tion of the vulnerability of specific populations (e.g., American Indians) and age groups (e.g., adolescents and aged).

  • An evaluation of the current status of primary and secondary prevention including risk, protective factors, and issues of contagion. Access to methods of suicide and the availability of emergency interventions will be considered. The committee will consider strategies for prevention of suicide, including an examination of the efficacy of national and international intervention and prevention efforts.

  • Strategies for studying suicide. This effort will consider the ethics of incorporating suicidal patients into drug trials, the current classifications of suicide and suicidal behavior, behavioral measures to evaluate suicide risk and outcomes, and statistical methods.

  • Conclusions concerning gaps in knowledge, research opportunities, and strategies for prevention of suicide.

The committee decided that it would focus on suicide and suicide attempts that were self-inflicted with an intent to die. Although important subjects in their own right, three types of self-destructive behavior were beyond the scope of this report. They are:

  • Self-destructive behaviors with high immediate or long-term physical risk and that may be motivated by a wish to die (Poussaint and Alexander, 2000)

  • Assisted suicide

  • Suicides in the face of terminal illness and/or suffering.

It should also be noted that this study is not intended as an all-inclusive review of the field. For such a review, we refer readers to a number of recent excellent books (e.g., Hawton and van Heeringen, 2000; Jacobs, 1999; Lester, 2001; Wasserman, 2001). Rather, this report aims to identify the next steps necessary to significantly reduce suicide, and within this task, discuss the most relevant information.

SUICIDE THROUGH HISTORY

Suicide is not a new phenomenon. Strikingly, accounts of suicide across the last millennium catalog the same factors associated with suicide as those revealed by modern scientific study in western cultures: serious mental illness, alcohol and substance abuse, co-morbidity, childhood abuse, loss of a loved one, fear of humiliation, and economic dislocation and insecurity. In Box 1.1, accounts of suicides in Europe across several centuries are presented.



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