Every year, about 30,000 people die by suicide in the U.S., and some 650,000 receive emergency treatment after a suicide attempt. Often, those most at risk are the least able to access professional help.

Reducing Suicide provides a blueprint for addressing this tragic and costly problem: how we can build an appropriate infrastructure, conduct needed research, and improve our ability to recognize suicide risk and effectively intervene. Rich in data, the book also strikes an intensely personal chord, featuring compelling quotes about people’s experience with suicide. The book explores the factors that raise a person’s risk of suicide: psychological and biological factors including substance abuse, the link between childhood trauma and later suicide, and the impact of family life, economic status, religion, and other social and cultural conditions. The authors review the effectiveness of existing interventions, including mental health practitioners’ ability to assess suicide risk among patients. They present lessons learned from the Air Force suicide prevention program and other prevention initiatives. And they identify barriers to effective research and treatment.

This new volume will be of special interest to policy makers, administrators, researchers, practitioners, and journalists working in the field of mental health.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON PATHOPHYSIOLOGY AND PREVENTION OF ADOLESCENT AND ADULT SUICIDE
• BOARD ON NEUROSCIENCE AND BEHAVIORAL HEALTH
• Reviewers
• Preface
• Executive Summary
• 1. Introduction
  • PERSONAL SUFFERING
  • THE FEDERAL RESPONSE
  • STATEMENT OF TASK
  • SUICIDE THROUGH HISTORY
  • SUICIDE AS AN INTERDISCIPLINARY EFFORT
  • DEFINITIONS
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Magnitude of the Problem
  • GEOGRAPHIC TRENDS
  • POPULATIONS AT RISK
  • LIMITATIONS OF DATA
  • COST TO SOCIETY
  • FINDINGS
  • REFERENCES
• 3. Psychiatric and Psychological Factors
  • PSYCHIATRIC/SUBSTANCE USE DISORDERS AND SUICIDE RISK
  • PSYCHOLOGICAL DIMENSIONS OF SUICIDE RISK
  • FINDINGS
  • REFERENCES
• 4. Biological Factors
  • THE PHYSIOLOGICAL STRESS SYSTEM
  • NEUROCHEMISTRY
  • GENETIC FACTORS
  • FINDINGS
  • REFERENCES
• 5. Childhood Trauma
  • SCOPE AND DEFINITIONS
  • CHILDHOOD TRAUMA AS A RISK FACTOR FOR SUICIDALITY
  • CHILDHOOD SEXUAL ABUSE AND POPULATION ATTRIBUTABLE RISK FOR SUICIDE
  • MODIFYING FACTORS
  • BIOPSYCHOSOCIAL EFFECTS OF CHILDHOOD TRAUMA
  • CHILDHOOD TRAUMA AS A RISK FACTOR FOR PSYCHOPATHOLOGY
  • PATHWAYS TO SUICIDALITY
  • PREVENTION/INTERVENTION
  • FINDINGS
  • REFERENCES
• 6. Society and Culture
  • FRAMEWORK: A SOCIAL SAFETY NET
  • SOCIETY AND CULTURE IN SUICIDE
  • CHALLENGES
  • FINDINGS
  • REFERENCES
• 7. Medical and Psychotherapeutic Interventions
  • ASSESSMENT
  • PSYCHOACTIVE MEDICATIONS
  • ELECTROCONVULSIVE THERAPY
  • PSYCHOTHERAPIES
  • INPATIENT AND FOLLOW-UP CARE FOR SUICIDALITY
  • CULTURAL CONSIDERATIONS AND FAITH-BASED INTERVENTIONS
  • FINDINGS
  • REFERENCES
• 8. Programs for Suicide Prevention
  • FRAMEWORK FOR PREVENTION
  • UNIVERSAL PREVENTIONS
  • SELECTIVE PREVENTION
  • INDICATED PREVENTION
  • INTEGRATED APPROACHES TO PREVENTION
  • ASSESSING THE EFFECTIVENESS OF PREVENTION APPROACHES
  • FINDINGS
  • REFERENCES
• 9. Barriers to Effective Treatment and Intervention
  • GENERAL BARRIERS TO TREATMENT
  • CLINICIAN BARRIERS TO TREATMENT
  • PATIENT BARRIERS TO TREATMENT
  • BARRIERS TO TREATMENT FOR HIGH-RISK GROUPS
  • GLOBAL BARRIERS
  • FINDINGS
  • REFERENCES
• 10. Barriers to Research and Promising Approaches
  • METHODOLOGY
  • SURVEILLANCE OF SUICIDE AND SUICIDE ATTEMPTS
  • ETHICS AND SAFETY
  • RESEARCH DESIGN AND ANALYSIS ISSUES
  • CENTERS
  • FINDINGS
  • REFERENCES
• 11. Findings and Recommendations
  • ENHANCING THE INFRASTRUCTURE
  • ENHANCING THE DATABASE ON SUICIDE
  • ENHANCING IDENTIFICATION OF THOSE AT RISK FOR SUICIDE
  • ENHANCING PREVENTION AND INTERVENTIONS
• Appendixes
  • A Statistical Details
  • B Consultants
  • C Workshop Agendas

Support for this project was provided by the Centers for Disease Control and Prevention, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, the Substance Abuse and Mental Health Services Administration, and the Veterans Administration. The views presented in this report are those of the Institute of Medicine Committee on Pathophysiology and Prevention of Adolescent and Adult Suicide and are not necessarily those of the funding agencies.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.