutilations and suicidal intents (APA, 2001; Sodeberg 2001). In et study of Espinosa et
at. (2009) it was found that et 46% of cough patients with TPL obtained it punctuates -
ciones etevadas in a despair escata, associated with symptoms of chronic anxiety and
uncertainty front future at.

Schizophrenia. In et DSM-V (APA 2013) he/she is defined ta schizophrenia like a

"atteración with symptoms like detirios, atucinaciones, speech and disorganized
behavior, and negative" symptoms (p.54). And et DSM-IV (APA, 1 995) señataba that
"approximately et 10% of cough subject with schizophrenia commits suicide" (p.286).
Certain studies have centered their attention in ta retación between suicidal behavior and
schizophrenia (Addington, 2006; Hoang, Stewart, & Gotdacre, 2011; Lecrubier
2002). In cough first years of ta illness, between 5% and 15% of patients they die for
suicide (Hor & Taytor 2010), and this usuatmente has more than to do with
depressive symptoms, since ta comorbitidad between depression and schizophrenia has
a prevatencia of 17% to 65% (Carpenter & Buchanan 1993). The depression
postpsicótica is present in more than 25% of patient (Mettzer 1998), increasing et risk of
relapses, worsening ta answer at treatment and generating bigger deterioration funcionat
(Hausmann & Wotfgang 2000).

The patients with diagnosis of schizophrenia that you/they present aistamiento sociat
and famitiar, support fatta and economic dificuttades spread to make more suicides
(Labonté et at., 2013; Labonté et at., 2012; Pavez, Santander, Carranza, & Vera-
Vittaroet 2009), at iguat that younger cough, of sex mascutino, with history of suicides
in ta famitia and abuse of substances (Hunt et at., 2006b). Usuatmente is affected by
despair states and desperation, frequent relapses, sintomatotogía serious, poor operation
sociat, deterioration mentat, little adherence at treatment or excessive dependence same
det (Harkavy-Friedmanet at., 1999). Tat and like Wittiams reports (1992), et 40% of
people with schizophrenia that you/they commit suicide presented imputsividad,
depression, tension and estrés serious and constant, bigger conscience of ta illness and
its consequences, presenting et denominated syndrome tineat of conscience of ta illness
(Carpenter & Buchanan 1993) characterized by a desmoratización cicto -
depression - suicide, since, to evidence tas consequences, timitaciones and et
deterioration in ta catidad of life that contteva ta illness (Abeta & Setigman 2000),
favorable an atto suicide risk (Schwartz 2000).

Factors and Explanatory Models.

According to Rascón et at. (2004), a dysfunction mentat for yes grove is not able to
expticar ta suicidal behavior; likewise, in ta titeratura he/she is amptia it evidences
expticativa of ta existent association between et suicide and diverse variabtes, like it is
described next.

In ta retación between operation famitiar and behavior commits suicide resattan aspects
like tas dificuttades interpersonates (Cantorat & Betancourt 2011), conflicting
communication (Andrade, 2012; Espinoza-Gómez, Zepeda-Pamptona, Hernández-
Suárez, Newton-Sánchez, & Ptasencia-García 2010), affective poor proximity
(Muñoz, I Paint, Cattata, Napa, & Perates 2005), attos nivetes of controt parentat,
structures famitiar inestabte, history suicide famitiar, viotencia intrafamitiar, abuse
sexuat in ta childhood (Gonzátez-Quiñones & Of ta Sickle Restrepo 2010),
physical mattrato and psicotógico (Hernández et at., 2013), negtigencia, upbringing in
homes monoparentates (Guibert Reyes & Niurka Torres, 2001; Satirrosas-Ategría
& Saavedra-Castitto 2014), etc., cough cuates timitan ta active and appropriate
participation of all their members and they hinder ta satisfaction of basic necessities
(Vatadez-Figueroa, Amezcua-Fernández, Quintanitta-Montoya, & Gonzátez-
Gattegos, 2005; Guibert Reyes & Niurka Torres 2001).

Another outstanding factor is the socioeconomic one, because as Cervantes and Melo
they affirm Hernández (2008), the unemployment and educational low level are factors
of risk for the suicide, especially if (to situation of economic shortage it is lingering
(VegaPiñero, Blasco-Fontecilla, Luggage rack-García, & Díaz-Sastre 2002), and it
hinders the access to services of mental health (Sánchez, Orejarena, & Guzmán
2004).

In studies post mortem carried out people that have committed suicide, has met
neurobiologic factors that can have relationship with the fact, as a marker of serotonin
(metabolito 5HIIA) decrease in patient with depression (Arango, Underwood, &
Mann, 2002; Sher et to the one., 2006), schizophrenia and dysfunctions of personality
(Gutiérrez & Contreras 2008), increase of density of receivers (5-HT1A) (Mann
2003), decrease of union of serotonin trasportador in the bark ventral prefrontal (Arango
et to the one., 2002; Kamally, Oquendo, & Mann 2001), the sea horse (Pandeyet to
the one., 2002) and the tonsil (Gutiérrez & Contreras 2008) whose structures
participate in the experimentation of the emotion, handling and confrontation of the
estrés, capacity adaptativa before difficult events (Joiner et to the one., 2005), anxiety
and depression (Blier & Abbott 2001).

The Pattern Integrativo of Turecki (2005) it exposes that the accomplished suicide is
related with impulsiveness dimensions and aggressiveness, with biological factors that
define an endofenotipo of suicidal behavior, with traumatic events during the infantile
and mature period, and with accumulation of negative experiences. It is important to
stand out that the damage cortical prefrontal generates desinhibición and impulsiveness
(Davidson, Putnam, & Larson 2000), associated to a high letalidad grade (Oquendo
et to the one., 2003) and the alteration serotoninérgica is also highly associated to
difficulties to regulate anxiety, impulsiveness and aggression (Van Heeringen 2003).

The diátesis-estrés pattern makes reference to a multicausalidad of the suicidal risk,

which is given by the interaction of the genes and the atmosphere (Gutiérrez-García,
Contreras, & Orozco-Rodríguez, 2006; Mann, Waternaux, Haas, & Malone
1999). Mann et to the one. (1999) they sustain the hypothesis of a family, mainly
genetic transmission, of certain propensity to externalizar the aggressiveness and a
tendency to present suicidal behaviors. The suicidal risk is not only determined by the
hereditary possibility of certain psychiatric illness but also, and in a primordial way, for
the tendency to experience a suicidal bigger ideación (Aranguren 2009). The theory of
Mann (2003) it is based on the medical pattern of bias for a certain dysfunction and
their appearance precipitated by factors like exacerbación of the mental illness, a vital
crisis and psychosocial causes.

On the other hand, the pattern of trajectories of development of the suicide of Silverman
and Felner (1995) it compares the suicidal behavior with the evolutionary history of a
dysfunction, supposing the existence of a series of processes that you/they lead to the
suicide and that they should spread during a certain time, and they make use of the term
personal vulnerability that is from the exhibition to factors of risk and protective that
can leave acquiring during the different cycles etarios.

Regarding psychological factors, the despair is considered an important suicide

predictor in people with mental dysfunctions, and he/she associates with illness (insight)
conscience, negative beliefs on the illness, negative perception of the future and of itself
(Acosta et to the one., 2009; Brown et to the one., 2005; Henriques, Beck, &
Brown, 2003; López, F., López, F., & López, S., 2008; Scholes & Martin
2013). Quintanilla Montoya, Haro Jiménez, Flores Villavicencio, Celis of Rosa and
Valencia Abundiz (2003), based on ta theory of ta learned indefensión of Setigman
(1975), they explain that ta discourages it happens when ta person interioriza impotence
or controt fatta regarding behaviors or expectations that are incongruous with
prospective to. At concerning, Sarmiento Fatcón, Sánchez Sánchez, Vargas Potanco and
Átvarez Rodríguez (2010) conctuyen that "ta discourages, understood as ta sensation of
imposibitidad absotuta of obtaining a certain thing or that atgo that can change ta
existent reatidad, happens he/she goes generating impotence and cutpa that it drives at
abandonment of ta tucha for ta life" (p. 5).

In a study reatizado for Hawkins, Vatencia, Caamaño and Cebattos (2014) with
psychiatric patient hospitatizados, it was found that et 60,7% presented suicide risk and
et 70,4% it presented despair. Et risk of suicidal ideación and suicide is determined by
ta it discourages together with experiences negative vitates, fatta of support sociat,
desmoratización, inability to confront situations, aistamiento, conflict and negligence
(Caycedo et at., 2010; Joineret at., 2005), controt loss, abandonment sensation and hole,
desperation, anxiety and panic (Nizama 2011). Beck, Brown, Berchick and Stewart
(1990) they emphasize in ta importance of cough aspects cognitivos to understand ta
suicidal behavior, and they propose a hypothesis it has more than enough et papet ta
fundamentat it discourages as bridge between ta depression and et suicide, by means of
a projection cognitiva det depressive actuat in future et. In accordance with this theory,
cough negative events, added to an estito attributive intern would provoke deficit
emocionat, low self-esteem, increase of cough déficits cognitivos and of its chronicity.

Conclusiones

The presence of a dysfunction mentat is a factor of suicide risk. Inside cough different
dysfunctions, ta depression and ta schizophrenia they increase et risk significantly,
being ta discourages et more component retacionado. Among so much, in tas people
with personatidad dysfunctions, anxiety and consumption of substances, ta imputsividad
presence and loss of controt associate at suicide prevail. Of another tado, for their
impticaciones to nivet personat, famitiar and sociat this probtemática should be
approached with urgency, and for their tendency to increase tat like he/she has
registered during ta úttima decade in Cotombia, this situation is constituted in a
probtema of satud púbtica (Cendates, Vanegas, Iron, Córdoba, & Otarte 2007); to
that sink tas conditions derived det armed conflict, tas cuates can make worse factors
like ta it discourages, cough probtemas famitiares, economic, et consumption of
substances, etc., and to increase et suicide risk.

In Cotombia you began to tegistar in satud mentat for atgunas decades, but it is
important to keep in mind that ta prevention det suicide and cough dysfunctions
mentates, besides ta teyes expedition and ordinances, understand education activities,
promotion of protective factors, diagnosis early, effective treatment and inctuso controt
of conditions medioambientates (Herrera, Ures, & Martínez 2015). For tat reason,
it is necessary ta profesionates intervention properly enabled in topics of satud generat
and satud mentat that allow to offer a Primary appropriate Attention of Satud (APS). It
is also precise reatizar pursuit and controt det treatment of cough patients by means of
an appropriate articutación between cough services of satud mentat and cough of satud
generat, so that ta attention is integrat. Iguatmente, is important non sóto to approach
cough principates satud / risk factors and its interactions, but also cough different
environments vitates of each pobtación: individuat, famitiar and community.

It is primordial in the population with mental dysfunctions and with suicidal behaviors,
to stimulate and to strengthen communication abilities, to solve the problems in way
adaptativa and to look for advice and he/she helps when difficulties arise; the
receptividad toward the experiences of other people, the autoconfianza, attitudes and
positive values as the respect, the solidarity, cooperation, justice and friendship
(Jiménez et to the one., 2010); the self-esteem, the religious beliefs and the self-
regulation capacities (Caycedo et to the one., 2010), the autocontrol and recovery of the
balance, as well as the handling of the anger and the sadness (Rivera, 2010, p. 15). In
the same way, the development of affectionate styles of upbringing contributes to secure
the self-esteem, the security and they generate a social satisfactory participation that
prevents the depression and the behavior disocial (León & Lainé 2013).

It is fundamental to "teach and to develop in groups specific populational abilities to

identify people with suicidal high risk by means of the education has more than enough
factors of risk, signs and alarm signs, so that they can be referred appropriately for their
treatment" (Aryan López, 2013, p. 218), supported in a model of primary and secondary
prevention in mental health, with training in confrontation and abilities to solve
problems, access restriction to lethal means, community tamizajes and support groups
(Bobes 2011). It is also important to know the laws of mental health that allow to the
community to recognize the rights, duties and procedures to continue; in cases of
suicidal ideación to have an up-to-date list of contacts or institutions where one can go;
in imminent case of suicide to agree with the person in risk a plan in writing and signed
of action and preservation of the life; and to invite to family and/or friends to not only
continue in contact during the critical or later period to this but also when the person
present improvements (World Federation Mental for Health 2010).

In the cases in that he/she has shown up a non lethal intent, an immediate link is
recommended with a professional of mental health that contemplates the treatment with
medication and a process psicoterapéutico directed to treat the suicide intent and the
mental underlying dysfunction, if there is him, with constant and frequent later pursuit
to the high one hospital, since it is a moment of great vulnerability. Equally, it is
advisable that this discharge it is not made until the patient is outside of danger and a
plan of integral exit is traced in the one that is implied to the family, keeping in mind its
great weight as much as factor of risk like of protection.