Abstract:

Promoting socioemotional skills has been highlighted among the evidence to prevent suicidal behavior in childhood and adolescence. This review aimed to map and analyze national and international scientific papers on initiatives and programs for the prevention of suicidal behavior in adolescence based on the theoretical framework of socioemotional skills. It is a scoping review using the methodology proposed by the Joanna Briggs Institute. Eleven academic bibliographic databases were analyzed, and searches were conducted on institutional websites related to suicide prevention and Google. Papers in Portuguese, Spanish, French, and English from 2010 to July 2022 were included in the review, which consisted of 97 studies, analyzed through data matrix and thematic grouping. The results show that most are international and focused on suicide, not on self-harm alone. In general, they have an informational and instructional bias for professionals, institutions, and governments, proposed laws, programs and action plans, studies on the role of socioemotional skills and intervention research. Few strategies have been clearly tested and validated. The key elements are the ability to perceive, recognize, understand, express, and regulate one’s own emotions, get motivated, and build empathy in relationships. Schools are key players in this process and the health system should act as a collaborative network. National and local prevention plans are required, emphasizing the role of schools, the health sector, and intersectoral coordination to promote health and quality of life.

Keywords:
Suicide; Self Injury; Suicidal Ideation; Adolescent; Suicide Prevention

Resumen:

El fomento de las habilidades socioemocionales se viene destacando entre las evidencias de prevención de la conducta suicida en la infancia y la adolescencia. Este artículo tiene como objetivo identificar y analizar la producción científica nacional e internacional sobre iniciativas y programas de prevención de la conducta suicida en la adolescencia a partir del marco teórico de las habilidades socioemocionales. Se trata de una revisión de alcance que utiliza la metodología propuesta por el Instituto Joanna Briggs. Se realizaron búsquedas en 11 bases de datos académicas, en sitios web institucionales relacionados con la prevención del suicidio y en Google. Los textos incluidos estaban publicados en portugués, español, francés o inglés, en el período entre 2010 y julio de 2022. La muestra consistió en 97 publicaciones, y se utilizaron la matriz de datos y agrupación temática para analizarlas. Los resultados muestran que la mayoría de las iniciativas son internacionales y dirigidas al suicidio, sin privilegiar la autolesión. En general, tienen un sesgo informativo e instruccional dirigido a profesionales, instituciones y gobiernos, proyecto de ley, programas y planes de acción, estudios sobre el papel de las habilidades socioemocionales e investigación de intervención. Pocas estrategias habían sido probadas y validadas claramente. Los elementos clave fueron la capacidad de percibir, reconocer, comprender, expresarse y regular las propias emociones, motivarse y establecer relaciones de empatía. Las escuelas son las protagonistas, y el sector salud necesita actuar en una red de colaboración. Se necesitan planes de prevención nacionales y locales, que pongan énfasis en el papel de la escuela, del sector salud y de la articulación intersectorial para la promoción de la salud y la calidad de vida.

Palabras-clave:
Suicidio; Autolesiones; Ideación Suicida; Adolescente; Prevención del Suicidio

Introduction

Promoting socioemotional skills has been highlighted among the evidence to prevent suicidal behavior in childhood and adolescence, besides limited access to means of suicide, interaction with media channels for reporting, information, and care; and early identification and monitoring ¹1. World Health Organization. Preventing suicide: a resource for establishing a crisis line. Geneva: World Health Organization; 2018.^,22. Purebl G, Petrea I, Shields L, Tóth MD, Székely A, Kurimay T, et al. Joint action on mental health and well-being: depression, suicide prevention and e-health. Situation analysis and recommendations for action. https://health.ec.europa.eu/system/files/2017-07/2017_depression_suicide_ehealth_en_0.pdf (accessed on 28/Nov/2022).
https://health.ec.europa.eu/system/files... ^,33. Stone D, Holland K, Bartholow B, Crosby A, Davis S, Wilkins N. Preventing suicide: a technical package of policies, programs, and practices. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2017.. Theories about suicide propose that adolescents who are unable to handle negative affect have their cognitive evaluation impacted, which leads to negative thoughts or expectations about the future and the perception of suicide as the only way out ⁴4. Klonsky ED, May AM. The Three-Step Theory (3ST): a new theory of suicide rooted in the "ideation-to-action" framework. Int J Cogn Ther 2015; 8:114-29.^,55. Selby EA, Anestis MD, Joiner TE. Understanding the relationship between emotional and behavioral dysregulation: emotional cascades. Behav Res Ther 2008; 46:593-611.. In addition, the lack of social connections and a feeling of belonging and, instead, the presence of feelings of failure and imprisonment control the emotional state. This way, the lack of awareness and understanding of emotions, the inability to control impulsive behavior and use resolution strategies, as well as the existence of pain combined with hopelessness, can be conditions for the development of suicidal thoughts ⁶6. Turton H, Berry K, Danquah A, Pratt D. The relationship between emotion dysregulation and suicide ideation and behaviour: a systematic review. J Affect Disord Rep 2021; 5:100136..

This way, many promising interventions with families, schools or in health services are based on socioemotional skills, prioritizing emotion regulation, problem resolution, and expansion of relational capacity ¹1. World Health Organization. Preventing suicide: a resource for establishing a crisis line. Geneva: World Health Organization; 2018.^,77. Fundo das Nações Unidas para a Infância. Cenário da exclusão escolar no Brasil: um alerta sobre os impactos da pandemia do COVID-19 na educação. https://www.unicef.org/brazil/relatorios/cenario-da-exclusao-escolar-no-brasil (accessed on 06/Dec/2022).
https://www.unicef.org/brazil/relatorios... . These skills include socioaffective, emotional, behavioral, and moral aspects. Among the theoretical constructs are intelligence and emotion regulation, which can be protective factors against emotional instability; difficult adaptation; guilt; feelings of failure, frustration, fear, and impulsiveness ⁸8. Abdollahi A, Carlbring P, Khanbani M, Abdollahi S. Emotional intelligence moderates perceived stress and suicidal ideation among depressed adolescent in patients. Pers Individ Dif 2016; 102:223-8.^,99. Gómez MJ, Limonero JT, Toro J, Montes J, Tomas J. Relación entre inteligencia emocional, afecto negativo y riesgo suicida en jóvenes universitarios. Ansiedad Estrés 2018; 24:18-23.^,1010. Mérida-López S, Extremera N, Rey L. Understanding the links between self-report emotional intelligence and suicide risk: does psychological distress mediate this relationship across time and samples? Front Psychiatry 2018; 9:184.^,1111. Oberst UY, Lizeretti N. Inteligencia emocional em psicología clínica y psicoterapia. Revista de Psicoterapia 2004; 60:5-22.^,1212. Carmona-Navarro MC, Pichardo-Martinez MC. Atitudes do profissional de enfermagem em relação ao comportamento suicida: influência da inteligência emocional. Rev Latinoam Enferm 2012; 20:1161-8.. They may receive interventions and can be taught, learned, and practiced over time, in order to achieve a sense of well-being and better social interaction. The “deficit” in social skills and in regulation of one’s own emotions seems to precede suicidal behaviors, where the search for the act can provide a false sense of relief ¹³13. Buerger A, Emser T, Seidel A, Scheiner C, von Schoenfeld C, Ruecker V, et al. DUDE - a universal prevention program for non-suicidal self-injurious behavior in adolescence based on effective emotion regulation: study protocol of a cluster-randomized controlled trial. Trials 2022; 23:97.^,1414. Kim KL, Galione J, Schettini E, DeYoung LLA, Gilbert AC, Jenkins GA, et al. Do styles of emotion dysregulation differentiate adolescents engaging in non-suicidal self-injury from those attempting suicide? Psychiatry Res 2020; 291:113240..

Suicidal behavior refers to an action of self-harm or that could end one’s own life ¹⁵15. World Health Organization. Preventing suicide: a global imperative. Geneva: World Health Organization; 2014.. It occurs in the form of suicidal ideation, planning or attempt, as well as self-harm, which may not be related to suicidal intent ¹⁵15. World Health Organization. Preventing suicide: a global imperative. Geneva: World Health Organization; 2014.. In general, there is a fine line between these actions ¹⁴14. Kim KL, Galione J, Schettini E, DeYoung LLA, Gilbert AC, Jenkins GA, et al. Do styles of emotion dysregulation differentiate adolescents engaging in non-suicidal self-injury from those attempting suicide? Psychiatry Res 2020; 291:113240.^,1616. Jans T, Vloet TD, Taneli Y, Warnke A. Suicide and self-harming behaviour. In: Rey JM, editor. IACAPAP textbook of child and adolescent mental health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions; 2018. p. 1-41.^,1717. Minayo MC, Souza ER. Suicídio: violência autoinfligida. In: Ministério da Saúde, editor. Impactos da violência na saúde dos brasileiros. Brasília: Ministério da Saúde; 2005. p. 311-31.. Suicide rates in adolescence are alarming, representing the number four leading cause of death among young people aged 15 to 29 in the world ¹⁸18. World Health Organization. Suicide worldwide in 2019: global health estimates. Geneva: World Health Organization; 2021.. In Brazil, there has been an increasing trend in suicide since 2000 ¹⁹19. Cicogna JIR, Hillesheim D, Hallal ALLC. Mortalidade por suicídio de adolescentes no Brasil: tendência temporal de crescimento entre 2000 e 2015. J Bras Psiquiatr 2019; 68:1-7.^,2020. Ministério da Saúde. Mortalidade por suicídio e notificações de lesões autoprovocadas no Brasil. Brasília: Ministério da Saúde; 2023.. Gender, age, and race/ethnicity have important implications for the epidemiology of suicide, especially when they show contexts of social vulnerability, discrimination, and violence ²¹21. Bahia CA, Avanci JQ, Pinto LW, Minayo MCS. Adolescent intentional self-harm notifications and hospitalizations in Brazil, 2007-2016. Epidemiol Serv Saúde 2020; 29:e2019060.. It is a multifactorial phenomenon, involving biological, social, psychological and philosophical-existential factors ²²22. Minayo MCS, Avanci JQ, Figueiredo AEB. Violência autoinfligida: ideações, tentativas e suicídio consumado. In: Minayo MCS, Assis SG, editors. Novas e velhas faces da violência no século XXI: visão da literatura brasileira do campo da saúde. Rio de Janeiro: Editora Fiocruz; 2017. p. 141-57.. Virtual social media have been highlighted in this debate for providing both risk and protection ²³23. Gonçalves AF, Avanci JQ, Njaine K. "As giletes sempre falam mais alto": o tema da automutilação em comunidades online. Cad Saúde Pública 2023; 39:e00197122..

Considering the expansion of this problem in Brazil and other regions of the world, particularly among adolescents, the World Health Organization (WHO) and national bodies have been invited to develop prevention strategies to ensure access to public health services, strengthen policies and funding for vulnerable locations and populations, and offer comprehensive treatment with an emphasis on preventive actions ¹³13. Buerger A, Emser T, Seidel A, Scheiner C, von Schoenfeld C, Ruecker V, et al. DUDE - a universal prevention program for non-suicidal self-injurious behavior in adolescence based on effective emotion regulation: study protocol of a cluster-randomized controlled trial. Trials 2022; 23:97.^,1414. Kim KL, Galione J, Schettini E, DeYoung LLA, Gilbert AC, Jenkins GA, et al. Do styles of emotion dysregulation differentiate adolescents engaging in non-suicidal self-injury from those attempting suicide? Psychiatry Res 2020; 291:113240.^,1616. Jans T, Vloet TD, Taneli Y, Warnke A. Suicide and self-harming behaviour. In: Rey JM, editor. IACAPAP textbook of child and adolescent mental health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions; 2018. p. 1-41.^,2424. Ministério da Saúde. Portaria nº 1.876, de 14 de agosto de 2006. Institui Diretrizes Nacionais para Prevenção do Suicídio, a ser implantadas em todas as unidades federadas, respeitadas as competências das três esferas de gestão. Diário Oficial da União 2006; 15 aug.^,2525. Ministério da Saúde. Prevenção do suicídio. Manual dirigido a profissionais das equipes de saúde mental. Brasília: Ministério da Saúde; 2006.^,2626. Ministério da Saúde. Portaria nº 1.271, de 6 de junho de 2014. Define a Lista Nacional de Notificação Compulsória de doenças, agravos e eventos de saúde pública nos serviços de saúde públicos e privados em todo o território nacional, nos termos do anexo, e dá outras providências. Diário Oficial da União 2014; 9 jun.^,2727. Departamento de Ações Programáticas Estratégicas, Secretaria de Atenção à Saúde, Ministério da Saúde. Agenda de ações estratégicas para a vigilância e prevenção do suicídio e promoção da saúde no Brasil: 2017 a 2020. Brasília: Ministério da Saúde; 2017.^,2828. TRT da 4ª Região (RS). Ministério da Saúde lança Agenda Estratégica de Prevenção do Suicídio. https://www.trt4.jus.br/portais/trt4/modulos/noticias/258974#:~:text=A%20iniciativa%20tem%20o%20objetivo,sexuais%20e%20identidades%20de%20g%C3%AAnero (accessed on 05/Aug/2022).
https://www.trt4.jus.br/portais/trt4/mod... ^,2929. World Health Organization. Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation. Geneva: World Health Organization; 2016.. Given the relevance of socioemotional aspects, this study aims to map and analyze national and international scientific papers on initiatives and programs to prevent suicidal behavior in adolescence based on the theoretical framework of socioemotional skills in order to support actions that can be implemented in education, health, governmental and non-governmental services, and the media.

Method

Study design

This is a scoping review, a systematic method to map scientific papers on a given topic in order to identify concepts and gaps. The methodological framework was based on the Joanna Briggs Institute manual ³⁰30. Peters MD, Godfrey C, McInerney P, Soares CB, Khalil H, Parker D. Scoping reviews. In: Aromataris E, Munn Z, editors. JBI reviewer's manual. Adelaide: Joanna Briggs Institute; 2017. p. 406-51. and included papers with a variety of study methods and document sources. The following question guided this review: “How are strategies and programs on socioemotional skills developed to prevent suicidal behavior in childhood and adolescence?”. A review protocol was created, registered in the Open Science Framework (OSF) ³¹31. Avanci JQ. Prevenção da autolesão e do comportamento suicida na adolescência: revisão da literatura para subsidiar ações em saúde. OSF Home 2022; 13 jul. https://osf.io/2ezjh/.
https://osf.io/2ezjh/... , and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines ³²32. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018; 169:467-73..

Search strategies

Search was conducted between January and July 2022 and included two stages organized according to the type of source: (i) focused on academic databases, which included 11 bibliographic databases: SciELO, VHL Regional Portal, VHL Regional Portal (Health Science Descriptors - DeCS, acronym in Portuguese), OASIS (from Brazilian Institute of Information in Science and Technology - IBICT, acronym in Portuguese), Scopus, Web of Science, PubMed/MEDLINE (title/abstract), PubMed (MeSH terms), Dimensions, Embase (Emtree), PsycNET; and Google Scholar; and (ii) a search on institutional websites related to suicide prevention and Google.

Structured search was adapted for each database investigated and type of source by an experienced librarian using the following descriptors: “prevenção”, “suicídio” (“comportamento suicida” OR “ideação suicida” OR “suicídio” OR “autolesão” OR “comportamento autodestrutivo”), “inteligência emocional” (“manejo emocional” OR “regulação emocional” OR “controle emocional” OR “autocontrole emocional” OR “gerenciamento emocional”), “adolescente,” and “criança” (Box 1). Papers in Portuguese, Spanish, French, and English were included, with the time frame of 2010 to July 2022. Primary studies, secondary studies, experience reports, theoretical essays, theses, dissertations, official documents, reports, among others were part of this review.

Google search was performed on pages from countries with high suicide mortality rates (≥ 2 per 100,000 inhabitants) in the 0-19 age group, according to the WHO (2021) (Table 1). The total number of pages was counted according to the country and organized by world region. The first 20 most relevant results were analyzed using the website found and/or documents related to the main website. In addition, institutional websites were investigated according to the recommendations of experts and information on the websites initially found ³³33. Gomes SLR, Mendonça MAR, de Souza CM. Literatura cinzenta. In: Campello BS, Cendón BV, Kremer JM, editors. Fontes de informação para pesquisadores e profissionais. Belo Horizonte: Editora UFMG; 2007. p. 97-103.. A simplified version of search terms was used here: “inteligência emocional” (emotional intelligence), “regulação emocional” (emotion regulation), “habilidade socioemocional” (socioemotional skill), “suicídio” (suicide), and “autolesão” (self-harm).

Selection of studies and eligibility criteria

The initial search presented the following numbers of papers: (i) 202 from academic databases, (ii) 300 documents on Google Scholar, (iii) 275 on the Google pages of countries with high suicide rates among children and adolescents, and (iv) 44 on institutional websites.

After excluding duplicates, selection was made in pairs using Rayyan (https://www.rayyan.ai/) ³⁴34. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan - a web and mobile app for systematic reviews. Syst Rev 2016; 5:210. reference manager for the initial screening of abstracts and titles. The evaluators worked independently and the individual results were checked by a third expert. Disagreements were resolved by consensus. The following exclusion criteria were applied: absence of a relationship between socioemotional skills and suicidal/self-harm behavior in childhood or adolescence; an age group other than childhood or adolescence; specific approach to the topics of interest; documents and websites not available; works without access to full text; commercial websites that sell books or texts; absence of the text in Portuguese, English, French or Spanish; and audiovisual products such as videos and podcasts. Eligible studies were those that addressed the themes of socioemotional skills in relation to suicidal/self-harm behavior, with a focus on prevention in childhood and adolescence.

Figure 1 shows the stages of identification and selection of papers, which totaled 97 papers. Of these, 56 were from bibliographic databases and 41 resulted from a combination of 29 documents from Google search and 12 from search on websites of institutions. Most documents from non-bibliographic databases are government guides, protocols or reports published for scientific dissemination, followed by texts from websites, end-of-course papers, books, book chapters or extended texts presented at congresses, online reports, and one proposed law.

Analysis of studies

All 97 studies were analyzed using two analytical methods: (i) characterization of papers by means of a data matrix describing the studies according to title, author, abstract, country, year of publication, target audience, main concepts, objectives, and methods applied; and (ii) thematic grouping according to actions/strategies/programs for schools, health services, governmental and nongovernmental services, and media.

Results

Characterization of papers

Box 2 shows that studies produced in the United States represent most papers analyzed (16.5%), followed by Brazil and Spain (12.3% each) ³3. Stone D, Holland K, Bartholow B, Crosby A, Davis S, Wilkins N. Preventing suicide: a technical package of policies, programs, and practices. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2017.^,1212. Carmona-Navarro MC, Pichardo-Martinez MC. Atitudes do profissional de enfermagem em relação ao comportamento suicida: influência da inteligência emocional. Rev Latinoam Enferm 2012; 20:1161-8.^,3535. Rural Health Infomantion, Department of Health and Human Services. School-based programming for suicide prevention. https://www.ruralhealthinfo.org/toolkits/suicide/2/schools/programming (accessed on 12/Aug/2022).
https://www.ruralhealthinfo.org/toolkits... ^,3636. Jacobson C, Batejan K, Kleinman M, Gould M. Reasons for attempting suicide among a community sample of adolescents. Suicide Life Threat Behav 2013; 43:646-62.^,3737. Valois RF, Zullig KJ, Hunter AA. Association between adolescent suicide ideation, suicide attempts and emotional self-efficacy. J Child Fam Stud 2015; 24:237-48.^,3838. Perloe A. A longitudinal examination of the association between non-suicidal self-injury, emotional intelligence, and family context in adolescents [Doctoral Dissertation]. Fairfax: George Mason University; 2016.^,3939. Bodzy ME, Barreto SJ, Swenson LP, Liguori G, Costea G. Self-reported psychopathology, trauma symptoms, and emotion coping among child suicide attempters and ideators: an exploratory study of young children. Arch Suicide Res 2016; 20:160-75.^,4040. Topper A. A proposed suicide prevention intervention for LGBTQ youth: addressing an unmet need [Masters Thesis]. Pittsburgh: University of Pittsburgh; 2017.^,4141. Roberts ML. Adolescent suicide prevention: life experiences contributing to suicidal ideation resilience [Doctoral Dissertation]. Oakland: Saybrook University; 2018.^,4242. Gallagher ML, Miller AB. Suicidal thoughts and behavior in children and adolescents: an ecological model of resilience. Adolesc Res Rev 2018; 3:123-54.^,4343. Brausch AM, Woods SE. Emotion regulation deficits and nonsuicidal self-injury prospectively predict suicide ideation in adolescents. Suicide Life Threat Behav 2019; 49:868-80.^,4444. Knight MA. Social emotional learning as a universal upstream approach to youth suicide prevention: a secondary data analysis of a prevention program evaluation. https://digitalscholarship.unlv.edu/thesesdissertations/4161/ (accessed on 16/Oct/2023).
https://digitalscholarship.unlv.edu/thes... ^,4545. Kaufman EA, Xia M, Fosco G, Yaptangco M, Skidmore CR, Crowell SE. The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): validation and replication in adolescent and adult samples. J Psychopathol Behav Assess 2016; 38:443-55.^,4646. Fuller AM, Haboush-Deloye A, Goldberg P, Grob K. Strategies & Tools to Embrace Prevention with Upstream Programs (STEP UP): a comprehensive evaluation report. Las Vegas: School of Community Health Sciences, University of Nevada; 2015.^,4747. Scavacini K, Guedes I, Cacciacarro MF. Prevenção do suicídio na internet: pais e educadores. São Paulo: Instituto Vita Alere de Prevenção e Posvenção do Suicídio; 2019.^,4848. Scavacini K, Cacciacarro MF, Motoyama ÉP, Cescon LF. Autolesão: guia prático de ajuda. São Paulo: Instituto Vita Alere de Prevenção e Posvenção do Suicídio; 2021.^,4949. Sociedade Brasileira de Neuropsicologia. Suicídio: compreender, identificar e intervir. https://sbnpbrasil.com.br/categoria_download/cartilhas/ (accessed on 25/Jul/2022).
https://sbnpbrasil.com.br/categoria_down... ^,5050. Nova Escola. Como lidar com a pré e posvenção do suicídio na escola. https://gestaoescolar.org.br/conteudo/2262/como-lidar-com-a-pre-e-posvencao-do-suicidio-na-escola (accessed on 25/Jul/2022).
https://gestaoescolar.org.br/conteudo/22... ^,5151. Sucena LG. Conecta Educação alerta para importância de discutir prevenção ao suicídio. https://feac.org.br/conecta-educacao-alerta-para-importancia-de-discutir-prevencao-ao-suicidio/ (accessed on 26/Jul/2022).
https://feac.org.br/conecta-educacao-ale... ^,5252. Senac Goiás. Educação emocional auxilia na prevenção ao suicídio entre jovens. https://v1.go.senac.br/faculdade/site/noticia/6092-educacao-emocional-auxilia-na-prevencao-ao-suicidio-entre-jovens (accessed on 05/Aug/2022).
https://v1.go.senac.br/faculdade/site/no... ^,5353. SOMOS Educação. Setembro Amarelo nas escolas: como abordar temas de saúde mental? https://blog.elevaplataforma.com.br/setembro-amarelo-nas-escolas/ (accessed on 05/Aug/2022).
https://blog.elevaplataforma.com.br/sete... ^,5454. Almeida VAS, Almeida GAS. A escola como um ambiente fundamental na prevenção do suicídio entre jovens: uma investigação de possíveis estratégias. In: CONEDU - VI Congresso Nacional de Educação. https://editorarealize.com.br/edicao/detalhes/anais-vi-conedu (accessed on 05/Aug/2022).
https://editorarealize.com.br/edicao/det... ^,5555. Massagli SCC, Lopes FPS, Sousa PRC. Aprendizagem socioemocional: espaço de reflexão e trocas de um projeto extencionista universitário para adolescentes na escola. Expressa Extensão 2021; 26:187-97.^,5656. Magalhães GS, Carrasco LMCM. Plano piloto de prevenção ao comportamento suicida e automutilação na adolescência: análise documental de uma ação proposta pela Secretaria Municipal de Palmas/TO. In: Dal Molin RS, editor. Saúde em foco: temas contemporâneos. v. 3. São Paulo: Editora Científica Digital; 2020. p. 507-26.^,5757. Bezerra JMM. PREVIDAS: prevenção, vida e saúde. Prevenção de suicídio em adolescentes rurais do Colégio Estadual Reis Magalhães-Glória/Bahia [Doctoral Dissertation]. Juazeiro: Universidade Federal do Vale do São Francisco; 2019.^,5858. Organização Mundial da Saúde. INSPIRE: sete estratégias para pôr fim à violência contra crianças. São Paulo: Núcleo de Estudos da Violência; 2018.^,5959. Sánchez T. Autolesiones en la adolescencia: significados, perspectivas y prospección para su abordaje terapéutico. Revista de Psicoterapia 2018; 29:185-209.^,6060. Domínguez-García E, Fernández-Berrocal P. The association between emotional intelligence and suicidal behavior: a systematic review. Front Psychol 2018; 9:2380.^,6161. Quintana-Orts C, Mérida-López S, Rey L, Neto F, Extremera N. Untangling the emotional intelligence-suicidal ideation connection: the role of cognitive emotion regulation strategies in adolescents. J Clin Med 2020; 9:3116.^,6262. Rey L, Mérida-López S, Sánchez-Álvarez N, Extremera N. When and how do emotional intelligence and flourishing protect against suicide risk in adolescent bullying victims? Int J Environ Res Public Health 2019; 16:2114.^,6363. Bonet C, Palma C, Santos MG. Effectiveness of emotional intelligence therapy on suicide risk among adolescents in residential care. Rev Int Psicol Ter Psicol 2020; 20:61-74.^,6464. Fernandez Moratilla E. Prevención del suicidio en adolescentes: un programa integral basado en sus factores de riesgo y de protección [Masters Thesis]. Madrid: Centro Universitario Cardenal Cisneros, Universidad de Alcalá; 2020.^,6565. Arrivillaga C, Rey L, Extremera N. Adolescents' problematic internet and smartphone use is related to suicide ideation: does emotional intelligence make a difference? Comput Human Behav 2020; 110:106375.^,6666. Quintana-Orts C, Rey L, Mérida-López S, Extremera N. What bridges the gap between emotional intelligence and suicide risk in victims of bullying? A moderated mediation study. J Affect Disord 2019; 245:798-805.^,6767. Velis Giménez MC. Programa de intervención integral de las autolesiones no suicidas en una comunidad educativa desde la terapia dialéctica comportamental [Undergraduate Thesis]. Valencia: Universidad Católica de Valencia San Vicente Mártir; 2020.^,6868. Fonseca-Pedrero E, Díez-Gómez A, De La Barrera U, Sebastian-Enesco C, Ortuño-Sierra J, Montoya-Castilla I, et al. Conducta suicida en adolescentes: un análisis de redes. Rev Psiquiatr Salud Mental 2020; 13:1-11.^,6969. Rastrollo Sasal LA. Suicidio en adolescentes: una propuesta de prevención [Masters Thesis]. Madrid: Universidad Rey Juan Carlos; 2021.^,7070. Garmendia Espinoza PA. La inteligencia emocional y su relación con la ideación suicida [Undergraduate Thesis]. Palma: Universitat de les Illes Balears; 2022., and in descending order: Colombia, Australia, Peru, Argentina, Switzerland, India, Mexico, Canada, Portugal, Costa Rica, the United Kingdom, Sweden, New Zealand, the Netherlands, Finland, Germany, Poland, Bolivia, Ecuador, Kenya, Malaysia, South Africa, and lastly, Egypt, China, and Turkey. Regarding the year of publication, a gradual increase has been observed in the number of studies since 2012, reaching the peak production in 2018 and maintaining an average of 15 studies per year between 2018 and 2021.

Most studies analyzed (32%) have actors from school institution as their target audience ¹³13. Buerger A, Emser T, Seidel A, Scheiner C, von Schoenfeld C, Ruecker V, et al. DUDE - a universal prevention program for non-suicidal self-injurious behavior in adolescence based on effective emotion regulation: study protocol of a cluster-randomized controlled trial. Trials 2022; 23:97.^,3636. Jacobson C, Batejan K, Kleinman M, Gould M. Reasons for attempting suicide among a community sample of adolescents. Suicide Life Threat Behav 2013; 43:646-62.^,3737. Valois RF, Zullig KJ, Hunter AA. Association between adolescent suicide ideation, suicide attempts and emotional self-efficacy. J Child Fam Stud 2015; 24:237-48.^,4444. Knight MA. Social emotional learning as a universal upstream approach to youth suicide prevention: a secondary data analysis of a prevention program evaluation. https://digitalscholarship.unlv.edu/thesesdissertations/4161/ (accessed on 16/Oct/2023).
https://digitalscholarship.unlv.edu/thes... ^,5555. Massagli SCC, Lopes FPS, Sousa PRC. Aprendizagem socioemocional: espaço de reflexão e trocas de um projeto extencionista universitário para adolescentes na escola. Expressa Extensão 2021; 26:187-97.^,5757. Bezerra JMM. PREVIDAS: prevenção, vida e saúde. Prevenção de suicídio em adolescentes rurais do Colégio Estadual Reis Magalhães-Glória/Bahia [Doctoral Dissertation]. Juazeiro: Universidade Federal do Vale do São Francisco; 2019.^,6161. Quintana-Orts C, Mérida-López S, Rey L, Neto F, Extremera N. Untangling the emotional intelligence-suicidal ideation connection: the role of cognitive emotion regulation strategies in adolescents. J Clin Med 2020; 9:3116.^,6262. Rey L, Mérida-López S, Sánchez-Álvarez N, Extremera N. When and how do emotional intelligence and flourishing protect against suicide risk in adolescent bullying victims? Int J Environ Res Public Health 2019; 16:2114.^,6464. Fernandez Moratilla E. Prevención del suicidio en adolescentes: un programa integral basado en sus factores de riesgo y de protección [Masters Thesis]. Madrid: Centro Universitario Cardenal Cisneros, Universidad de Alcalá; 2020.^,6565. Arrivillaga C, Rey L, Extremera N. Adolescents' problematic internet and smartphone use is related to suicide ideation: does emotional intelligence make a difference? Comput Human Behav 2020; 110:106375.^,6666. Quintana-Orts C, Rey L, Mérida-López S, Extremera N. What bridges the gap between emotional intelligence and suicide risk in victims of bullying? A moderated mediation study. J Affect Disord 2019; 245:798-805.^,6767. Velis Giménez MC. Programa de intervención integral de las autolesiones no suicidas en una comunidad educativa desde la terapia dialéctica comportamental [Undergraduate Thesis]. Valencia: Universidad Católica de Valencia San Vicente Mártir; 2020.^,6868. Fonseca-Pedrero E, Díez-Gómez A, De La Barrera U, Sebastian-Enesco C, Ortuño-Sierra J, Montoya-Castilla I, et al. Conducta suicida en adolescentes: un análisis de redes. Rev Psiquiatr Salud Mental 2020; 13:1-11.^,6969. Rastrollo Sasal LA. Suicidio en adolescentes: una propuesta de prevención [Masters Thesis]. Madrid: Universidad Rey Juan Carlos; 2021.^,7171. Voon D, Hasking P, Martin G. Emotion regulation in first episode adolescent non-suicidal self-injury: what difference does a year make? J Adolesc 2014; 37:1077-87.^,7272. Oktan V. A characterization of self-injurious behavior among Turkish adolescents. Psychol Rep 2014; 115:645-54.^,7373. Kwok SYCL, Yeung JWK, Low AYT, Lo HHM, Tam CHL. The roles of emotional competence and social problem-solving in the relationship between physical abuse and adolescent suicidal ideation in China. Child Abuse Negl 2015; 44:117-29.^,7474. Alvino Advíncula IR, Huaytalla Pariona AM. Inteligencia emocional en estudiantes que se autolesionan, del nivel secundario en la I.E.P. Gelicich del distrito de El Tambo-2015 [Undergraduate Thesis]. Huancayo: Universidad Continental; 2017.^,7575. Du Plooy H. The role of emotional intelligence in the relationship between psychosocial factors and suicide behaviour in South African adolescents [Doctoral Dissertation]. Bloemfontein: University of the Free State; 2017.^,7676. Xavier AMJ. Experiências emocionais precoces e (des)regulação emocional: implicações para os comportamentos autolesivos na adolescência [Doctoral Dissertation]. Coimbra: Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra; 2017.^,7777. Ganaprakasam C. Emotional intelligence on suicidal ideation and mental health. Muallim Journal of Social Sciences and Humanities 2018; 2:185-95.^,7878. Okello LM, Aomo JA. Relationship between emotional intelligence and suicidal behaviour among secondary school students in Kitutu Central Sub-County, Kisii County, Kenya. International Journal of Educational Policy Research and Review 2018; 5:109-16.^,7979. Zachariah B, De Wit EE, Bahirat JD, Bunders-Aelen JFG, Regeer BJ. What is in it for them? Understanding the impact of a 'Support, Appreciate, Listen Team' (SALT)-based suicide prevention peer education program on peer educators. School Ment Health 2018; 10:462-76.^,8080. Fernández LR. Síntomas y causas de las autoagresiones para la prevención de conductas autodestructivas [Masters Thesis]. Azogues: Universidad Nacional de Educación; 2018.^,8181. Galarreta Mostacero ADL. Programa de habilidades sociales para la prevención del cutting en estudiantes de secundaria de una institución-Moche [Masters Thesis]. Trujillo: Escuela de Posgrado, Universidad César Vallejo; 2019.^,8282. Acuña de la Cruz YY, Gamarra Zelada AG. Inteligencia emocional e ideación suicida en estudiantes de educación secundaria de un colegio estatal de Cajamarca, 2019 [Undergraduate Thesis]. Cajamarca: Universidad Privada Antonio Guillermo Urrelo; 2020.^,8383. Aquino Huanca H. Programa de inteligencia emocional para la prevención del cutting en los estudiantes de primero y segundo de Secundaria "de la Unidad Educativa Marcelo Quiroga Santa Cruz de la Ciudad de El Alto" [Masters Thesis]. La Paz: Universidad Mayor de San Andrés; 2020.^,8484. Hermosillo-de-la-Torre AE, Arteaga-de-Luna SM, Acevedo-Rojas DL, Juárez-Loya A, Jiménez-Tapia JA, Pedroza-Cabrera FJ, et al. Psychosocial correlates of suicidal behavior among adolescents under confinement due to the COVID-19 pandemic in Aguascalientes, Mexico: a cross-sectional population survey. Int J Environ Res Public Health 2021; 18:4977.^,8585. Cano Quevedo JK. Programa "Fortaleciendo mi salud emocional" para reducir las conductas autolesivas en estudiantes de un distrito de Lima Norte, 2021 [Doctoral Dissertation]. Trujillo: Universidad César Vallejo; 2021.^,8686. Wasserman D, Hoven CW, Wasserman C, Wall M, Eisenberg R, Hadlaczky G, et al. School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial. Lancet 2015; 385:1536-44.^,8787. Vollandt L. Social-emotional learning and suicide prevention in schools. https://www.goguardian.com/blog/social-emotional-learning-and-suicide-prevention (accessed on 12/Aug/2022).
https://www.goguardian.com/blog/social-e... ^,8888. Santos JCP, Erse MPQA, Façanha JDN, Marques LAFA, Simões RMP. Mais Contigo: promoção de saúde mental e prevenção de comportamentos suicidários na comunidade educativa. Coimbra: Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola Superior de Enfermagem de Coimbra; 2014. (Série Monográfica : Educação e Investigação em Saúde).. Other studies address the theme in a clinical context ¹⁴14. Kim KL, Galione J, Schettini E, DeYoung LLA, Gilbert AC, Jenkins GA, et al. Do styles of emotion dysregulation differentiate adolescents engaging in non-suicidal self-injury from those attempting suicide? Psychiatry Res 2020; 291:113240.^,3838. Perloe A. A longitudinal examination of the association between non-suicidal self-injury, emotional intelligence, and family context in adolescents [Doctoral Dissertation]. Fairfax: George Mason University; 2016.^,3939. Bodzy ME, Barreto SJ, Swenson LP, Liguori G, Costea G. Self-reported psychopathology, trauma symptoms, and emotion coping among child suicide attempters and ideators: an exploratory study of young children. Arch Suicide Res 2016; 20:160-75.^,8989. Mohamed NA, Latief SAA, Madbouly NM, Rashid EAMA. The effect of emotional intelligence enhancement program on suicidal ideations among attempted suicide adolescents. International Journal of Research in Applied, Natural and Social Sciences 2017; 5:111-20., three show a community perspective ⁴¹41. Roberts ML. Adolescent suicide prevention: life experiences contributing to suicidal ideation resilience [Doctoral Dissertation]. Oakland: Saybrook University; 2018.^,9090. Pathare S, Shields-Zeeman L, Vijayakumar L, Pandit D, Nardodkar R, Chatterjee S, et al. Evaluation of the SPIRIT Integrated Suicide Prevention Programme: study protocol for a cluster-randomised controlled trial in rural Gujarat, India. Trials 2020; 21:572.^,9191. Flores-Kanter PE, García-Batista ZE, Moretti LS, Medrano LA. Towards an explanatory model of suicidal ideation: the effects of cognitive emotional regulation strategies, affectivity and hopelessness. Span J Psychol 2019; 22:E43. and only one has an institutional view, conducted with children under guardianship in Catalonia (Spain) ⁶³63. Bonet C, Palma C, Santos MG. Effectiveness of emotional intelligence therapy on suicide risk among adolescents in residential care. Rev Int Psicol Ter Psicol 2020; 20:61-74.. Also, most texts focus on adolescents, while some include children and young adults ³⁹39. Bodzy ME, Barreto SJ, Swenson LP, Liguori G, Costea G. Self-reported psychopathology, trauma symptoms, and emotion coping among child suicide attempters and ideators: an exploratory study of young children. Arch Suicide Res 2016; 20:160-75.^,9292. World Health Organization. Live life: preventing suicide. Geneva: World Health Organization; 2018.^,9393. Stern R, Divecha D. Emotional intelligence education has a role in suicide prevention. https://medium.com/thrive-global/how-emotional-intelligence-plays-a-role-in-suicide-prevention-8e81fb0ce204 (accessed on 25/Jul/2022).
https://medium.com/thrive-global/how-emo... ^,9494. National Suicide Prevention Taskforce. Summary of outcomes: towards zero suicide prevention forum. https://www.health.gov.au/sites/default/files/documents/2020/11/towards-zero-suicide-prevention-forum-summary-of-outcomes.pdf (accessed on 24/Nov/2022).
https://www.health.gov.au/sites/default/... . The approach to the categories of gender, sexual orientation, race/ethnicity, and social class is restricted to a brief theoretical reflection, considered in sample constitution and in the descriptive analysis of the results. However, there is a consensus that minorities should be studied because they suffer more discrimination, isolation, exclusion or find obstacles to access any kind of support ⁹⁵95. National Suicide Prevention Taskforce. Interim Advice Report: towards a national whole-of-government approach to suicide prevention. Canberra: National Suicide Prevention Taskforce; 2020.. Particular attention should be dedicated to the LGBTQIA+ population; black young people; Indigenous, rural, immigrant and refugee communities; adolescents deprived of their liberty, people with disabilities and those in foster care institutions ²2. Purebl G, Petrea I, Shields L, Tóth MD, Székely A, Kurimay T, et al. Joint action on mental health and well-being: depression, suicide prevention and e-health. Situation analysis and recommendations for action. https://health.ec.europa.eu/system/files/2017-07/2017_depression_suicide_ehealth_en_0.pdf (accessed on 28/Nov/2022).
https://health.ec.europa.eu/system/files... ^,4040. Topper A. A proposed suicide prevention intervention for LGBTQ youth: addressing an unmet need [Masters Thesis]. Pittsburgh: University of Pittsburgh; 2017.^,9090. Pathare S, Shields-Zeeman L, Vijayakumar L, Pandit D, Nardodkar R, Chatterjee S, et al. Evaluation of the SPIRIT Integrated Suicide Prevention Programme: study protocol for a cluster-randomised controlled trial in rural Gujarat, India. Trials 2020; 21:572.^,9494. National Suicide Prevention Taskforce. Summary of outcomes: towards zero suicide prevention forum. https://www.health.gov.au/sites/default/files/documents/2020/11/towards-zero-suicide-prevention-forum-summary-of-outcomes.pdf (accessed on 24/Nov/2022).
https://www.health.gov.au/sites/default/... ^,9595. National Suicide Prevention Taskforce. Interim Advice Report: towards a national whole-of-government approach to suicide prevention. Canberra: National Suicide Prevention Taskforce; 2020.^,9696. Consejo Nacional de Políticas Públicas para la Juventud. Protocolo de atención en el tema del suicidio por parte del Consejo de Persona Joven (CPJ). https://cpj.go.cr/ (accessed on 05/Aug/2022).
https://cpj.go.cr/... ^,9797. Northern Territory Department of Health. Suicide prevention implementation plan 2018-2023. https://health.nt.gov.au/governance-strategies-committees/nt-health-strategies/suicide-prevention-strategy-review (accessed on 25/Jul/2022).
https://health.nt.gov.au/governance-stra... ^,9898. Black Dog Institute. An evidence-based systems approach to suicide prevention: guidance on planning, commissioning and monitoring. Sydney: Black Dog Institute/Australian Government Department of Health; 2016.^,9999. World Health Organization; United Nations Children's Fund. Helping adolescents thrive toolkit: strategies to promote and protect adolescent mental health and reduce self-harm and other risk behaviours. Geneva: World Health Organization; 2021.^,100100. Trew S, Russell D, Higgins D, Stewart J. Effective interventions to reduce suicidal thoughts and behaviours among children in contact with child protection and out-of-home care systems - a rapid evidence review. Sydney: Institute of Child Protection Studies, Australian Catholic University; 2020.^,101101. Bloomer E. Self-harm needs assessment for children & young people. Hove: Brighton & Hove City Council; 2018..

Regarding the main concepts of socioemotional skills, a common theoretical basis was identified among the studies rooted in social emotional learning, emotion regulation, emotional intelligence, social and emotional intelligence, resilience, empathy, emotional skills, self-knowledge, emotional competence, promotion of self-esteem and mental health (Box 2). Of these, emotional intelligence and emotion regulation are highlighted. The key elements are the ability to perceive, recognize, understand, express, and regulate one’s own emotions, get motivated, recognize the emotions of other people, and build empathy in relationships. The expression of emotions is highly valued.

In general, the studiees can be organized as follows: (i) studies with an informational and instructional bias for professionals, institutions, and governments, addressing not only the prevention of suicidal/self-harm behavior, but also risk habits, mental disorders, promotion of mental well-being, care, coping with violence, and promotion of social emotional learning ⁴⁷47. Scavacini K, Guedes I, Cacciacarro MF. Prevenção do suicídio na internet: pais e educadores. São Paulo: Instituto Vita Alere de Prevenção e Posvenção do Suicídio; 2019.^,4848. Scavacini K, Cacciacarro MF, Motoyama ÉP, Cescon LF. Autolesão: guia prático de ajuda. São Paulo: Instituto Vita Alere de Prevenção e Posvenção do Suicídio; 2021.^,4949. Sociedade Brasileira de Neuropsicologia. Suicídio: compreender, identificar e intervir. https://sbnpbrasil.com.br/categoria_download/cartilhas/ (accessed on 25/Jul/2022).
https://sbnpbrasil.com.br/categoria_down... ^,9494. National Suicide Prevention Taskforce. Summary of outcomes: towards zero suicide prevention forum. https://www.health.gov.au/sites/default/files/documents/2020/11/towards-zero-suicide-prevention-forum-summary-of-outcomes.pdf (accessed on 24/Nov/2022).
https://www.health.gov.au/sites/default/... ^,102102. Ministerio de Salud de la Nación; Sociedad Argentina de Pediatría; Fondo de las Naciones Unidas para la Infancia. Abordaje integral del suicidio en las adolescencias: lineamientos para equipos de salud. Buenos Aires: Ministerio de Salud de la Nación/Sociedad Argentina de Pediatría/Fondo de las Naciones Unidas para la Infancia; 2021.^,103103. Ministerio de las Tecnologías de la Información y las Comunicaciones. Del ciberacoso al suicidio: cómo prevenirlo. https://www.enticconfio.gov.co/Del_ciberacoso_al_suicidio_como_prevenirlo (accessed on 05/Aug/2022).
https://www.enticconfio.gov.co/Del_ciber... ; (ii) proposed law, which takes emotional education as a framework integrated into the educational training process ¹⁰⁴104. Senado de Colombia. Por medio de la cual se crea y se implementa la cátedra de educación emocional en todas las instituciones educativas de Colombia en los niveles de preescolar, básica y media y se adoptan otras disposiciones. Projecto de Ley nº 348/2021. Bogotá: Senado de Colombia; 2021.; (iii) programs and action plans ²2. Purebl G, Petrea I, Shields L, Tóth MD, Székely A, Kurimay T, et al. Joint action on mental health and well-being: depression, suicide prevention and e-health. Situation analysis and recommendations for action. https://health.ec.europa.eu/system/files/2017-07/2017_depression_suicide_ehealth_en_0.pdf (accessed on 28/Nov/2022).
https://health.ec.europa.eu/system/files... ^,33. Stone D, Holland K, Bartholow B, Crosby A, Davis S, Wilkins N. Preventing suicide: a technical package of policies, programs, and practices. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2017.^,4646. Fuller AM, Haboush-Deloye A, Goldberg P, Grob K. Strategies & Tools to Embrace Prevention with Upstream Programs (STEP UP): a comprehensive evaluation report. Las Vegas: School of Community Health Sciences, University of Nevada; 2015.^,5858. Organização Mundial da Saúde. INSPIRE: sete estratégias para pôr fim à violência contra crianças. São Paulo: Núcleo de Estudos da Violência; 2018.^,9595. National Suicide Prevention Taskforce. Interim Advice Report: towards a national whole-of-government approach to suicide prevention. Canberra: National Suicide Prevention Taskforce; 2020.^,9696. Consejo Nacional de Políticas Públicas para la Juventud. Protocolo de atención en el tema del suicidio por parte del Consejo de Persona Joven (CPJ). https://cpj.go.cr/ (accessed on 05/Aug/2022).
https://cpj.go.cr/... ^,9797. Northern Territory Department of Health. Suicide prevention implementation plan 2018-2023. https://health.nt.gov.au/governance-strategies-committees/nt-health-strategies/suicide-prevention-strategy-review (accessed on 25/Jul/2022).
https://health.nt.gov.au/governance-stra... ^,9898. Black Dog Institute. An evidence-based systems approach to suicide prevention: guidance on planning, commissioning and monitoring. Sydney: Black Dog Institute/Australian Government Department of Health; 2016.^,9999. World Health Organization; United Nations Children's Fund. Helping adolescents thrive toolkit: strategies to promote and protect adolescent mental health and reduce self-harm and other risk behaviours. Geneva: World Health Organization; 2021.^,101101. Bloomer E. Self-harm needs assessment for children & young people. Hove: Brighton & Hove City Council; 2018.^,102102. Ministerio de Salud de la Nación; Sociedad Argentina de Pediatría; Fondo de las Naciones Unidas para la Infancia. Abordaje integral del suicidio en las adolescencias: lineamientos para equipos de salud. Buenos Aires: Ministerio de Salud de la Nación/Sociedad Argentina de Pediatría/Fondo de las Naciones Unidas para la Infancia; 2021.^,105105. Towers Hamlets. Suicide prevention strategy action plan: update 2017/18. London: Tower Hamlets Health and Wellbeing Board; 2017.^,106106. World Health Organization. Guidelines on mental health promotive and preventive interventions for adolescents: helping adolescents thrive (HAT). Geneva: World Health Organization; 2020.^,107107. Community-Led Action for Resilience. The CLARITY Project. https://blenkfamilyfund.ca/clarity/ (accessed on 24/Nov/2022).
https://blenkfamilyfund.ca/clarity/... ; (iv) association studies aiming to understand the role of socioemotional skills in the development of suicidal behavior, whether as a risk or protection ³⁷37. Valois RF, Zullig KJ, Hunter AA. Association between adolescent suicide ideation, suicide attempts and emotional self-efficacy. J Child Fam Stud 2015; 24:237-48.^,3838. Perloe A. A longitudinal examination of the association between non-suicidal self-injury, emotional intelligence, and family context in adolescents [Doctoral Dissertation]. Fairfax: George Mason University; 2016.^,3939. Bodzy ME, Barreto SJ, Swenson LP, Liguori G, Costea G. Self-reported psychopathology, trauma symptoms, and emotion coping among child suicide attempters and ideators: an exploratory study of young children. Arch Suicide Res 2016; 20:160-75.^,6969. Rastrollo Sasal LA. Suicidio en adolescentes: una propuesta de prevención [Masters Thesis]. Madrid: Universidad Rey Juan Carlos; 2021.^,7373. Kwok SYCL, Yeung JWK, Low AYT, Lo HHM, Tam CHL. The roles of emotional competence and social problem-solving in the relationship between physical abuse and adolescent suicidal ideation in China. Child Abuse Negl 2015; 44:117-29.^,108108. Benito M, Javier O, Minaya B, Alejandra M, Zuñiga C, Neyma D, et al. La inteligencia emocional como factor protector contra la ideación suicida. In: Celis DP, Zicavo N, Calviño M, editors. El hacer y el pensar de la psicología con América Latina. San Jose de Costa Rica: Alfepsi Editorial; 2016. p. 27-39. (Memorias del V Congreso de la Asociación Latinoamericana para la Formación y la Enseñanza de la Psicología, 3).^,109109. Halicka J, Szewczuk-Boguslawska M, Adamska A, Misiak B. Neurobiology of the association between non-suicidal self-injury, suicidal behavior and emotional intelligence: a review. Archives of Psychiatry and Psychotherapy 2020; 22:25-35.; and (v) intervention studies that seek to determine the effectiveness and applicability of interventions based on socioemotional skills and promotion of mental health in order to reduce suicidal/self-harm behavior ¹³13. Buerger A, Emser T, Seidel A, Scheiner C, von Schoenfeld C, Ruecker V, et al. DUDE - a universal prevention program for non-suicidal self-injurious behavior in adolescence based on effective emotion regulation: study protocol of a cluster-randomized controlled trial. Trials 2022; 23:97.^,1414. Kim KL, Galione J, Schettini E, DeYoung LLA, Gilbert AC, Jenkins GA, et al. Do styles of emotion dysregulation differentiate adolescents engaging in non-suicidal self-injury from those attempting suicide? Psychiatry Res 2020; 291:113240.^,5757. Bezerra JMM. PREVIDAS: prevenção, vida e saúde. Prevenção de suicídio em adolescentes rurais do Colégio Estadual Reis Magalhães-Glória/Bahia [Doctoral Dissertation]. Juazeiro: Universidade Federal do Vale do São Francisco; 2019.^,6060. Domínguez-García E, Fernández-Berrocal P. The association between emotional intelligence and suicidal behavior: a systematic review. Front Psychol 2018; 9:2380.^,7070. Garmendia Espinoza PA. La inteligencia emocional y su relación con la ideación suicida [Undergraduate Thesis]. Palma: Universitat de les Illes Balears; 2022.^,8686. Wasserman D, Hoven CW, Wasserman C, Wall M, Eisenberg R, Hadlaczky G, et al. School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial. Lancet 2015; 385:1536-44.^,8888. Santos JCP, Erse MPQA, Façanha JDN, Marques LAFA, Simões RMP. Mais Contigo: promoção de saúde mental e prevenção de comportamentos suicidários na comunidade educativa. Coimbra: Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola Superior de Enfermagem de Coimbra; 2014. (Série Monográfica : Educação e Investigação em Saúde).^,9090. Pathare S, Shields-Zeeman L, Vijayakumar L, Pandit D, Nardodkar R, Chatterjee S, et al. Evaluation of the SPIRIT Integrated Suicide Prevention Programme: study protocol for a cluster-randomised controlled trial in rural Gujarat, India. Trials 2020; 21:572.^,110110. Krishnamoorthy P, Kalpana B. Emotional intelligence and suicidal thoughts - how related are they? Systematic review. Ann Rom Soc Cell Biol 2021; 25:9664-71..

Most studies are theoretical (55.6%), with an emphasis on suicide and self-harm prevention (Box 2). Risk behaviors, mental disorders, promotion of mental well-being, care, coping with violence against children and adolescents, and social emotional learning are also mentioned ²2. Purebl G, Petrea I, Shields L, Tóth MD, Székely A, Kurimay T, et al. Joint action on mental health and well-being: depression, suicide prevention and e-health. Situation analysis and recommendations for action. https://health.ec.europa.eu/system/files/2017-07/2017_depression_suicide_ehealth_en_0.pdf (accessed on 28/Nov/2022).
https://health.ec.europa.eu/system/files... ^,33. Stone D, Holland K, Bartholow B, Crosby A, Davis S, Wilkins N. Preventing suicide: a technical package of policies, programs, and practices. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2017.^,4646. Fuller AM, Haboush-Deloye A, Goldberg P, Grob K. Strategies & Tools to Embrace Prevention with Upstream Programs (STEP UP): a comprehensive evaluation report. Las Vegas: School of Community Health Sciences, University of Nevada; 2015.^,4747. Scavacini K, Guedes I, Cacciacarro MF. Prevenção do suicídio na internet: pais e educadores. São Paulo: Instituto Vita Alere de Prevenção e Posvenção do Suicídio; 2019.^,4848. Scavacini K, Cacciacarro MF, Motoyama ÉP, Cescon LF. Autolesão: guia prático de ajuda. São Paulo: Instituto Vita Alere de Prevenção e Posvenção do Suicídio; 2021.^,4949. Sociedade Brasileira de Neuropsicologia. Suicídio: compreender, identificar e intervir. https://sbnpbrasil.com.br/categoria_download/cartilhas/ (accessed on 25/Jul/2022).
https://sbnpbrasil.com.br/categoria_down... ^,5858. Organização Mundial da Saúde. INSPIRE: sete estratégias para pôr fim à violência contra crianças. São Paulo: Núcleo de Estudos da Violência; 2018.^,9494. National Suicide Prevention Taskforce. Summary of outcomes: towards zero suicide prevention forum. https://www.health.gov.au/sites/default/files/documents/2020/11/towards-zero-suicide-prevention-forum-summary-of-outcomes.pdf (accessed on 24/Nov/2022).
https://www.health.gov.au/sites/default/... ^,9595. National Suicide Prevention Taskforce. Interim Advice Report: towards a national whole-of-government approach to suicide prevention. Canberra: National Suicide Prevention Taskforce; 2020.^,9696. Consejo Nacional de Políticas Públicas para la Juventud. Protocolo de atención en el tema del suicidio por parte del Consejo de Persona Joven (CPJ). https://cpj.go.cr/ (accessed on 05/Aug/2022).
https://cpj.go.cr/... ^,9797. Northern Territory Department of Health. Suicide prevention implementation plan 2018-2023. https://health.nt.gov.au/governance-strategies-committees/nt-health-strategies/suicide-prevention-strategy-review (accessed on 25/Jul/2022).
https://health.nt.gov.au/governance-stra... ^,9898. Black Dog Institute. An evidence-based systems approach to suicide prevention: guidance on planning, commissioning and monitoring. Sydney: Black Dog Institute/Australian Government Department of Health; 2016.^,9999. World Health Organization; United Nations Children's Fund. Helping adolescents thrive toolkit: strategies to promote and protect adolescent mental health and reduce self-harm and other risk behaviours. Geneva: World Health Organization; 2021.^,101101. Bloomer E. Self-harm needs assessment for children & young people. Hove: Brighton & Hove City Council; 2018.^,102102. Ministerio de Salud de la Nación; Sociedad Argentina de Pediatría; Fondo de las Naciones Unidas para la Infancia. Abordaje integral del suicidio en las adolescencias: lineamientos para equipos de salud. Buenos Aires: Ministerio de Salud de la Nación/Sociedad Argentina de Pediatría/Fondo de las Naciones Unidas para la Infancia; 2021.^,104104. Senado de Colombia. Por medio de la cual se crea y se implementa la cátedra de educación emocional en todas las instituciones educativas de Colombia en los niveles de preescolar, básica y media y se adoptan otras disposiciones. Projecto de Ley nº 348/2021. Bogotá: Senado de Colombia; 2021.^,105105. Towers Hamlets. Suicide prevention strategy action plan: update 2017/18. London: Tower Hamlets Health and Wellbeing Board; 2017.^,106106. World Health Organization. Guidelines on mental health promotive and preventive interventions for adolescents: helping adolescents thrive (HAT). Geneva: World Health Organization; 2020.^,111111. Ministerio de Salud Pública, Gobierno de la Provincia de Misiones. Orientaciones para el abordaje integral de la problemática del suicidio en población adolescente en la Provincia de Misiones. https://salud.misiones.gob.ar/wp-content/uploads/2022/03/Protocolo-prevencion-suicidio.pdf (accessed on 31/Jul/2022).
https://salud.misiones.gob.ar/wp-content... .

Quantitative cross-sectional studies are also observed (30%), which analyze the association of constructs with a focus on risk and protective factors ¹⁴14. Kim KL, Galione J, Schettini E, DeYoung LLA, Gilbert AC, Jenkins GA, et al. Do styles of emotion dysregulation differentiate adolescents engaging in non-suicidal self-injury from those attempting suicide? Psychiatry Res 2020; 291:113240.^,3636. Jacobson C, Batejan K, Kleinman M, Gould M. Reasons for attempting suicide among a community sample of adolescents. Suicide Life Threat Behav 2013; 43:646-62.^,3737. Valois RF, Zullig KJ, Hunter AA. Association between adolescent suicide ideation, suicide attempts and emotional self-efficacy. J Child Fam Stud 2015; 24:237-48.^,3838. Perloe A. A longitudinal examination of the association between non-suicidal self-injury, emotional intelligence, and family context in adolescents [Doctoral Dissertation]. Fairfax: George Mason University; 2016.^,3939. Bodzy ME, Barreto SJ, Swenson LP, Liguori G, Costea G. Self-reported psychopathology, trauma symptoms, and emotion coping among child suicide attempters and ideators: an exploratory study of young children. Arch Suicide Res 2016; 20:160-75.^,4242. Gallagher ML, Miller AB. Suicidal thoughts and behavior in children and adolescents: an ecological model of resilience. Adolesc Res Rev 2018; 3:123-54.^,4343. Brausch AM, Woods SE. Emotion regulation deficits and nonsuicidal self-injury prospectively predict suicide ideation in adolescents. Suicide Life Threat Behav 2019; 49:868-80.^,6060. Domínguez-García E, Fernández-Berrocal P. The association between emotional intelligence and suicidal behavior: a systematic review. Front Psychol 2018; 9:2380.^,6262. Rey L, Mérida-López S, Sánchez-Álvarez N, Extremera N. When and how do emotional intelligence and flourishing protect against suicide risk in adolescent bullying victims? Int J Environ Res Public Health 2019; 16:2114.^,6565. Arrivillaga C, Rey L, Extremera N. Adolescents' problematic internet and smartphone use is related to suicide ideation: does emotional intelligence make a difference? Comput Human Behav 2020; 110:106375.^,6666. Quintana-Orts C, Rey L, Mérida-López S, Extremera N. What bridges the gap between emotional intelligence and suicide risk in victims of bullying? A moderated mediation study. J Affect Disord 2019; 245:798-805.^,6868. Fonseca-Pedrero E, Díez-Gómez A, De La Barrera U, Sebastian-Enesco C, Ortuño-Sierra J, Montoya-Castilla I, et al. Conducta suicida en adolescentes: un análisis de redes. Rev Psiquiatr Salud Mental 2020; 13:1-11.^,7070. Garmendia Espinoza PA. La inteligencia emocional y su relación con la ideación suicida [Undergraduate Thesis]. Palma: Universitat de les Illes Balears; 2022.^,7171. Voon D, Hasking P, Martin G. Emotion regulation in first episode adolescent non-suicidal self-injury: what difference does a year make? J Adolesc 2014; 37:1077-87.^,7373. Kwok SYCL, Yeung JWK, Low AYT, Lo HHM, Tam CHL. The roles of emotional competence and social problem-solving in the relationship between physical abuse and adolescent suicidal ideation in China. Child Abuse Negl 2015; 44:117-29.^,7474. Alvino Advíncula IR, Huaytalla Pariona AM. Inteligencia emocional en estudiantes que se autolesionan, del nivel secundario en la I.E.P. Gelicich del distrito de El Tambo-2015 [Undergraduate Thesis]. Huancayo: Universidad Continental; 2017.^,7575. Du Plooy H. The role of emotional intelligence in the relationship between psychosocial factors and suicide behaviour in South African adolescents [Doctoral Dissertation]. Bloemfontein: University of the Free State; 2017.^,7676. Xavier AMJ. Experiências emocionais precoces e (des)regulação emocional: implicações para os comportamentos autolesivos na adolescência [Doctoral Dissertation]. Coimbra: Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra; 2017.^,7777. Ganaprakasam C. Emotional intelligence on suicidal ideation and mental health. Muallim Journal of Social Sciences and Humanities 2018; 2:185-95.^,7878. Okello LM, Aomo JA. Relationship between emotional intelligence and suicidal behaviour among secondary school students in Kitutu Central Sub-County, Kisii County, Kenya. International Journal of Educational Policy Research and Review 2018; 5:109-16.^,8282. Acuña de la Cruz YY, Gamarra Zelada AG. Inteligencia emocional e ideación suicida en estudiantes de educación secundaria de un colegio estatal de Cajamarca, 2019 [Undergraduate Thesis]. Cajamarca: Universidad Privada Antonio Guillermo Urrelo; 2020.^,8484. Hermosillo-de-la-Torre AE, Arteaga-de-Luna SM, Acevedo-Rojas DL, Juárez-Loya A, Jiménez-Tapia JA, Pedroza-Cabrera FJ, et al. Psychosocial correlates of suicidal behavior among adolescents under confinement due to the COVID-19 pandemic in Aguascalientes, Mexico: a cross-sectional population survey. Int J Environ Res Public Health 2021; 18:4977.^,9191. Flores-Kanter PE, García-Batista ZE, Moretti LS, Medrano LA. Towards an explanatory model of suicidal ideation: the effects of cognitive emotional regulation strategies, affectivity and hopelessness. Span J Psychol 2019; 22:E43.^,100100. Trew S, Russell D, Higgins D, Stewart J. Effective interventions to reduce suicidal thoughts and behaviours among children in contact with child protection and out-of-home care systems - a rapid evidence review. Sydney: Institute of Child Protection Studies, Australian Catholic University; 2020.^,109109. Halicka J, Szewczuk-Boguslawska M, Adamska A, Misiak B. Neurobiology of the association between non-suicidal self-injury, suicidal behavior and emotional intelligence: a review. Archives of Psychiatry and Psychotherapy 2020; 22:25-35.^,110110. Krishnamoorthy P, Kalpana B. Emotional intelligence and suicidal thoughts - how related are they? Systematic review. Ann Rom Soc Cell Biol 2021; 25:9664-71.^,112112. Rodríguez AMG. Situaciones detonantes del comportamiento e ideación suicida en adolescentes víctimas de acoso escolar [Undergraduate Thesis]. Bogotá: Facultad de Ciencias Sociales y Humanas, Universidad Cooperativa de Colombia; 2021.^,113113. González Suárez LF, Vasco-Hurtado IC, Nieto-Betancurt L. Revisión de la literatura sobre el papel del afrontamiento en las autolesiones no suicidas en adolescentes. Cuadernos Hispanoamericanos de Psicología 2016; 16:41-56.^,114114. Shahram SZ, Smith ML, Ben-David S, Feddersen M, Kemp TE, Plamondon K. Promoting "zest for life": a systematic literature review of resiliency factors to prevent youth suicide. J Res Adolesc 2021; 31:4-24.. Others list strategies and programs with strong scientific evidence and effectiveness testing ⁴⁰40. Topper A. A proposed suicide prevention intervention for LGBTQ youth: addressing an unmet need [Masters Thesis]. Pittsburgh: University of Pittsburgh; 2017.^,5454. Almeida VAS, Almeida GAS. A escola como um ambiente fundamental na prevenção do suicídio entre jovens: uma investigação de possíveis estratégias. In: CONEDU - VI Congresso Nacional de Educação. https://editorarealize.com.br/edicao/detalhes/anais-vi-conedu (accessed on 05/Aug/2022).
https://editorarealize.com.br/edicao/det... ^,5656. Magalhães GS, Carrasco LMCM. Plano piloto de prevenção ao comportamento suicida e automutilação na adolescência: análise documental de uma ação proposta pela Secretaria Municipal de Palmas/TO. In: Dal Molin RS, editor. Saúde em foco: temas contemporâneos. v. 3. São Paulo: Editora Científica Digital; 2020. p. 507-26.^,115115. Appelhoff R. School-based programmes to prevent suicide and build resilience among students: a literature review and national stocktake. https://www.cph.co.nz/wp-content/uploads/schoolbasedprogrammespreventsuicide.pdf (accessed on 24/Nov/2022).
https://www.cph.co.nz/wp-content/uploads... ^,116116. Cruz Cob AL, Balam Gómez M, Gómez López LY, Pool Góngora RA. PLACE para la prevención y detección del riesgo de suicidio en adolescentes y adultos jóvenes. CuidArte 2017; 6:34-43.. One study presents a validation study of a scale on emotion regulation challenges ⁴⁵45. Kaufman EA, Xia M, Fosco G, Yaptangco M, Skidmore CR, Crowell SE. The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): validation and replication in adolescent and adult samples. J Psychopathol Behav Assess 2016; 38:443-55.. Interventions are analyzed in a school, community or clinical context ⁶³63. Bonet C, Palma C, Santos MG. Effectiveness of emotional intelligence therapy on suicide risk among adolescents in residential care. Rev Int Psicol Ter Psicol 2020; 20:61-74.^,8383. Aquino Huanca H. Programa de inteligencia emocional para la prevención del cutting en los estudiantes de primero y segundo de Secundaria "de la Unidad Educativa Marcelo Quiroga Santa Cruz de la Ciudad de El Alto" [Masters Thesis]. La Paz: Universidad Mayor de San Andrés; 2020.^,8585. Cano Quevedo JK. Programa "Fortaleciendo mi salud emocional" para reducir las conductas autolesivas en estudiantes de un distrito de Lima Norte, 2021 [Doctoral Dissertation]. Trujillo: Universidad César Vallejo; 2021.^,8989. Mohamed NA, Latief SAA, Madbouly NM, Rashid EAMA. The effect of emotional intelligence enhancement program on suicidal ideations among attempted suicide adolescents. International Journal of Research in Applied, Natural and Social Sciences 2017; 5:111-20.^,108108. Benito M, Javier O, Minaya B, Alejandra M, Zuñiga C, Neyma D, et al. La inteligencia emocional como factor protector contra la ideación suicida. In: Celis DP, Zicavo N, Calviño M, editors. El hacer y el pensar de la psicología con América Latina. San Jose de Costa Rica: Alfepsi Editorial; 2016. p. 27-39. (Memorias del V Congreso de la Asociación Latinoamericana para la Formación y la Enseñanza de la Psicología, 3)..

The actions assess the application of suicide/self-harm prevention strategies/programs among adolescents aiming to strengthen socioemotional skills ¹³13. Buerger A, Emser T, Seidel A, Scheiner C, von Schoenfeld C, Ruecker V, et al. DUDE - a universal prevention program for non-suicidal self-injurious behavior in adolescence based on effective emotion regulation: study protocol of a cluster-randomized controlled trial. Trials 2022; 23:97.^,5757. Bezerra JMM. PREVIDAS: prevenção, vida e saúde. Prevenção de suicídio em adolescentes rurais do Colégio Estadual Reis Magalhães-Glória/Bahia [Doctoral Dissertation]. Juazeiro: Universidade Federal do Vale do São Francisco; 2019.^,7070. Garmendia Espinoza PA. La inteligencia emocional y su relación con la ideación suicida [Undergraduate Thesis]. Palma: Universitat de les Illes Balears; 2022., implement actions for adolescents at risk ⁶¹61. Quintana-Orts C, Mérida-López S, Rey L, Neto F, Extremera N. Untangling the emotional intelligence-suicidal ideation connection: the role of cognitive emotion regulation strategies in adolescents. J Clin Med 2020; 9:3116., support teacher training to detect suicidal/self-harm behavior ⁵⁷57. Bezerra JMM. PREVIDAS: prevenção, vida e saúde. Prevenção de suicídio em adolescentes rurais do Colégio Estadual Reis Magalhães-Glória/Bahia [Doctoral Dissertation]. Juazeiro: Universidade Federal do Vale do São Francisco; 2019.^,9191. Flores-Kanter PE, García-Batista ZE, Moretti LS, Medrano LA. Towards an explanatory model of suicidal ideation: the effects of cognitive emotional regulation strategies, affectivity and hopelessness. Span J Psychol 2019; 22:E43., and adopt treatment-based interventions with an emphasis on dialectical behavior therapy ¹¹⁴114. Shahram SZ, Smith ML, Ben-David S, Feddersen M, Kemp TE, Plamondon K. Promoting "zest for life": a systematic literature review of resiliency factors to prevent youth suicide. J Res Adolesc 2021; 31:4-24..

Interventions based on emotional intelligence with adolescents presenting a history of suicidal/self-harm behavior ⁸³83. Aquino Huanca H. Programa de inteligencia emocional para la prevención del cutting en los estudiantes de primero y segundo de Secundaria "de la Unidad Educativa Marcelo Quiroga Santa Cruz de la Ciudad de El Alto" [Masters Thesis]. La Paz: Universidad Mayor de San Andrés; 2020.^,8585. Cano Quevedo JK. Programa "Fortaleciendo mi salud emocional" para reducir las conductas autolesivas en estudiantes de un distrito de Lima Norte, 2021 [Doctoral Dissertation]. Trujillo: Universidad César Vallejo; 2021.^,8989. Mohamed NA, Latief SAA, Madbouly NM, Rashid EAMA. The effect of emotional intelligence enhancement program on suicidal ideations among attempted suicide adolescents. International Journal of Research in Applied, Natural and Social Sciences 2017; 5:111-20.^,108108. Benito M, Javier O, Minaya B, Alejandra M, Zuñiga C, Neyma D, et al. La inteligencia emocional como factor protector contra la ideación suicida. In: Celis DP, Zicavo N, Calviño M, editors. El hacer y el pensar de la psicología con América Latina. San Jose de Costa Rica: Alfepsi Editorial; 2016. p. 27-39. (Memorias del V Congreso de la Asociación Latinoamericana para la Formación y la Enseñanza de la Psicología, 3)., especially in school and community contexts ⁸⁷87. Vollandt L. Social-emotional learning and suicide prevention in schools. https://www.goguardian.com/blog/social-emotional-learning-and-suicide-prevention (accessed on 12/Aug/2022).
https://www.goguardian.com/blog/social-e... ^,106106. World Health Organization. Guidelines on mental health promotive and preventive interventions for adolescents: helping adolescents thrive (HAT). Geneva: World Health Organization; 2020. tend to produce positive effects. However, few of them use methods that show robust evidence of results ¹¹11. Oberst UY, Lizeretti N. Inteligencia emocional em psicología clínica y psicoterapia. Revista de Psicoterapia 2004; 60:5-22.^,8686. Wasserman D, Hoven CW, Wasserman C, Wall M, Eisenberg R, Hadlaczky G, et al. School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial. Lancet 2015; 385:1536-44.. The strategies analyzed in studies are based on revealing emotions and/or feelings, resolving conflicts, and finding alternative solutions in the face of adversity. They include social interaction skills, which require empathy, reciprocity, cooperation, and negotiation strategies, as well as good relationships ⁴⁴44. Knight MA. Social emotional learning as a universal upstream approach to youth suicide prevention: a secondary data analysis of a prevention program evaluation. https://digitalscholarship.unlv.edu/thesesdissertations/4161/ (accessed on 16/Oct/2023).
https://digitalscholarship.unlv.edu/thes... ^,5353. SOMOS Educação. Setembro Amarelo nas escolas: como abordar temas de saúde mental? https://blog.elevaplataforma.com.br/setembro-amarelo-nas-escolas/ (accessed on 05/Aug/2022).
https://blog.elevaplataforma.com.br/sete... ^,5757. Bezerra JMM. PREVIDAS: prevenção, vida e saúde. Prevenção de suicídio em adolescentes rurais do Colégio Estadual Reis Magalhães-Glória/Bahia [Doctoral Dissertation]. Juazeiro: Universidade Federal do Vale do São Francisco; 2019.^,6969. Rastrollo Sasal LA. Suicidio en adolescentes: una propuesta de prevención [Masters Thesis]. Madrid: Universidad Rey Juan Carlos; 2021.^,8080. Fernández LR. Síntomas y causas de las autoagresiones para la prevención de conductas autodestructivas [Masters Thesis]. Azogues: Universidad Nacional de Educación; 2018.. With these skills, adolescents would be better prepared to address daily social and individual challenges and risk factors associated with suicidal/self-harm behavior ⁶⁰60. Domínguez-García E, Fernández-Berrocal P. The association between emotional intelligence and suicidal behavior: a systematic review. Front Psychol 2018; 9:2380.^,6464. Fernandez Moratilla E. Prevención del suicidio en adolescentes: un programa integral basado en sus factores de riesgo y de protección [Masters Thesis]. Madrid: Centro Universitario Cardenal Cisneros, Universidad de Alcalá; 2020.^,7474. Alvino Advíncula IR, Huaytalla Pariona AM. Inteligencia emocional en estudiantes que se autolesionan, del nivel secundario en la I.E.P. Gelicich del distrito de El Tambo-2015 [Undergraduate Thesis]. Huancayo: Universidad Continental; 2017.^,8383. Aquino Huanca H. Programa de inteligencia emocional para la prevención del cutting en los estudiantes de primero y segundo de Secundaria "de la Unidad Educativa Marcelo Quiroga Santa Cruz de la Ciudad de El Alto" [Masters Thesis]. La Paz: Universidad Mayor de San Andrés; 2020.^,117117. Farias I. DBT para adolescentes: 5 habilidades. https://www.psicoactiva.com/blog/dbt-para-adolescentes/ (accessed on 24/Nov/2022).
https://www.psicoactiva.com/blog/dbt-par... .

The role of school

There is a consensus on the role of school as an important place to address emotions in a strategy to prevent suicidal behavior and self-harm ⁵²52. Senac Goiás. Educação emocional auxilia na prevenção ao suicídio entre jovens. https://v1.go.senac.br/faculdade/site/noticia/6092-educacao-emocional-auxilia-na-prevencao-ao-suicidio-entre-jovens (accessed on 05/Aug/2022).
https://v1.go.senac.br/faculdade/site/no... . With more or less emphasis, the studies reinforce the need to include the emotional dimension as an essential element for cognitive development, responsible for controlling feelings and emotions and indispensable in selecting information to guide thinking and actions in social and cultural practices ³⁵35. Rural Health Infomantion, Department of Health and Human Services. School-based programming for suicide prevention. https://www.ruralhealthinfo.org/toolkits/suicide/2/schools/programming (accessed on 12/Aug/2022).
https://www.ruralhealthinfo.org/toolkits... ^,4848. Scavacini K, Cacciacarro MF, Motoyama ÉP, Cescon LF. Autolesão: guia prático de ajuda. São Paulo: Instituto Vita Alere de Prevenção e Posvenção do Suicídio; 2021.^,5454. Almeida VAS, Almeida GAS. A escola como um ambiente fundamental na prevenção do suicídio entre jovens: uma investigação de possíveis estratégias. In: CONEDU - VI Congresso Nacional de Educação. https://editorarealize.com.br/edicao/detalhes/anais-vi-conedu (accessed on 05/Aug/2022).
https://editorarealize.com.br/edicao/det... ^,8585. Cano Quevedo JK. Programa "Fortaleciendo mi salud emocional" para reducir las conductas autolesivas en estudiantes de un distrito de Lima Norte, 2021 [Doctoral Dissertation]. Trujillo: Universidad César Vallejo; 2021.^,9999. World Health Organization; United Nations Children's Fund. Helping adolescents thrive toolkit: strategies to promote and protect adolescent mental health and reduce self-harm and other risk behaviours. Geneva: World Health Organization; 2021.. Schools are strategic for the development of universal prevention actions, i.e. those for all audiences aiming to help them acquire skills of acceptance and emotional tolerance, promoting a school environment of emotional validation ³⁵35. Rural Health Infomantion, Department of Health and Human Services. School-based programming for suicide prevention. https://www.ruralhealthinfo.org/toolkits/suicide/2/schools/programming (accessed on 12/Aug/2022).
https://www.ruralhealthinfo.org/toolkits... ^,4646. Fuller AM, Haboush-Deloye A, Goldberg P, Grob K. Strategies & Tools to Embrace Prevention with Upstream Programs (STEP UP): a comprehensive evaluation report. Las Vegas: School of Community Health Sciences, University of Nevada; 2015.^,5757. Bezerra JMM. PREVIDAS: prevenção, vida e saúde. Prevenção de suicídio em adolescentes rurais do Colégio Estadual Reis Magalhães-Glória/Bahia [Doctoral Dissertation]. Juazeiro: Universidade Federal do Vale do São Francisco; 2019.^,7676. Xavier AMJ. Experiências emocionais precoces e (des)regulação emocional: implicações para os comportamentos autolesivos na adolescência [Doctoral Dissertation]. Coimbra: Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra; 2017.^,8787. Vollandt L. Social-emotional learning and suicide prevention in schools. https://www.goguardian.com/blog/social-emotional-learning-and-suicide-prevention (accessed on 12/Aug/2022).
https://www.goguardian.com/blog/social-e... ^,9999. World Health Organization; United Nations Children's Fund. Helping adolescents thrive toolkit: strategies to promote and protect adolescent mental health and reduce self-harm and other risk behaviours. Geneva: World Health Organization; 2021.. Selective prevention programs are also indicated for those who already show warning signs of suicidal or self-harm behavior ³⁵35. Rural Health Infomantion, Department of Health and Human Services. School-based programming for suicide prevention. https://www.ruralhealthinfo.org/toolkits/suicide/2/schools/programming (accessed on 12/Aug/2022).
https://www.ruralhealthinfo.org/toolkits... ^,101101. Bloomer E. Self-harm needs assessment for children & young people. Hove: Brighton & Hove City Council; 2018.^,115115. Appelhoff R. School-based programmes to prevent suicide and build resilience among students: a literature review and national stocktake. https://www.cph.co.nz/wp-content/uploads/schoolbasedprogrammespreventsuicide.pdf (accessed on 24/Nov/2022).
https://www.cph.co.nz/wp-content/uploads... , helping adolescents deal with the negative emotional states resulting from interpersonal difficulties and avoid their negative impact on mental health ⁴⁶46. Fuller AM, Haboush-Deloye A, Goldberg P, Grob K. Strategies & Tools to Embrace Prevention with Upstream Programs (STEP UP): a comprehensive evaluation report. Las Vegas: School of Community Health Sciences, University of Nevada; 2015.^,7676. Xavier AMJ. Experiências emocionais precoces e (des)regulação emocional: implicações para os comportamentos autolesivos na adolescência [Doctoral Dissertation]. Coimbra: Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra; 2017.^,8787. Vollandt L. Social-emotional learning and suicide prevention in schools. https://www.goguardian.com/blog/social-emotional-learning-and-suicide-prevention (accessed on 12/Aug/2022).
https://www.goguardian.com/blog/social-e... ^,9999. World Health Organization; United Nations Children's Fund. Helping adolescents thrive toolkit: strategies to promote and protect adolescent mental health and reduce self-harm and other risk behaviours. Geneva: World Health Organization; 2021.^,106106. World Health Organization. Guidelines on mental health promotive and preventive interventions for adolescents: helping adolescents thrive (HAT). Geneva: World Health Organization; 2020..

Actions for parents and teachers are essential for the development of their own socioemotional skills and those of adolescents ⁷7. Fundo das Nações Unidas para a Infância. Cenário da exclusão escolar no Brasil: um alerta sobre os impactos da pandemia do COVID-19 na educação. https://www.unicef.org/brazil/relatorios/cenario-da-exclusao-escolar-no-brasil (accessed on 06/Dec/2022).
https://www.unicef.org/brazil/relatorios... ^,9292. World Health Organization. Live life: preventing suicide. Geneva: World Health Organization; 2018.. In the perspective of psychoeducation, the studies report that parents and teachers must be informed about the negative effects of interpersonal relationships that involve threat, criticism, subordination, and depreciation.

The studies emphasize the positive effects of the school environment, the importance of developing listening spaces and encouraging mechanisms for students to develop socioemotional skills ⁵¹51. Sucena LG. Conecta Educação alerta para importância de discutir prevenção ao suicídio. https://feac.org.br/conecta-educacao-alerta-para-importancia-de-discutir-prevencao-ao-suicidio/ (accessed on 26/Jul/2022).
https://feac.org.br/conecta-educacao-ale... ^,5353. SOMOS Educação. Setembro Amarelo nas escolas: como abordar temas de saúde mental? https://blog.elevaplataforma.com.br/setembro-amarelo-nas-escolas/ (accessed on 05/Aug/2022).
https://blog.elevaplataforma.com.br/sete... . In general, the interventions at school are based on a standard curriculum and adapted to the school and sociocultural reality. Longer curricula (not necessarily in hours, but over time) seem to be more manageable, as those that train school staff and teachers. Actions in the school environment reduce violence, improve learning, increase the time of adolescents at school, facilitate peer relationships, and reduce suffering - important elements for well-being and, consequently, for the prevention of suicidal behavior.

Among the actions highlighted in the school context is training the education team to act as guardians, creating a supportive school environment, recognizing risk factors and warning signs of suicidal behavior, supporting distressed students, and enabling collaborative actions to obtain additional support for those in distress ⁹²92. World Health Organization. Live life: preventing suicide. Geneva: World Health Organization; 2018.^,115115. Appelhoff R. School-based programmes to prevent suicide and build resilience among students: a literature review and national stocktake. https://www.cph.co.nz/wp-content/uploads/schoolbasedprogrammespreventsuicide.pdf (accessed on 24/Nov/2022).
https://www.cph.co.nz/wp-content/uploads... . In addition, they have a focus on promoting staff mental health (training and access to support) ²2. Purebl G, Petrea I, Shields L, Tóth MD, Székely A, Kurimay T, et al. Joint action on mental health and well-being: depression, suicide prevention and e-health. Situation analysis and recommendations for action. https://health.ec.europa.eu/system/files/2017-07/2017_depression_suicide_ehealth_en_0.pdf (accessed on 28/Nov/2022).
https://health.ec.europa.eu/system/files... ^,5252. Senac Goiás. Educação emocional auxilia na prevenção ao suicídio entre jovens. https://v1.go.senac.br/faculdade/site/noticia/6092-educacao-emocional-auxilia-na-prevencao-ao-suicidio-entre-jovens (accessed on 05/Aug/2022).
https://v1.go.senac.br/faculdade/site/no... ^,9292. World Health Organization. Live life: preventing suicide. Geneva: World Health Organization; 2018. and training on the healthy use of the internet and social media ⁵¹51. Sucena LG. Conecta Educação alerta para importância de discutir prevenção ao suicídio. https://feac.org.br/conecta-educacao-alerta-para-importancia-de-discutir-prevencao-ao-suicidio/ (accessed on 26/Jul/2022).
https://feac.org.br/conecta-educacao-ale... . They also encourage a safe school environment, with anti-bullying programs and initiatives to strengthen social connections ⁹²92. World Health Organization. Live life: preventing suicide. Geneva: World Health Organization; 2018.^,9393. Stern R, Divecha D. Emotional intelligence education has a role in suicide prevention. https://medium.com/thrive-global/how-emotional-intelligence-plays-a-role-in-suicide-prevention-8e81fb0ce204 (accessed on 25/Jul/2022).
https://medium.com/thrive-global/how-emo... ^,112112. Rodríguez AMG. Situaciones detonantes del comportamiento e ideación suicida en adolescentes víctimas de acoso escolar [Undergraduate Thesis]. Bogotá: Facultad de Ciencias Sociales y Humanas, Universidad Cooperativa de Colombia; 2021.. Other important actions include creating, strengthening, and advertising contacts with external support services and providing clear policy and protocols for staff when a risk of suicide is identified. In addition, it is essential to support the return to school for a student after a suicide attempt ⁹²92. World Health Organization. Live life: preventing suicide. Geneva: World Health Organization; 2018.^,9696. Consejo Nacional de Políticas Públicas para la Juventud. Protocolo de atención en el tema del suicidio por parte del Consejo de Persona Joven (CPJ). https://cpj.go.cr/ (accessed on 05/Aug/2022).
https://cpj.go.cr/... . Parents should be engaged in this process to raise awareness of mental health ⁵⁷57. Bezerra JMM. PREVIDAS: prevenção, vida e saúde. Prevenção de suicídio em adolescentes rurais do Colégio Estadual Reis Magalhães-Glória/Bahia [Doctoral Dissertation]. Juazeiro: Universidade Federal do Vale do São Francisco; 2019.^,8282. Acuña de la Cruz YY, Gamarra Zelada AG. Inteligencia emocional e ideación suicida en estudiantes de educación secundaria de un colegio estatal de Cajamarca, 2019 [Undergraduate Thesis]. Cajamarca: Universidad Privada Antonio Guillermo Urrelo; 2020.. The importance of early discussion about suicidal behavior and stress management is highlighted, encouraging emotion regulation and anti-stigma actions ⁸⁸88. Santos JCP, Erse MPQA, Façanha JDN, Marques LAFA, Simões RMP. Mais Contigo: promoção de saúde mental e prevenção de comportamentos suicidários na comunidade educativa. Coimbra: Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola Superior de Enfermagem de Coimbra; 2014. (Série Monográfica : Educação e Investigação em Saúde).. Earlier prevention and intervention tend to produce better outcomes. Another recommendation is to create spaces where children, adolescents, and parents/guardians can find help, advice, information, and online tools ⁷⁴74. Alvino Advíncula IR, Huaytalla Pariona AM. Inteligencia emocional en estudiantes que se autolesionan, del nivel secundario en la I.E.P. Gelicich del distrito de El Tambo-2015 [Undergraduate Thesis]. Huancayo: Universidad Continental; 2017..

Implementation of actions in health services

Strategies in health seem to result from actions in education, highlighting the role of intersectorality, showing a scenario in which those who “did not work out as a result of school actions” come to a health service already in a serious situation; i.e. preventive actions in health would be selective or recommended, while school actions would be basically universal. It is important to bring the health system into basic education. In terms of implementation in the Brazilian Unified National Health System (SUS, acronym in Portuguese), care strategies must not lose sight of the principles of health promotion and primary health care ³3. Stone D, Holland K, Bartholow B, Crosby A, Davis S, Wilkins N. Preventing suicide: a technical package of policies, programs, and practices. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2017.^,9898. Black Dog Institute. An evidence-based systems approach to suicide prevention: guidance on planning, commissioning and monitoring. Sydney: Black Dog Institute/Australian Government Department of Health; 2016.^,9999. World Health Organization; United Nations Children's Fund. Helping adolescents thrive toolkit: strategies to promote and protect adolescent mental health and reduce self-harm and other risk behaviours. Geneva: World Health Organization; 2021.^,102102. Ministerio de Salud de la Nación; Sociedad Argentina de Pediatría; Fondo de las Naciones Unidas para la Infancia. Abordaje integral del suicidio en las adolescencias: lineamientos para equipos de salud. Buenos Aires: Ministerio de Salud de la Nación/Sociedad Argentina de Pediatría/Fondo de las Naciones Unidas para la Infancia; 2021., while identifying warning signs so that young people can have alternative coping actions available to them in mental health programs and support groups. These initiatives can involve schools, which could provide training to guardians, peers, and adults on how to recognize warning signs of suicide. They can also develop a school culture of psychological well-being and screening to identify those who may be at risk ⁶⁷67. Velis Giménez MC. Programa de intervención integral de las autolesiones no suicidas en una comunidad educativa desde la terapia dialéctica comportamental [Undergraduate Thesis]. Valencia: Universidad Católica de Valencia San Vicente Mártir; 2020.^,8181. Galarreta Mostacero ADL. Programa de habilidades sociales para la prevención del cutting en estudiantes de secundaria de una institución-Moche [Masters Thesis]. Trujillo: Escuela de Posgrado, Universidad César Vallejo; 2019.^,8585. Cano Quevedo JK. Programa "Fortaleciendo mi salud emocional" para reducir las conductas autolesivas en estudiantes de un distrito de Lima Norte, 2021 [Doctoral Dissertation]. Trujillo: Universidad César Vallejo; 2021.^,101101. Bloomer E. Self-harm needs assessment for children & young people. Hove: Brighton & Hove City Council; 2018..

The main strategies for primary health care are: (i) promotion of health in the community, ensuring the right to comprehensive health from universal access to services that promote equity and effective coverage; (ii) guarantee of comprehensive, integrated, appropriate, quality care that is sustained over time; (iii) development of mechanisms for intersectoral articulation and participation of all community actors in the planning and development of interventions; and (iv) creation of participatory planning and implementation methodologies aiming to identify prevalent problems in the territory, map actors and resources, address emergency conditions, detect and enhance the protective factors of individuals in their singularity and of communities, and evaluate processes and results ⁴⁹49. Sociedade Brasileira de Neuropsicologia. Suicídio: compreender, identificar e intervir. https://sbnpbrasil.com.br/categoria_download/cartilhas/ (accessed on 25/Jul/2022).
https://sbnpbrasil.com.br/categoria_down... ^,5151. Sucena LG. Conecta Educação alerta para importância de discutir prevenção ao suicídio. https://feac.org.br/conecta-educacao-alerta-para-importancia-de-discutir-prevencao-ao-suicidio/ (accessed on 26/Jul/2022).
https://feac.org.br/conecta-educacao-ale... ^,102102. Ministerio de Salud de la Nación; Sociedad Argentina de Pediatría; Fondo de las Naciones Unidas para la Infancia. Abordaje integral del suicidio en las adolescencias: lineamientos para equipos de salud. Buenos Aires: Ministerio de Salud de la Nación/Sociedad Argentina de Pediatría/Fondo de las Naciones Unidas para la Infancia; 2021..

The studies also discuss the need for a cross-sectional approach at all levels of the health system. It seems essential to have a strategic positioning of teams at the first level of care, implementing a role of mediation and coordination that effectively transforms the pyramid of care into a network, where relationships between the health team and other services and institutions are based on cooperative actions ⁵⁴54. Almeida VAS, Almeida GAS. A escola como um ambiente fundamental na prevenção do suicídio entre jovens: uma investigação de possíveis estratégias. In: CONEDU - VI Congresso Nacional de Educação. https://editorarealize.com.br/edicao/detalhes/anais-vi-conedu (accessed on 05/Aug/2022).
https://editorarealize.com.br/edicao/det... ^,7777. Ganaprakasam C. Emotional intelligence on suicidal ideation and mental health. Muallim Journal of Social Sciences and Humanities 2018; 2:185-95.^,9696. Consejo Nacional de Políticas Públicas para la Juventud. Protocolo de atención en el tema del suicidio por parte del Consejo de Persona Joven (CPJ). https://cpj.go.cr/ (accessed on 05/Aug/2022).
https://cpj.go.cr/... ^,102102. Ministerio de Salud de la Nación; Sociedad Argentina de Pediatría; Fondo de las Naciones Unidas para la Infancia. Abordaje integral del suicidio en las adolescencias: lineamientos para equipos de salud. Buenos Aires: Ministerio de Salud de la Nación/Sociedad Argentina de Pediatría/Fondo de las Naciones Unidas para la Infancia; 2021.. It is crucial to prioritize and implement intra- and inter-institutional interventions according to the reality of each territory and the personal and community stories, which must be settled in order to restore and strengthen the social bond ⁵⁴54. Almeida VAS, Almeida GAS. A escola como um ambiente fundamental na prevenção do suicídio entre jovens: uma investigação de possíveis estratégias. In: CONEDU - VI Congresso Nacional de Educação. https://editorarealize.com.br/edicao/detalhes/anais-vi-conedu (accessed on 05/Aug/2022).
https://editorarealize.com.br/edicao/det... ^,102102. Ministerio de Salud de la Nación; Sociedad Argentina de Pediatría; Fondo de las Naciones Unidas para la Infancia. Abordaje integral del suicidio en las adolescencias: lineamientos para equipos de salud. Buenos Aires: Ministerio de Salud de la Nación/Sociedad Argentina de Pediatría/Fondo de las Naciones Unidas para la Infancia; 2021.^,118118. Colorado YS. El suicidio en la adolescencia: una aproximación desde el apego y la regulación emocional. In: Marenco Escuderos AD, editor. Estudios del desarrollo humano y socioambiental. Barranquilla: Corporación Universitaria Reformada; 2018. p. 178-207..

Governmental and nongovernmental actions and the role of the media

Governmental actions are crucial for the prevention of suicidal/self-harm behavior because of the potential to create and implement regulations at municipal, state, and federal levels, such as restriction to lethal means. In addition, interventions with the participation of society as a whole and institutions for children and adolescents are relevant, including workshops; forums; round tables with teachers, parents/guardians, and children/adolescents; articulation of governmental bodies from municipal, state, and federal levels with schools, youth organizations, clubs, recreational centers, nongovernmental organizations (NGOs), etc.; studies to analyze strategic themes at the local level; identification and training of adolescent tutors/leaders in their communities; promotion of processes of knowledge transfer and peer learning; dissemination of cultural, recreational, and educational resources for children and adolescents; implementation of mental health advisory services in schools; and prevention and awareness campaigns in the media and public spaces ⁷⁷77. Ganaprakasam C. Emotional intelligence on suicidal ideation and mental health. Muallim Journal of Social Sciences and Humanities 2018; 2:185-95.^,102102. Ministerio de Salud de la Nación; Sociedad Argentina de Pediatría; Fondo de las Naciones Unidas para la Infancia. Abordaje integral del suicidio en las adolescencias: lineamientos para equipos de salud. Buenos Aires: Ministerio de Salud de la Nación/Sociedad Argentina de Pediatría/Fondo de las Naciones Unidas para la Infancia; 2021.^,104104. Senado de Colombia. Por medio de la cual se crea y se implementa la cátedra de educación emocional en todas las instituciones educativas de Colombia en los niveles de preescolar, básica y media y se adoptan otras disposiciones. Projecto de Ley nº 348/2021. Bogotá: Senado de Colombia; 2021.^,116116. Cruz Cob AL, Balam Gómez M, Gómez López LY, Pool Góngora RA. PLACE para la prevención y detección del riesgo de suicidio en adolescentes y adultos jóvenes. CuidArte 2017; 6:34-43..

Media were highlighted in a significant number of studies as a partner in the educational prevention process. They are also indicated as a strategic place in the debate and promotion of actions related to communication rules in the media about suicidal events ²2. Purebl G, Petrea I, Shields L, Tóth MD, Székely A, Kurimay T, et al. Joint action on mental health and well-being: depression, suicide prevention and e-health. Situation analysis and recommendations for action. https://health.ec.europa.eu/system/files/2017-07/2017_depression_suicide_ehealth_en_0.pdf (accessed on 28/Nov/2022).
https://health.ec.europa.eu/system/files... ^,7777. Ganaprakasam C. Emotional intelligence on suicidal ideation and mental health. Muallim Journal of Social Sciences and Humanities 2018; 2:185-95.^,9595. National Suicide Prevention Taskforce. Interim Advice Report: towards a national whole-of-government approach to suicide prevention. Canberra: National Suicide Prevention Taskforce; 2020.. Emphasis is placed on media role in raising awareness and reducing the stigma of suicide, in the sense of restricting information about the means and environments/places that favor the act of suicide, without giving visibility to methods of suicide or self-harm. It is suggested that media can help by disseminating information about where to seek help and can help develop guidelines for responsible coverage of suicide, training professionals in reporting cases. Developing policies to monitor content on digital media platforms, creating web pages designed to help young people manage or reduce suicidal ideation or self-harm, and promoting social interaction by enabling peer support are other actions cited in the literature ²2. Purebl G, Petrea I, Shields L, Tóth MD, Székely A, Kurimay T, et al. Joint action on mental health and well-being: depression, suicide prevention and e-health. Situation analysis and recommendations for action. https://health.ec.europa.eu/system/files/2017-07/2017_depression_suicide_ehealth_en_0.pdf (accessed on 28/Nov/2022).
https://health.ec.europa.eu/system/files... ^,33. Stone D, Holland K, Bartholow B, Crosby A, Davis S, Wilkins N. Preventing suicide: a technical package of policies, programs, and practices. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2017.^,5151. Sucena LG. Conecta Educação alerta para importância de discutir prevenção ao suicídio. https://feac.org.br/conecta-educacao-alerta-para-importancia-de-discutir-prevencao-ao-suicidio/ (accessed on 26/Jul/2022).
https://feac.org.br/conecta-educacao-ale... ^,9393. Stern R, Divecha D. Emotional intelligence education has a role in suicide prevention. https://medium.com/thrive-global/how-emotional-intelligence-plays-a-role-in-suicide-prevention-8e81fb0ce204 (accessed on 25/Jul/2022).
https://medium.com/thrive-global/how-emo... ^,9999. World Health Organization; United Nations Children's Fund. Helping adolescents thrive toolkit: strategies to promote and protect adolescent mental health and reduce self-harm and other risk behaviours. Geneva: World Health Organization; 2021.^,102102. Ministerio de Salud de la Nación; Sociedad Argentina de Pediatría; Fondo de las Naciones Unidas para la Infancia. Abordaje integral del suicidio en las adolescencias: lineamientos para equipos de salud. Buenos Aires: Ministerio de Salud de la Nación/Sociedad Argentina de Pediatría/Fondo de las Naciones Unidas para la Infancia; 2021.^,119119. Tóth MD, Purebl G, Àdám S, Birkás E. Risk factors for multiple suicide attempts among Roma in Hungary. Transcult Psychuatry 2020; 55:55-72..

Discussion

In Brazil and around the world, little is known about what can be done to prevent suicidal behavior and self-harm. Although different strategies have been described, few of them have been clearly tested and validated. Health services, schools, and social protection services face many challenges and impasses when handling children and adolescents who deliberately hurt themselves, and think about or try to kill themselves. Our scoping review shows that: (i most existing initiatives are international; (ii) most knowledge produced is focused on suicide, few exclusively address self-harm, and others address both, with little emphasis on their differences; (iii) schools are key actors in developing preventive actions, and health has to expand its actions and act in a collaborative network; and (iv) the main themes developed in prevention actions around the world focus on early identification of suicidal behavior/self-harm, promotion of socioemotional life, restricted access to means, media support, and a focus on mental health.

This scoping review reveals that actions focused on socioemotional skills are strategic, as they support the process of expression and production of emotions, acting on the meaning of the situation and modulating the emotional response. They involve physiological, cognitive, behavioral, and experiential components with varied intensity and subjective evaluation by the individual, and can usually be triggered by interpersonal situations and events that deserve attention because they affect well-being ¹²⁰120. Senado da República. Projecto de Ley nº 348 de 2021. http://svrpubindc.imprenta.gov.co/senado/ (accessed on 28/Nov/2022).
http://svrpubindc.imprenta.gov.co/senado... . This way, adolescents change the way they expose themselves to certain situations, with the ability to better assess a problem, reducing tension and presenting a more flexible cognitive and emotional response to events ⁴²42. Gallagher ML, Miller AB. Suicidal thoughts and behavior in children and adolescents: an ecological model of resilience. Adolesc Res Rev 2018; 3:123-54.^,118118. Colorado YS. El suicidio en la adolescencia: una aproximación desde el apego y la regulación emocional. In: Marenco Escuderos AD, editor. Estudios del desarrollo humano y socioambiental. Barranquilla: Corporación Universitaria Reformada; 2018. p. 178-207.^,120120. Senado da República. Projecto de Ley nº 348 de 2021. http://svrpubindc.imprenta.gov.co/senado/ (accessed on 28/Nov/2022).
http://svrpubindc.imprenta.gov.co/senado... .

Also important are the prevention actions based on socioemotional skills with a focus on parents and teachers ⁷7. Fundo das Nações Unidas para a Infância. Cenário da exclusão escolar no Brasil: um alerta sobre os impactos da pandemia do COVID-19 na educação. https://www.unicef.org/brazil/relatorios/cenario-da-exclusao-escolar-no-brasil (accessed on 06/Dec/2022).
https://www.unicef.org/brazil/relatorios... ^,9292. World Health Organization. Live life: preventing suicide. Geneva: World Health Organization; 2018.. In addition, intersectoral collaboration with governmental and nongovernmental actors is essential for early care, monitoring, and evaluation of cases ²2. Purebl G, Petrea I, Shields L, Tóth MD, Székely A, Kurimay T, et al. Joint action on mental health and well-being: depression, suicide prevention and e-health. Situation analysis and recommendations for action. https://health.ec.europa.eu/system/files/2017-07/2017_depression_suicide_ehealth_en_0.pdf (accessed on 28/Nov/2022).
https://health.ec.europa.eu/system/files... ^,33. Stone D, Holland K, Bartholow B, Crosby A, Davis S, Wilkins N. Preventing suicide: a technical package of policies, programs, and practices. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2017.. The fields of health, education, and social care should act together, since they are strategic in the daily care of children and adolescents with early or already established signs of suicidal behavior/self-harm. Significant actions have been proposed in a debate seeking to create protective environments by reducing access to lethal means. In Brazil, the National Policy for the Prevention of Self-Harm and Suicide, through Law n. 13,819/2019¹²¹121. Brasil. Lei nº 13.819, de 26 de abril de 2019. Institui a Política Nacional de Prevenção da Automutilação e do Suicídio, a ser implementada pela União, em cooperação com os Estados, o Distrito Federal e os Municípios; e altera a Lei nº 9.656, de 3 de junho de 1998. Diário Oficial da União 2019; 29 apr., represents an important legal framework and emphasizes the need for prevention strategies, but does not guarantee advances in mental health care.

In general, prevention programs provide tips and show how to deal with situations. Few of them detail the implementation of their actions and often fail to present results and evaluation criteria. Therefore, it is strongly recommended that actions and results should be documented. Another weakness concerns the debate and primary findings on specific prevention actions for vulnerable groups, such as the LGBTQIA+ population, unemployed people, migrants, people deprived of liberty or with black skin, which are aspects with timid discussion in the studies.

One of the strengths of this review is the breadth of the bibliographic search, which included literature from strategic sources, ensuring a new character to this review as well as an emphasis on prevention based on socioemotional aspects.

Finally, in many parts of the world, and especially in Brazil, there are still no clear guidelines for the prevention of suicidal and self-harm behavior. The government has to assume a leading role in guiding the care and protection of children, adolescents, and their family members who are suffering. Brazil has not yet made progress in creating national and local prevention plans, with different guidelines for each of these behaviors and the adoption of a practical and effective approach, emphasizing the role of the SUS, mental health care, and intersectoral coordination for the promotion of health and quality of life and prevention of suffering and mental disorders.

Acknowledgments

To the Brazilian National Research Council (process n. 401882/2021-7).

References

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