It is estimated that approximately 3000 people end their lives daily¹. However, it is possible that this is an underestimation due to a lack of information due to multiple causes such as stigmatization, cultural and religious attitudes and beliefs, differences in the registration of deaths or the absence of a registration system for suicide deaths². The prevalence of suicide rates in countries with low economic resources, due to the absence of adequate medical care, is worrisome. It is estimated that 79% of suicide cases occur in low-income countries¹. Similarly, suicide attempts are more frequent in these countries^3,4. In 2019, 1.3% of deaths worldwide were due to suicide. Figure 1 allows us to observe the number of suicides as a share of total deaths in countries around the world. For example, at the high end, 4.5% of deaths in South Korea in 2019 were by suicide; 3.0% in Qatar; and 3.3% in Sri Lanka; whereas, in Greece, this proportion is ten times lower at 0.4% and in Indonesia it is 0.5%⁵.

Despite this high suicide rate, studies on suicide prevention are mostly focused on high-income countries, while only 10% of the research is confined to low-income countries¹. In Peru, it is estimated that 548 suicide attempts are made every year⁶. In addition, about 25% of the Peruvian population presents symptoms of depression, and of this group, 15% is at risk of suicide⁷. A recent study conducted in Peru⁶ reported that 69.5% of suicide cases occurred in men, 79.5% in single people and 26.6% in people with completed secondary education. In addition, the highest suicide rates occurred in Lima (20.3%), Arequipa (19.2%), Cusco (9.5%) and Junin (7.8%). People committed suicide mainly by hanging (56.6%), poisoning (29.2%), firearm (4.0%), precipitation (3.1%) and knife (1.7%). Another recent study (7), indicated that the suicide rate presented an increase from 2017 (1.44 deaths/100,000 inhabitants) to 2019 (1.95) in Peru.

These percentages raise the question, what are the attitudes of health professionals towards suicidal behavior? A study of mental health professionals reported that participants indicated deficiencies in training, knowledge and skills in the assessment and management of suicide. Also, the perception that suicide is illegal was identified as the most frequent barrier, along with family involvement and poor parenting, while religious beliefs were a protective factor⁸. Another study with nurses reported that the participants indicated that they had no experience or training in mental health or suicide, presented more negative feelings towards the patient and a lower perception of professional competence regarding suicidal behaviors⁹.

The study entitled "Attitudinal beliefs about suicidal behavior in health professionals in the emergency area of a public hospital in Lima, Peru" is part of this framework. This research reported that the health professionals participating in the study presented attitudes of rejection of legitimizing suicidal behavior and suicide itself; while they showed attitudes in favor of suicide in terminally ill patients and suicide morality. In addition, 51.6% presented attitudes and beliefs indifferent to suicide and 34.7% presented attitudes and beliefs in favor of suicide. This finding is similar to what was previously reported in an investigation where it was pointed out that a large part of a group of health care workers presented negative attitudes, such as irritation towards suicidal behavior, and beliefs about suicide attempts as a way of making others repent. This was contrary to what was presented by psychiatric workers, who were less likely to present critical attitudes and to believe that suicide attempts were selfish or a way to obtain sympathy from others¹⁰.

Due to the limited space in this editorial, I will mention some recommendations based on the results of the study in question, which may be useful for the Peruvian context or for countries with similar characteristics. Specifically, it is necessary to receive knowledge about suicide risk¹¹ and to distinguish between myths and facts about suicide¹⁰. For example, it is important to know that more than 50% of people who commit suicide have sought, one month before, medical care services¹² and previous suicide attempt is the strongest predictor of completed suicide¹³. Regarding the affective area, emotional support should be provided to health care workers, where negative emotions such as irritation or helplessness are recognized and can be explored through group discussions supported by professionals¹⁴. In these spaces, workers could recognize the source of their negative feelings and how they might affect their professional work with suicidal patients¹⁵. Finally, skills-based training is required for the implementation of suicide crisis detection or management tools¹⁶. For this, the implementation of continuing medical education programs is necessary, which discuss suicide cases and where collaboration with mental health and psychiatry departments facilitate the exchange and improvement of these skills¹⁷. In conclusion, the training that health professionals receive should emphasize the areas of knowledge, affectivity and skills in suicide prevention and management.