review the scientific gaps that are discussed throughout the report and will present a vision for a solution.

Magnitude of the Problem

Yearly, there are almost 30,000 reported suicides in the United States and a million worldwide. However, suicide rates are underestimates because of the lack of internationally accepted case definition and uniform ascertainment methods. Moreover, data are lacking on changing profiles of mental disorders and social factors associated with changes in suicide rates over time. Suicide attempt prevalence has been determined in some national epidemiological studies, but no data on changing rates are available in the United States. Suicide attempt rates estimated from cases presenting to emergency rooms or health care professionals are a significant underestimate of true rates. Because longitudinal studies are lacking, incidence cannot be estimated from existing data sets. Thus, accurate rates of suicide and particularly suicide attempts are not available at a national level. Data gathering must consider ethnic and social subgroups, including cross-cultural groups, in which rates may be strikingly different and where risk and protective factors may differ in relative importance.

Risk and Protective Factors

Biological, psychological, and cultural factors all have a significant impact on the risk of suicide in any individual. Risk factors associated with suicide include serious mental illness, alcohol and drug abuse, childhood abuse, loss of a loved one, joblessness and loss of economic security, and other cultural and societal influences. Resiliency and coping skills, on the other hand, can reduce the risk of suicide. Social support, including close relationships, is a protective factor.

However, knowledge regarding the relative importance of risk and protective factors is limited, and we are far from being able to integrate these factors in order to understand how they work in concert to evoke suicidal behavior or to prevent it. Where such knowledge is emerging, the results are difficult to generalize because of a lack of population level data. Without a combination of a population-based approach and studies at the level of the individual patient within higher risk sub-groups, macro-social trends cannot be related to biomedical measures. Most existing studies are retrospective or cross-sectional, involve a few correlates, and do not address prediction of risk. Without specific data from well-defined and characterized populations whose community level social descriptives are well-known, normative behavior and abnormality cannot be estimated.

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