Introducción:

La historia es por definición, la narración veraz y ordenada de sucesos socioeconómicos, políticos y culturales que influyeron en la marcha de la comunidad hacia el progreso.

Otra definición es aquella que considera la historia como los hechos y manifestaciones de la actividad humana de cualquier clase.

Es por ello que pretendo en este artículo exponer el surgimiento de la Sección de Suicidiologia de la Asociación Mundial de Psiquiatría (AMP) para evitar el peor de los significados que tiene la palabra historia, que es el cuento, el chisme, el enredo y preservar la memoria histórica a las nuevas generaciones de suicidólogos de nuestra asociación.

Desarrollo:

En  Octubre de 1998 se efectuó en el Palacio de las Convenciones de La Habana, Cuba, el XX Congreso de la Asociación de Psiquiatras de América Latina (APAL) al que asistí formando parte de la delegación de mi país para impartir una conferencia titulada “Psicoterapia del Comportamiento Suicida”.

Durante un intervalo entre las sesiones del congreso, en una conversación con el Profesor Norman Sartorius, en ese momento Presidente de la Asociación Mundial de Psiquiatría,  le pregunte que gestiones debía hacer para contactar la Sección de Suicidiologia de la Sociedad Cubana de Psiquiatría que presido desde su fundación en 1995, con la Sección de Suicidiologia de la Asociación Mundial de Psiquiatría.

El Profesor Sartorius me contestó (para mi asombro  debido a que el suicidio en esos momentos era una de las diez primeras causas de muerte en el mundo según la OMS y así también se comportaba en muchos de los países miembros de la AMP):

“No existe en la Asociación Mundial de Psiquiatría una sección que se encargara del suicidio” y menciona otras que ya estaban creadas.

 Acto seguido le pregunté: ¿Qué debo hacer para fundarla? Y el Profesor Sartorius me dijo que le escribiera para ofrecerme los detalles de los procedimientos para fundar una sección.

En el propio congreso el Dr. Rubén Rendón Aponte, experto suicidólogo de Venezuela, me propone y es aprobado en la asamblea de la APAL, que asuma como Coordinador de la Sección de Suicidiologia de la Asociación Mundial de Psiquiatría.

El 18 de Noviembre de 1998 envío la primera carta al Profesor Norman Sartorius y recibo la respuesta el 9 de Diciembre del propio año. El texto de la misiva es el siguiente:

 

Dear Professor Barrero:

Thank you very much for your setter of 18 November 1998. I was very interested to hear about your wish to establish a Suicidology Section in the WPA.

Next step would be to write to Professor A. Okasha, the WPA Secretary for Sections (who address is indicated below) about your initiative.

Professor Okasha will let you have all the necessary information about the steps necessary to proceed with this project.

With kindest regards,

Yours sincerely,

Professor Norman Sartorius.

 

Cc: Prof. A. Okasha (Ain Shams University, 3, Shawarby Street, Kasr-el-Nil, Cairo, Egypt. Fax + 20-2-3481786

 

Pasaron varias semanas y recibo por correo electrónico, el documento titulado:
Section Formation within the World Psychiatric Association, en la que se exponían los procedimientos que debía continuar realizando para lograr la fundación de la mencionada sección.

Inicio los contactos con varios suicidólogos y responden  afirmativamente para incorporarse a la Sección los siguientes:

1. Prof. Dr. Robert Goldney quien en ese momento fungía como Presidente de la Asociación Internacional de Prevención del Suicidio. Australia
2.  Dr. Hamisk Gevorkian del Departamento de Sociología de La Universidad de Yerevan. Armenia
3. Mr. Gert Jessen del Centro de Investigaciones del Suicidio de Dinamarca.
4. Dr. Michael Crawford de la Sección de Epidemiología de Londres. UK.
5. Dr. Nicoleta Lucia Tataru  del Hospital Neuropsiquiatrico de Oradea, Rumania.
6. Paúl Siu Fai del Departamento de Estadísticas de la Universidad de Hong Kong.
7. Marcelo Ferrada Noli del Departamento de Psicología de la Universidad de Tromso. Noruega
8. Dr. Lilia Solórzano Presidente de la Asociación Centroamericana de Psiquiatría. Costa Rica
9. Dr. Edgard Belfort Coordinador de la Sección Infanto-Juvenil de la APAL. Venezuela.
10. Dr. Juan C. Liotta. Argentina
11. Dr. Ladislav Valach del Centro de Terapia de la Cruz Roja en Suiza
12. Dr. Danuta Wasserman del Centro de Prevención del Suicidio del Instituto Karolinska de Suecia.
13. Dr. Brian Tanney de la Universidad de Calgary, Canadá
14. Dr. Manuel Casado Blanco. Departamento de Medicina Legal de Extremadura. España.
15. Dr Laars Mehlum de Noruega.
16. Prof. Dr. John Connolly del Hospital Santa Maria de Irlanda.
17. Prof. Dr. Sergio A. Pérez Barrero. Coordinador. Cuba (2)

Ese fue el núcleo inicial de la Sección de Suicidiologia de la AMP que fue enviado a las autoridades junto a otros requisitos que se pedían como el nombre de la sección, sus propósitos, el plan de actividades, entre otros.

El 26 de Noviembre de 1999, un año después de haber iniciado la fundación de la Sección de Suicidiologia, recibí la siguiente carta del Profesor Norman Sartorius, esta vez enviada desde HUG, el Hospital Universitario de Ginebra, Suiza:

Dear Dr Barrero:

Thank you very much for your setter which I have read with great interest. As before, I am convinced that it will be of a great value to the World Psychiatric Association to have a specific section dealing with suicide prevention and in so far as I know, all the steps have already been taken to create such a section and facilitate its work.

I have taken the liberty of sending a copy of your letter to the President of the World Psychiatric Association, Professor J.J. Lopez Ibor and the Secretary for Sections, Professor George N. Christodoulou. I am sure that they will take the necessary action and that you will hear from them in the not so distant future.

With every good wish and kind regards,

Professor Norman Sartorius

Cc: Professor J.J. Lopez Ibor

Professor George N. Christodoulou (3)

 

El 1 de Enero del 2000 recibo la primera de las cartas que intercambiamos el Profesor

Christodoulou de Grecia y el autor del presente articulo. La misiva dice lo siguiente:

 

Dear Professor Barrero:

I have received a copy of  your letter to Prof. Norman Sartorius concerning the establishment of a Section on Suicidology.

I will be vary pleased to bring your proposal to the Executive Committee but before doing this I need more information, namely the rationale for the establishment of the proposed Section Committee, the proposed officers and the proposed task of the Section. In building your proposal please take into consideration the WPA statutes and by laws (sent to your association by the WPA Secretariat)

Please address all correspondence concerning the proposed section to me.

Looking forward to hearing from you and with kind regards and best wishes for the New Year

Yours sincerely

Prof. G.N. Christodoulou

Cc: Professor N. Sartorius

      Professor J. López Ibor

      Professor J. Mezzich (4)

Continúo trabajando según las orientaciones y sugerencias del Profesor Christodoulou y aglutinado otras personas interesadas en la prevención del suicídio y a aquel núcleo inicial se suman:

18.- Dr. José A. Bertolote de Brasil y miembro de la OMS

19.- Dr. Silvia Peláez del Uruguay

20.- Dr. Diego De Leo de Australia

21.- Dr Annette Beautrais de Nueva Zelanda

22.- Dr. Maximiliano Luna de Argentina

23.- Dr. Alexander Botsis de Grecia

Envío dicha relación a través del correo electrónico al Secretario para las Secciones. (5)

El 24 de Mayo del 2000 recibo la siguiente misiva del Prof. Christodoulou cuyo texto es el siguiente:

Dear Dr Barrero:

Your proposal for the establishment of a WPA Section on Suicidology has been brought to the EC Committee of the WPA during its meeting in Chicago this month and it has been discussed extensively.

It has been decided to accept your proposal in principle provided that you will let me have the following information (in accordance with the Manual of procedures of the World Psychiatric Association)

1. Define the area of specialty of the proposed Section (Suicidology) and point out that section does not overlap with the rest of the Sections.
2. Submit to me a list of the members of the Organizing Committee (al least 10 members, no more than two of which may be from the same country)
3. Present a plan on how the Section intends to recruit Section members and what activities it proposes undertake.

These are the necessary requirement for acceptance of your Section on an ad hoc basis

Al a later stage (in Yokohama, August 2002) the WPA will give permanent approval of the Section, provided that the Section has:

1. A roster of 20 or more members that has been accepted by the Secretary for Sections.
2. Prepared a set of by –laws that have been approved by the Secretary for Sections
3. Elected a Section Committee from among its members (8 members, three of who shall be elected Chair, Co-chair and Secretary)
4. Has produced a program of its activities

For the time being please concentrate on the requirements for an ad hoc approval. As soon as I receive the information that I requested I will bring the issue to the next Executive Committee (Paris, 24^th June). But please respond to me urgently.

With kindest regards

Prof. George N. Christodoulou (6)

 

Continua mi labor de reclutamiento de  un mayor numero de miembros para conformar la Sección y el 30 de Junio del 2000 recibo la siguiente carta del Secretario para las Secciones de la AMP.

Dear Barrero:

The Sections’ Operational Committee met recently in Paris and some names of experts on suicide have been mentioned by members of the Committee. Perhaps you could consider inclusion of these colleagues in the memberships of your section

Dr Nelson Moreno Ceballos (Dominican Republic)

Prof. Janos Furedi (Budapest, Hungary)

Prof. Faruk Lotaif (Egypt)

With kind regards

Prof. George N. Christodoulou (7)

Con la misma fecha de 30 de Junio del 2000 recibo otra misiva con el siguiente texto:

Dear Dr Barrero:

I am glad to inform you that your application for the establishment of a new Section on Suicidology has been approved by the Executive Committee. Congratulation¡ I look forward to a productive collaboration..

In addition to Prof. Kontaxakis about I wrote to you recently I wonder if you could consider Prof. Jean Soubrier who works at the American Hospital in Paris, who has been proposed by Ahmed Okasha , as well as Prof. Janos Furedi, Professor of Psychiatry at the University of Budapest. They are both very well known in the field of Suicidology.

I would very much like to hear about the progress of your Section in due time.

With kindest regards and all my wishes for the progress of your Section.

Sincerely yours

Prof. George N. Christodoulou (8)

 

Como se pone en evidencia, el Secretario para las Secciones  comienza en estas misivas de inicios de año, a reconocer mi protagonismo en la creación de la Sección, lo que se hace patente en la siguiente carta recibida el 18 de Agosto del 2000 y que inicia por vez primera con el siguiente encabezamiento:

 

Prof. Sergio Pérez Barrero

Chair, Section on Suicidology

 

Dear Prof. Barrero.

Scientific developments in our discipline are, indeed, dramatic and, at least in some areas, it is difficult for a general psychiatrist to follow the pace of all these developments. Additionally, the richness and diversity of Psychiatry renders acquisition of global information even more difficult.

I would like to share with you my conviction that the Scientific Section of our Association could make a substantial contribution towards dissemination of information in all these diverse scientific areas. Our Sections cover practically all aspects of Psychiatry, they include among their members the top authorities worldwide and should grasp the opportunity to contribute.

One of the ways to contribute would be the production of a compilation of state of the arts reports bringing together up-to-date evidence in each Section’s sphere of expertise.

 

La misiva continua y en otro de sus párrafos expresa:

I should be grateful if you would let me have, by the end of December 2000, a paper of about 2000 words (5-6 pages) with a bibliography of not more than 15 references dealing with recent developments in the spheres that your section is representing. (9)

 

La carta termina con la habitual despedida del Profesor Christodoulou.

El 4 de Octubre de 2000 recibo un mensaje por correo electrónico del Profesor Juan J. López Ibor quien se desempeñaba como Presidente de la AMP el cual dice:

Querido amigo:

Muchas gracias por la información  que me envía de la Sección de Suicidiologia. A través del Profesor Christodoulou ya tenía conocimiento de algunas de sus actividades y hemos hablado en el Comité Ejecutivo de la AMP de la importancia que tiene su trabajo.

El tema del suicidio es una de las prioridades de la Oficina Regional Europea de la OMS debido al crecimiento de la incidencia del mismo en los países de l este de Europa coincidiendo con cambios políticos y sociales  profundos por lo que yo le sugeriría planeara en un futuro una reunión en esta parte del mundo o eventualmente un simposio durante el próximo Congreso Europeo de la AMP que se va a celebrar en Madrid del 30 de septiembre al 4 de Octubre de 2001.

Un saludo afectuoso

Prof. Juan J. López Ibor (10)

 

El 6 de Enero recibo el siguiente Email del  Dr Alexander Botsis de Grecia y cuyo texto decía:

Dear Dr Pérez Barrero:

Thank you for your wishes for the new year. I also wish you the best. Please give me some more information about the Symposium on Suicide in the WPA.

Sincerely yours

Alexander Botsis

General Secretary

IASR (11)

 

El 8 de Enero de 2001, recibo un mensaje por correo electrónico de Dr. Airi Varnik, que decía lo siguiente:

Dear Professor Barrero:

Thank you for good wishes and invitation to Madrid Congress. I appreciated the proposal to be speaker and mailed to Lopez Ibor

Sincerely yours

Airi Varnik (12)

 

 

 

El 14 de Enero del 2001 recibo un mensaje por correo electrónico de Dr. Nicoleta Tataru  que decía en una de sus partes:

Dear Professor:

Thank you for your Email. I should like to participate at our first activity of Suicidology new Section of WPA. Would you organise some Symposia or round table? Please be informed that I’ll join you to organise something.

Yours friendly,

Nicoleta Tataru, Oradea, Romania. (13)

Se continua incrementando la membresía de la Sección de Suicidiologia de la AMP y el

7 de Febrero de 2001 se contaba con 40 miembros de 34 países de todos los continentes.

Por esa fecha le envío al Profesor G.N.Christodoulou  el siguiente artículo (14) para ser incluido en Advances in Psychiatry y que a continuación se muestra:

 

Advances in Psychiatry (Editor: G.N. Christodoulou)

Beta Medical Publishers, 2002, pp 205–209

 

Suicide: an Avoidable Tragedy

Sergio Perez Barrero

Section of Suicidology, World Psychiatric Association

 

Suicide is a serious public health problem. According to World Health Organization (WHO) estimates, in the year 2000 approximately one million people will die from suicide and 10 to 20 times more people will attempt suicide worldwide. In other words, one death every 40 sec and one attempt every 3 sec, on average.

Approximately 45% of all suicides worldwide are committed in the following countries:

– China: 195,000

– India: 87,000

– Russia: 52,000

– USA: 31,000

– Japan: 2,000

– Germany: 12,500

– France: 11,600

– Ukraine: 11,000

– Brazil: 5,400

– Sri Lanka: 5,400

Two countries (China and India) are responsible for almost 30% of all cases of suicide committed worldwide. Conversely, the top ten countries in terms of rates represent less than 8% of all completed suicides. Only two countries –the Russian Federation and Sri Lanka– are among the top ten countries by both suicide rate and number of cases of suicide (WHO, 1999). Though suicide, suicide attempts and suicide thoughts are the main components of suicide behaviour, they are not the only ones. Threat, gestures and frustrated suicide are also clinical manifestations of suicide behaviour (Perez Barrero 1999, 2000).

Risk factors

Suicide is a complex problem for which there is not a single cause. It results from a complex interaction of biological, genetic, psychological, social, cultural and environmental factors (WHO, 2000). The following risk factors are common in suicidal people:

– Mental disorders, particularly mood disorders such as depression and bipolar disorder.

– Previous suicide attempt

– Co-occurring mental and alcohol and substance abuse disorders

– Family history of suicide

– Hopelessness

– Impulsive and/or aggressive tendencies

– Barriers to accessing mental health treatment

– Relational, social, work, or financial loss

– Physical illness

– Easy access to lethal methods, especially guns

– Unwillingness to seek help because of the stigma attached to mental and substance abuse disorders and/or suicidal thoughts

– Influence of significant people –family members, celebrities, peers who have died by suicide– both through direct personal contact or inappropriate media representations

– Cultural and religious belief; for instance, the belief that suicide is a noble resolution of personal dilemma

– Local epidemics of suicide that have a contagious influence

– Isolation, a feeling of being cut off from other people (US Public Health Service, 1999).

Lately, biological risk factors have been shown to be of great interest in suicidológica research, for example: monoaminergic correlates of suicidality, genetic factors in suicide attempters, excess of the tryptophan hydroxylase (TPH) and serotonin transporter (5-HTTLPR) genotypes to suicidality, the platelet monoamine oxidase activity, serotonergic dysfunction, low cholesterol levels (IASP Congress, 1999).

Protective factors

The protective factors to the suicidal behaviour are the following:

Family patterns

– Good relationships with family members

– Support from the family.

Cognitive style and personality

– Good social skills

– Confidence in oneself and one’s own situation and achievements

– Seeking advice when important choice must be made

– Openness to new knowledge

– Good self-esteem, self-image and self-efficiency

– Intelligence and problem solving abilities.

Cultural and sociodemographic factors

– Social integration, e.g. through participation in sport, Church associations, clubs, extended family

– Good relationship with friends, neighbors, peers, mates

– Positive labor experiences

– External interests

– Be resilient (Suicide Guidelines, 1999) (WHO, 2000).

The WHO considers six basic steps for the prevention of suicide:

1. Treatment of psychiatric patients

2. Gun possession control

3. Detoxification of domestic gas

4. Detoxification of car emission

5. Control of toxic substances availability

6. Tuning down reports in the press (WHO, 2000).

SUPRE, the WHO worldwide initiative for the prevention of suicide has prepared a series of resources:

1. Α resource for general physicians

2. A resource for media professionals

3. A resource for teachers and other school staff

4. A resource for primary health care workers

5. A resource for prison officers

6. How to start a survivors group.

These resources have been addressed to specific social and professional groups particularly relevant to the prevention of suicide (WHO, 2000). Some countries have their own national strategies to prevent suicide behaviour, according to their own particularities, for example: England (Kingdom, 1995), Norway (Retterstol, 1995), Sweden (Beskow, 1995) Slovenia (Grad, 1995), Cuba (WHO, 2000).

In England, a wide-range approach to preventing suicide has been adopted which incorporates measures aimed at improving the detection and management of depression and suicide risk in General Practice, General Hospital and Mental Health Services; targeting high risk groups; public health measures to reduce access to means and in changing public attitudes toward depression and suicide.

In Norway the preventive measures to diminish the suicidal behaviour are:

– Better treatment of persons at risk for psychiatric reasons

– Better treatment in somatic hospitals, intoxication units, etc.

– Better facilities for treatment of particular risk groups (people in crisis, children and adolescents, students, prisoners, people in military service, immigrants, and unemployed persons

– Improvement of health and social services in the municipalities

– Availability of school health facilities

– Cooperation with and activation of organizations

– Teaching, medical training and general education

– Participation of the media

– Research, mainly studies using epidemiological methods.

In Sweden, the strategic document currently being drawn up will focus on the following areas and responsible organizations within the areas concerned:

1. Enhancing public awareness of suicidal behaviour

2. Support and treatment of suicide-prone people

3. Care for children and young people

4. Care for people at work

5. Training programmes

6. Reduced availability of means of suicide

7. National expertise

8. Database

9. Systems of regulation.

In Slovenia, the target groups of the National programme for suicide prevention are:

a. Risk groups (people who have attempted suicide and/or have suicidal tendencies, people with mental health problems and diseases, people in crisis, somatically or chronically ill people, and disabled people)

b. The wider population (children, young people and elderly people)

c. Professionals involved in the area (medical staff, teachers and school counselors, social workers, clergy, media, professionals working in prison and in half-way homes)

d. Each level includes

• Current programmes

• Future perspectives

• Institutions and/or services responsible.

In Cuba, the National Programme for Suicide Prevention began in 1989 with three main objectives:

– Avoid the first suicidal attempt

– Avoid the repetition of suicidal attempt

– Avoid suicide.

The programme included six levels: doctor’s office, clinic, hospital, municipality, province and nation. Each level has its own task, but the doctor’s office is the main level and the participation of the community leaderships, the neighbors, the institutions of the community are the keystone of the suicide prevention programme. Other countries do not have a national suicide prevention programme as that mentioned above, but they have a national strategy to prevent youth suicide, for example New Zealand (Beautrais, 1998).

There is also a group of organizations which develop serious efforts in the suicide prevention task, for example WHO (SUPRE), International Association for Suicide Prevention (IASP), International Academy for Suicide Research (IASR), Befrienders International (BI), The Samaritans, International Association of Thanatology and Suicidology (IATS), American Association of Suicidology (AAS) and the Suicidology Section of the World Psychiatric Association, founded recently.

In summary, suicide is a global tragedy, but an avoidable tragedy provided that there is participation of all individuals in the society.

 

Bibliography

1. Beautrais A. A review of evidence: in our hands. The New Zealand Youth Suicide Prevention Strategy, Ministry of Health, 1998

2. Beskow J, Wasserman D. A national programme for suicide prevention in Sweden. Ital J Suicid 1995, 1:25–27

3. Grad O. How to reduce suicide in Slovenia. Ministry of Health, 1995

4. IASP. 20th Congress. Book of Abstracts, Greece, 1999

5. WHO. Report of the workshop about the suicide prevention in the Americas’ Region. Montevideo, Uruguay, Geneva, 2000

6. Perez Barrero S. What you should know about suicide. México. Imagen Grafica, SA de CV, 1999

7. Pérez Barrero S. Psychoterapy of the suicidal behaviour, Cuba, HPH, 2000

8. Retterstol N. The national plan for suicide prevention in Norway. Ital J Suici 1995, 1:19–24

9. Suicide Guidelines. Guidelines for primary care providers. Detection and management of young people at risk of suicide. Ministry of Youth Affairs, New Zealand, 1999

10. US. Public Health Service. The Surgeon General’s Call to Action to Prevent Suicide. Washington DC, 1999

11. WHO. Figures and facts about suicide. Geneva, 1995

12. WHO. Preventing suicide: a resource for primary health care workers. Geneva, 2000

13. WHO. Preventing suicide: A resource for media professionals, 2000

14. WHO. A resource for teachers and other school staff, Geneva, 2000

15. WHO. A resource for general physicians. Geneva, 2000

 En el Congreso de Madrid, efectuado entre el 29 de Septiembre al 4 de Octubre de 2001 se realizo la primera actividad científica de la Sección de Suicidiologia de la Asociación Mundial de Psiquiatría que fue el simposio titulado: Incidencia del Suicidio en los Países del Este de Europa a raíz de lo Cambios Geo-socio-políticos. Los participantes fueron:

Moderadores: Dr. José M. Bertolote,  Dra. Silvia Peláez.

Como Ponentes los siguientes suicidólogos:

• Dra Airi Varnik: Suicide in Former USSR Republics and in Baltic States.
•  Dra Nicoleta Tataru : Suicide and Attempted Suicide in the Elderly. Experience in Bihor.
• Alexander Botsis: Social Changes in Greece as Potential Suicide Risk Factors.

Finalmente en el informe del Secretario General, Dr John Cox en WPA NEWS, Third Quarter 2002, (15) en las conclusiones de la Asamblea de dicha asociación, se mencionan las nuevas secciones científicas y aparecen en ese orden:

• Section on Personality Disorders
• Section on Psicoanálisis in Psychiatry
• Section on Schizophrenia
• Section on Suicidology

 CHAIR: SERGIO PEREZ BARRERO

CO-CHAIR: GOFFREDO BARTOCCI

SECRETARY: FUMIKATA NODA

 

Conclusiones:

La Sección de Suicidiologia de la Asociación Mundial de Psiquiatría comenzó a fundarse en La Habana, Cuba en Octubre de 1998, siendo su primera actividad el simposio realizado en el Congreso de Madrid y fue aprobada como Sección en el 2000.

 

Referencias

 

1. Pérez Barrero SA (correspondencia personal de su Archivo Sección de Suicidiologia de la AMP)
2. Ídem
3. Ídem
4. Ídem
5. Ídem
6. Ídem
7. Ídem
8. Ídem
9. Ídem
10. Ídem
11. Ídem
12. Ídem
13. Ídem
14.  Perez Barrero S. Suicide: An avoidable tragedy. In Advances in Psychiatry (Editor: G.N. Christodoulou)
15. Beta Medical Publishers, 2002, pp 205–209
16. WPA NEWS Third Quarter 2002 page 2

Prof. Dr. Sergio A. Pérez Barrero
Fundador de la Sección de Suicidiología de la Asociación Mundial de Psiquiatría
Asesor Temporal de OPS/OMS para la Prevención del Suicidio en Las Américas
Miembro Fundador de ASULAC
Miembro de IASP, AITS, IASR.
www.redsia.net