Interventions to Prevent Suicidal Behavior

Abstract

There is now a substantial literature on risk factors for suicide in the United States (U.S. Dept of Health and Human Services, PHS, 2001; Committee on Pathophysiology & Prevention of Adolescent & Adult Suicide Board, 2002) that can be used to guide the development of prevention programs to reduce the rates of suicide in this country. There is a wealth of evidence that having a mental disorder increases the risk for both attempted suicide and suicide. However, in and of itself a mental disorder should not be equated with elevated suicide risk because the majority of individuals with a mental illness never kill themselves (Bostwick & Pankratz, 2000). Suicide is the outcome of extremely complex circumstances, and it is likely we will never be able to predict its occurrence given the putative interaction between psychiatric, psychological, physiological, social, and cultural factors. For example, there is considerable evidence that aggression and impulsivity, acute and chronic stress, trauma, and substance or alcohol use are associated with suicidality, but their effects are moderated by gender and age. Because of the inability to predict who will kill themselves, suicide is a public health problem of considerable magnitude. In the United States in 2002 there were 31,655 deaths from suicide, making suicide the overall 11th leading cause of death (Kochanek & Smith, 2004). Suicide is now the 3rd leading cause of death for individuals aged 10–24 years (Kochanek & Smith, 2004). Since the 1950s, the rate of youth suicide has tripled, and there was an alarming gradual upswing in suicide among young African American males in the United States between l980 and 1995 (Shaffer, Gould, & Hicks, 1994). Substantially higher rates of suicide in elders in the United States have been observed consistently for some time (Pearson & Brown, 2000).