Prevenția sinuciderii la locul de muncă prin screening și psihoeducație

 Introduction

According to the World Health Organization (WHO) report on suicide, published online on 25 March 2025⁽¹⁾, 727,000 people take their own lives each year, and the number of people who attempt suicide is much higher. For the 15-29 age group, suicide became the third leading cause of death worldwide in 2021. It affects both high-income and low- and middle-income countries.

From a workplace perspective, the top 5 areas with the highest suicide risk rates for men are: aerospace products and parts manufacturing, performing arts, forestry, fishing, hunting and trapping of wild animals, and coal mining. For women, the top 5 occupations with a higher risk of suicide are: performing arts, drinking establishments, design and engineering, beauty and nail salons, and other personal care services. The top 5 occupations with a higher risk of suicide for men are: agricultural and food researchers, forestry workers, musicians, singers and related occupations, fishermen and hunters, and mining workers. For women, the top 5 occupations with a higher risk of suicide are: artists and related occupations, construction workers, chefs, masseurs and bartenders. These fields and jobs are associated with either low qualifications or a lower absolute and relative level of education and socioeconomic status, or with easier access to lethal means of suicide related to the field in which they work, but also with occupational stress, including insufficient support from superiors and colleagues, reduced control over the job and its insecurity⁽²⁾.

Factors of suicidal risk at the workplace

Going deeper into the study of occupational fields from the perspective of suicide risk, we find the existence of certain factors that can determine suicidal behavior. One of these factors is the precariousness of workplace conditions. When these are stressful, the pressure on employees increases. Those who have adaptive coping mechanisms face them and overcome them or withdraw, protecting themselves. The others, who do not have functional coping styles, end up exhausted, developing various neuropsychiatric disorders or, sometimes, can even end up fatally, through suicide^(3-6). The insecurity of the workplace induced by globalization⁽⁷⁾ along with the lack of social support from superiors and colleagues, for both sexes, and the high demands of the workplace among men⁽⁸⁾ are also added as a precipitating factor for the emergence of suicidal behavior. Employment relationships also play an important role not only for productivity, but also for the mental health of employees. When these are characterized by (sexual) harassment or tension, social isolation can increase the risk of death by suicide^(9-11). Along with all these factors listed above, conflicts and violence, as a traumatic event in the workplace, play an important role in triggering suicidal behavior^(12,13). Job insecurity does not only reside in instability and unhealthy employment relationships, but also in longer working hours⁽¹⁴⁾, increasingly high/many demands on employees and constraints through intrusive surveillance of them⁽¹⁵⁾.

Screening for suicidal risk in the workplace

Because work conditions and environments play such an important role in triggering and/or precipitating suicidal behavior, Waters et al. (2016)⁽¹⁶⁾ recommend screening and prevention to prevent this from becoming a public health phenomenon. Screening alone or followed by counseling or referral to a specialist is ineffective, and screening followed by facilitated access to therapeutic interventions brings a slight improvement in mental health. To be effective as a method of preventing suicide in the workplace, screening should be followed by interventions and programs targeted at this objective, such as interventions based on cognitive-behavioral therapy combined with interventions that target the work environment and broader organizational systems (e.g., flexible working hours), participatory interventions that target job design and improvements in workload and work schedules, training for managers in mental health, and the application of behaviors to better support the mental health of staff⁽¹⁷⁾.

A very useful form of employee mental health screening for the early detection of suicidal risk is natural language processing from social media, as figures from 2019 show that over 4.33 billion people worldwide are active internet users⁽¹⁸⁾. Large technology companies are becoming important players in this effort through the algorithms they have developed, and can be further optimized to detect individuals at risk of suicide, as previous research has shown associations between exposure to online suicide-related content and a lifetime history of suicidal ideation and behavior^(19-21).

Large technology companies can also play a very important role in providing support information to those in a suicidal crisis. For example, Google, the leading search engine, has developed the “Suicide Prevention Result” (SPR), a service which, in 14 countries, when users search for certain suicide-related keywords, displays the contact details of the national suicide prevention hotline⁽²²⁾ to interrupt the suicide planning. The drawback is that, in four German-speaking countries, the SPR is not displayed when people use suicide-related search terms along with the names of celebrities⁽²³⁾. Information from the broader literature on suicide research can also help to refine and expand the SPR. A potential future goal for SPR could be to display, in response to searches involving expectations about the outcome of suicide and specific suicide methods, such as searches regarding the expected pain, ease or lethality of suicide, or even adding the names of celebrities who have committed suicide to the list of keywords that feed the SPR algorithm⁽²²⁾.

The Netflix movie platform has also attracted interest from experts. Research by Ayers et al. (2017)⁽²⁴⁾ demonstrated a significant increase in internet searches related to suicide (including for the purpose of seeking help) after the release of the first season of the Netflix series 13 Reasons Why due to the extremely graphic depiction of the protagonist’s suicide⁽²⁵⁾.

#ChatSafe is an Australian initiative to help young people talk safely about suicide online. It consists of an international suicide prevention program and a set of evidence-based guidelines designed to help young people (aged 12-25) to communicate safely online about sensitive topics such as self-harm and suicide⁽²⁶⁾.

In March 2017, Facebook Inc. announced that it would expand its pattern recognition software to other countries after successful tests in the United States of America to detect users with suicidal thoughts. The software scans social media posts and comments for phrases that could signal an imminent suicide attempt. It then alerts a team of Facebook employees who are specialized in such cases. They can provide the user or the person’s friends with a number to call a suicide hotline or even contact local authorities to ask them to intervene^(27-29).

Another social network with a strong public appeal, especially among young people, is Instagram™. In 2018, Brown et al.⁽³⁰⁾ and Carlyle et al.⁽³¹⁾ published two analyses of the content of Instagram posts that either discussed self-harm or were tagged with hashtags that targeted suicide. Thus, Brown et al. analyzed posts from April 2016 that discussed non-suicidal self-harm (cutting) behaviors, and concluded that images with increasing degrees of severity of injuries and those depicting multiple methods of non-suicidal self-injury (NSSI) aroused more interest than those with mild or moderate injuries, interest manifested through neutral or empathetic and very rarely hostile comments. High views and comments, even empathetic ones, may act as social reinforcement for posting more severe NSSI images on Instagram, potentially leading to online social contagion of parasuicide. Carlyle et al. analyzed a random sample of 500 Instagram posts that included the hashtags #suicide and/or #suicidal, a sample that was drawn from a larger one collected between March and June 2016. The study authors concluded that self-harm was present in the majority of Instagram posts, and the posts that mentioned the idea of suicide generated more interest than posts that did not, while public health voices were largely absent from conversations about suicide on Instagram, with the exception of some constructive WHO recommendations for preventing media contagion which were visible in a few places in the sample studied⁽³¹⁾.

In 2019, Arendt⁽³²⁾ published a content analysis of all posts created between 5 and 11 July 2017 and tagged with the hashtag #selbstmord, a German suicide-related hashtag. This analysis revealed that videos posted during the period covered by this tag relied on very rapid cutting techniques in which subliminal messages related to suicide could be inserted – i.e., exposure to the content without the user’s awareness. The author came to this conclusion because he observed a discrepancy between a person’s emotional state (e.g., sadness) and his external behavior (e.g., smiling), and help-seeking, death wishes, awareness and professional intervention materials were very rare. For now, the results of the study cannot be generalized due to the fact that the analysis only targeted the content of posts on a German hashtag and the sample size was quite small, but these can be a starting point for an extended analysis and, also, for the publication of more awareness and intervention materials from suicide prevention organizations.

Since 2019, Instagram™ has improved its ways to better support and protect the most vulnerable people using this platform⁽³³⁾, intensifying its collaboration with experts to protect users from self-harm and suicide⁽³⁴⁾.

Not only social networks, but also the internet and film platforms play an important role in the early identification of suicidal behavior and its prevention, with the entire media, that is, what is broadcast on television stations – news, shows, films, etc.⁽³⁵⁾

Interventions and psychoeducation

As we have already mentioned, simple screening for suicidal risk in the workplace would not bring any improvement in the mental health of employees, if it were not doubled by (specialized) interventions and psychoeducation. Interventions in organizations should be carried out on several levels. Some would be indicated to aim at reducing stress factors, because they can function as activating elements for employees with cognitive and behavioral predisposition to suicide: the presence of cognitive distortions such as overgeneralization (of autobiographical memory), catastrophizing, dichotomous thinking/cognitive rigidity, despair, inability to solve problems, behavioral inhibition (anxious avoidance), maladaptive coping mechanisms that lead to poor stress management⁽³⁶⁾. Other interventions may consist in implementing mental health policies at the level of organizations to protect all employees, especially those who, following specific screening, have been identified as having suicidal risk. Changes in organizational culture can also be a stress factor for people with low activity levels, who prefer routine to challenges/innovations, and for those who exhibit cognitive and behavioral rigidity. Therefore, they must be introduced progressively and systematically, through (in)formation training. Also, interventions should increase the resilience of employees, especially those with problematic backgrounds (personality traits such as aggression, hostility, impulsivity, pessimism, neuroticism and high emotional instability) and personal and family (para)suicidal history⁽³⁶⁾ by raising awareness of the specifics and risks of their work, work relationships, the need for support (to effectively ask for help even if the job requires courage and manliness – military personnel, rescuers, etc.) and resources, but also of personal limits⁽³⁶⁾, through Information, Education and Communication (IEC) packages, individual cognitive-behavioral psychotherapy, family therapy, psychoeducation regarding assertiveness training and group therapy⁽³⁷⁾. Interventions should not only target employees, but also their supervisors. They will consist of training and awareness sessions on both suicidal risk and early identification of signs of (para)suicide.

Psychoeducation should aim to increase awareness of suicidal risk among employees by conducting information sessions on pre-/perisuicidal behavioral and attitudinal manifestations, risk factors for suicide, along with specific professional training of non/paramedical personnel in organizations for the early identification of suicidal risk at work through training guides/manuals and specific psychological screening tests. These two types of activities should be complemented by the development of support networks for people at risk of suicide (employees who have suffered significant losses, who suffer from an affective, anxiety, psychotic, personality or burnout disorder, who have a drug/alcohol addiction, who are single/widowed, strongly introverted, have poor/inconstant social relationships, who are at risk of unemployment, etc.⁽³⁶⁾) and cooperation between internal resources – (non/para)medical staff, psychologists, social workers, human resources department representatives, managers, etc. – and external resources (medical and psychological offices, specialized NGOs, mass media, state institutions, etc.) of the organization⁽³⁸⁾.

Conclusions

With suicide becoming the third leading cause of death globally in 2021 for those aged 15-29 years old, the importance of identifying the suicide risk among employees is becoming a priority for mental health services and organizations alike. Occupations with an increased risk of suicide are: for men – agricultural and food researchers, forestry workers, musicians, singers and related professionals, fishermen and hunters and extractive workers; for women – artists and related workers, construction workers, chefs, masseurs and bartenders.  Occupational risk factors are: precarious working conditions, insecurity, increasingly high demands, problematic/harmonious relationships, lack of social support, conflicts, violence at work, long and/or busy work schedules, intrusive supervision, to which there are added the maladaptive coping mechanisms of employees, their personality traits and various mental disorders.

As methods of preventing suicide in the workplace, screening followed by targeted interventions and programs, as well as psychoeducation, are recommended. A very useful form of screening is the processing of employees’ natural language used on social networks. Already well-known companies such as Google, Netflix, Facebook and Instagram have developed ways to support and protect people vulnerable to suicidal behavior. They are joined by the entire media through radio and television stations. Interventions in organizations related to suicide prevention must be carried out on several levels: reducing occupational stress, implementing mental health policies, progressively and systematically introducing organizational culture changes, increasing employee resilience and training and raising awareness of managers and supervisors on the risk of suicide in the workplace. Psychoeducation should consist of information and awareness sessions on personal and organizational factors of suicidal risk, specific professional training of non/paramedical personnel in organizations, the development of social support networks for employees at suicidal risk, and cooperation between internal and external resources of organizations.

Through these combined multimodal efforts, the risk of suicide in the workplace can be considerably reduced.