According to the National Institute of Statistics, last year 3,952 fatal suicides were recorded in Spain. In addition to this high number of deaths, which is likely lower than the actual figure, there is an even greater number of suicide survivors: people who have had to face the painful and often incomprehensible loss of a loved one due to this cause, and all those who must deal with the consequences of a non-fatal suicide.

Suicidal behavior represents a serious social and health issue worldwide, but for various reasons, it has only begun to receive the necessary attention relatively recently. Currently, in Catalonia, as in other autonomous communities and throughout the State, suicide prevention policies are being promoted, often led by health administrations and focused on addressing the mental health issues of individuals who show a high-risk profile related to suicidal behavior.

Like many other health problems, suicide results from a set of determinants rather than a single cause. Although our focus often centers on the individual determinants that contribute to a person showing a higher risk of engaging in suicidal behavior, it is clear that the circumstances in which people live, shaped by the political, social, and economic context—known as social determinants of health—explain the enormous disparities in suicide mortality according to variables such as gender, age, social support, or socioeconomic level.

The series of articles recently published in Lancet Public Health reminds us that suicide prevention policies must continue to strengthen care for those suffering from disorders associated with a higher risk of developing suicidal behaviors (some of whom suffer from depressive disorders, alcohol use, or pathological gambling, as well as those who express suicidal thoughts). However, they must also ensure a public health approach that goes beyond a purely clinical perspective. This public health approach to suicide prevention should be based on quality data about the magnitude of the problem and its determinants and should address issues such as alcohol use, gambling, safety in building designs (bridges, skyscrapers, railways, etc.), or access to firearms and toxic products, which are often influenced by economic interests in what are called commercial determinants of health. It should also influence public policies such as education, access to housing, employment, or social services to bring universal preventive actions to the entire population. The public health perspective that this series of articles advocates for will effectively complement the appropriate selective actions that health services are beginning to provide to those with a suicide risk profile or those who have already exhibited suicidal behavior.

Paper 1 (Preventing suicide: a public health approach to a global problem) is a great addition to the literature because it brings together decades of research on suicide prevention from a public health perspective. It also facilitates the conceptualization of the problem in a succinct and graphic manner, with a conceptual model that summarizes the causes of suicidal thoughts and behaviors at different levels in the population. Facilitating this conceptualization is very important for policy-making and for society in general, to view the risk of suicide not only as a clinical problem that can potentially be prevented solely in mental health consultations but as a global issue that can potentially be addressed through various layers of society.

Paper 5 (Addressing key risk factors for suicide at a societal level) directly focuses on four of the most well-understood social causes of suicidal behaviors in the literature: alcohol use, gambling disorder, domestic violence, and the grief from losing someone to suicide. It is a narrative review that can guide individuals who are not very familiar with these issues.

In general, this represents a major scientific effort to bring suicide to the forefront of the international stage as a public health problem, highlighting its social causes at both individual and population levels as key avenues for prevention. Notably, it calls attention to the commercial interests at play in population-level suicide risk and the potential role of commercial regulation in reducing this risk.