Childhood trauma has emerged as a strong risk factor for suicidal behavior in adolescents and adults. The official rate of child victimization in 1999 was about 12 per 1000 and but the rates are even higher in surveys of children and parents. Independent of psychopathology and other known risk factors, child sexual abuse has been reported in 9–20 percent of suicide attempts in adults.

Social support is a protective factor. Those who enjoy close relationships cope better with various stresses, including bereavement, job loss, and illness, and enjoy better psychological and physical health. Divorced, separated and widowed persons are more likely to die by suicide. Being a parent, particularly for mothers, appears to decrease the risk of suicide. Discord within the family is correlated with increased suicide, while parental and family connectedness has a protective effect, especially among youth. Participation in religious activities is a protective factor for suicide, perhaps in part because of the social support it affords, but belief structures and spiritualism may also be important factors. Furthermore, epidemiological analyses reveal that occupation, employment status, and socioeconomic status affect the risk of suicide. These factors are not specific to the United States or even to the Western world, but global.

At both the individual and collective levels, the suicide rate has long been understood to correlate with cultural, social, political, and economic forces. Political coercion or violence can increase suicide. For example, in the former Soviet Union, areas experiencing sociopolitical oppression (the Baltic States) and forced social change (Russia) had higher suicide rates compared to other regions. Twenty years of civil war in Sri Lanka are associated with increased suicide rates, as well. Vast social changes associated with modernization and globalization are thought to break down traditional values and practices and result in increased suicide. Since the fall of the Soviet Union and its Eastern European satellite states much of East Europe has reported worsening health statistics, including adult mortality, alcohol and drug abuse, and some of the highest suicide rates in the world today. Here suicide is correlated with societal breakdown, severe economic dislocation, major cultural change and new political systems. Suicide carries a social and moral meaning in all societies. A society’s perception of suicide, or its stigma, can influence its rate, preventing suicide in those societies and social groups where it is frowned upon but increasing suicide where it is a culturally acceptable option in certain situations.

Despite the extensive knowledge that research has provided regarding these risk and protective factors, we are still far from being able to integrate these factors so as to understand how they work in concert to evoke suicidal behavior or to prevent it. We do not understand why sig-



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