eralized to other sites. Long-term assessments are important for evaluation of the impact of interventions on suicide and suicide attempts rather than more proximal measures.

Intervention studies to evaluate means and effectiveness of promoting greater continuity of care, treatment adherence, and access to emergency services because patients recently discharged from inpatient care are among those at highest risk for suicide. Descriptive studies to identify markers for increased risk should aid in the design of intervention studies to decrease risk.

Psychological Risk and Protective Factors

Clinical trials on the specific effects of reducing hopelessness on suicide. Hopelessness is related to suicidality across age, diagnoses, and severity of disorder, yet the field lacks research on the pathways to hopelessness, interrelationships between hopelessness and other psychological aspects of suicide risk, and on the specific effects of reducing hopelessness on suicide.

Treatment Research

Carefully designed trials to understand the potential of pharmacotherapies to reduce suicidal behavior. Studies should include the antidepressants, anticonvulsants, lithium, and clozapine. The lack of long-term assessment of therapeutic strategies and the exclusion of high-risk patient from clinical trials represent critical gaps in the field.

Controlled clinical trials to determine the types and aspects of psychotherapy that are effective in reducing suicide for diverse individuals. Current evidence suggests that continued contact with a psychotherapist is critical. This needs to be rigorously evaluated.

Neurobiology

Longitudinal, prospective studies of the influence of HPA axis function on suicidality. The utility of assessing HPA axis function as a physiological screening tool for suicide risk should be explored. Medical and psychosocial treatments that attenuate HPA dysregulation should be further developed and tested for their efficacy in reducing suicide.

Biological predictors of suicidal behavior should be sought through brain mapping studies. Prospective, rather than cross-sectional studies, are crucial. Analyses in vivo would allow the examination of changes over time to elucidate response to treatment and remission from episodes of mental illness. Moreover, brain mapping studies may help to identify individuals at risk for suicidal behavior.



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