suicidal. Despite years of research, we cannot predict who will commit suicide. African-American women, for example, have many risk factors including discrimination, poverty, exposure to violence, etc., but also have one of the lowest suicide rates. Why do some people with such adversity not commit suicide while others do? An understanding of this seemingly paradoxical relationship through biopsychosocial research is critical to the advancement of suicidology. Suicide can only be understood by integrating approaches that have historically remained distinct.

FINDINGS

  • Culture strongly influences how individuals view suicide. Cultural values and social structures largely determine the type and degree of both stressors and support, availability of means and access to treatment, and social prescriptions or proscriptions concerning suicidal behavior.

  • Across cultures, family cohesion and support acts as a buffer against suicidality; parenthood protects against suicide, particularly for women. Divorced and never-married status generally increases suicide risk, especially among men. Social support and various types of religious involvement and beliefs are protective against suicide.

  • Unemployment and low socioeconomic status generally increase suicide risk. Societal-wide economic and social changes also influence the incidence of suicide. Social change can create economic hardship, increase family discord, result in migration or separation of families and friends, increase use of alcohol, etc. Investigation into the complex interaction of the macro-social and individual variables is valuable. Yet there are few studies that integrate the events at an individual level with events at an aggregate level.

The field requires additional research on the interactions of individual and aggregate level variables. Since biological, psychosocial, and sociological factors all amplify or buffer the risk of suicide, future research needs to incorporate interdisciplinary, multi-level approaches. Studies on the interactions of genetics and psychosocial, socio-political, and socioeconomic context, for example, are necessary.

Use of data from developing societies that comprise more than 80 percent of the world’s population and look somewhat different than United States data may provide a more representative picture for poor and middle income countries. Contrasts among international



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