Index

Acetaminophen, 285-286

Adherence to treatment, 253-254, 316, 429

adolescents, 354

elderly persons, 43, 353

lithium, 234-235, 254

medications, 43, 234-235, 253-254, 255, 337-338, 350, 353

Administration on Aging, 15, 438

Adolescents and youth, 2, 15, 19, 40-41, 42, 70, 87-89, 131, 200, 211, 425, 438, 452

see also School factors

adherence to treatment, 354

alcohol and substance abuse, 40-41, 49, 88-89, 276

assessment instruments, 230

barriers to treatment, 20, 333, 336, 343, 354-355, 362, 475

childhood trauma, 167, 173-174, 177, 179-180, 199

clustering of suicides, 395

cost of suicide to society, 56

crisis centers and hotlines, 290

drug overdoses, 286

emergency care, 345, 354

firearm use in suicide, 41, 167, 280, 283-284

follow-up care, 255-256, 345

genetic factors, 131-132

imitation and contagion, 131-132, 278, 395

military personnel, 305

Native Americans, 308-309

number of suicides, xi, 1, 17, 40, 46, 57-58 , 425

physicians of, 354-355

pregnancy prevention, 275

preventive efforts, 20, 333, 336, 343, 354-355 , 362, 475

psychological autopsies, 378

racial/ethnic factors, 45, 46, 47-48, 49, 256

religious influences, 256

rural areas, 36

serotonin, 127

sexual abuse, 161, 179-180

sexual orientation, 54-55

surveillance, 386

violence and aggressive behavior, 95, 100

Adoption, children, 2, 132, 133, 140-141

Adrenal gland, see Hypothalamic-pituitary-adrenal axis;

Noradrenergic system

African-Americans, 44-47, 57, 256, 397-398, 452

childhood trauma, 162

employment factors, 205-206



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Reducing Suicide: A National Imperative Index Acetaminophen, 285-286 Adherence to treatment, 253-254, 316, 429 adolescents, 354 elderly persons, 43, 353 lithium, 234-235, 254 medications, 43, 234-235, 253-254, 255, 337-338, 350, 353 Administration on Aging, 15, 438 Adolescents and youth, 2, 15, 19, 40-41, 42, 70, 87-89, 131, 200, 211, 425, 438, 452 see also School factors adherence to treatment, 354 alcohol and substance abuse, 40-41, 49, 88-89, 276 assessment instruments, 230 barriers to treatment, 20, 333, 336, 343, 354-355, 362, 475 childhood trauma, 167, 173-174, 177, 179-180, 199 clustering of suicides, 395 cost of suicide to society, 56 crisis centers and hotlines, 290 drug overdoses, 286 emergency care, 345, 354 firearm use in suicide, 41, 167, 280, 283-284 follow-up care, 255-256, 345 genetic factors, 131-132 imitation and contagion, 131-132, 278, 395 military personnel, 305 Native Americans, 308-309 number of suicides, xi, 1, 17, 40, 46, 57-58 , 425 physicians of, 354-355 pregnancy prevention, 275 preventive efforts, 20, 333, 336, 343, 354-355 , 362, 475 psychological autopsies, 378 racial/ethnic factors, 45, 46, 47-48, 49, 256 religious influences, 256 rural areas, 36 serotonin, 127 sexual abuse, 161, 179-180 sexual orientation, 54-55 surveillance, 386 violence and aggressive behavior, 95, 100 Adoption, children, 2, 132, 133, 140-141 Adrenal gland, see Hypothalamic-pituitary-adrenal axis; Noradrenergic system African-Americans, 44-47, 57, 256, 397-398, 452 childhood trauma, 162 employment factors, 205-206

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Reducing Suicide: A National Imperative firearm use in suicide, 280 violence, 215, 305 Age factors, xi, 7, 10, 38, 396-400, 452-453 see also Adolescents and youth; Children; Elderly persons alcohol abuse, 84 anti-psychotic medications, 236 anxiety disorders, 75 assessment of patients, 231, 232 bipolar disorder, 234 cost of suicide to society, 56, 57 hotlines, 290 inpatient care, 250 Native Americans, 308 number of suicides, 1, 38, 39 racial/ethnic factors, 44-45, 47-48 serotonin, 126-127 sexual orientation, 54-55 Agency for Health Care Policy and Research, 302 Agency for Health Care Research and Quality (AHRQ), 14, 436 Aggression, see Child abuse; Impulsivity; Sexual abuse; Violence and aggressive behavior Agoraphobia, 76, 87 AIDS, see HIV/AIDS Air Force, see U.S. Air Force Alaskan Natives, 47-49, 199, 310, 355-356 Alcohol abuse, 2, 3, 5, 69, 70, 81-85, 86, 96, 99-100, 394 see also Substance abuse adolescents, 49, 88-89, 276 barriers to treatment, 342 bipolar disorder, 74 childhood trauma, 165, 167, 168, 179 diagnosis, 71 firearm use in suicide, 40, 81, 83, 282 gender factors, 40, 84 genetic factors, 131, 136, 137-138 historical perspectives, 21, 22 international perspectives, 81, 83, 85, 211 National Institute on Alcohol Abuse and Alcoholism (NIAAA), 1, 12, 20, 433 Native Americans, 81, 82, 83, 308, 309-310 race/ethnicity, 81, 82, 83, 84, 308, 309-310 religious influences, 202, 203 school-based prevention programs, 276 serotonin, 123-124, 137 surveillance, 380 Ambulatory care, see Inpatient care American Academy of Pediatrics, 14, 183, 436 American Association of Suicidology, 14, 278, 290 American College of Family Physicians, 14, 436 American College of Physicians, 14, 436 American Foundation for the Prevention of Suicide, 14, 278, 438 American Indians, see Native Americans American Medical Association, 5, 339-340 American Psychiatric Association, 14, 71, 438 American Psychological Association, 14 American Society of Internal Medicine, 14, 436 Amitriptyline, 287 Animal studies, 77, 122, 128 childhood trauma, 158, 172 Annenberg Public Policy Center, 278 Anticonvulsants, 233, 235-236, 287 Antidepressant medications, 2, 235, 237-242 , 299, 340, 341, 347, 349, 353, 403 clinical trials, 238-240, 241-242, 257 overdose suicides, 287, 340 serotonin reuptake inhibitors (SSRIs), 238-239, 240, 241, 342 tricyclic antidepressants, 239, 240, 287 Anti-psychotic medications, 4, 236-237, 350 Anxiety disorders, 75-76, 84, 86, 95, 400-401 , 462 see also Panic disorder; Post-traumatic stress disorder agoraphobia, 76, 87 antidepressant medications and, 240, 242 assessment of patients, 231 Beck Anxiety Scale, 231 childhood trauma, 176, 178, 183 inpatient care, 250 medications, 240, 242, 258, 299 neurochemistry, 77, 92-93 panic disorder, 76 psychotherapy, 247 religious influences, 203 Anxiolytics, 240, 242, 258, 299

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Reducing Suicide: A National Imperative Asia, 35, 196, 208 see also specific countries immigrants from, 50, 51 insecticides as means of suicide, 280 Assisted suicide, 21, 44 Association of Poison Control Centers, 287 Attitudes and beliefs, 6, 70, 89-90, 204, 230, 316, 349-350, 351, 352-353 see also Depression; Guilt and shame; Religious influences; Self-efficacy and self-esteem; Social and cultural factors; Stigma; Temperament clergy, 257 correctional institution staff, 358, 359 discrimination, gender-based, 209-210 racial/ethnic, 209-210, 214, 215, 332-334 , 355, 358-359 gatekeeper training, 299 school-based prevention programs, 294-295 Australia, 36, 39, 50, 81, 134, 164, 196, 207, 208, 256, 278, 285, 312 Austria, 35, 196, 278, 279-280, 288, 296 Auto exhaust, 19, 288-289 Autopsies, see Brain and brain repositories; Coroners and medical examiners; Psychological autopsies; Tissue samples Beck Anxiety Scale, 231 Beck Depression Inventory, 231, 400 Beck Hopelessness Scale, 231 Befrienders International Centers, 289, 290 Benzodiazepines, 242 Bereavement, 4, 13, 19, 22 elderly persons, 42, 352 widows and widowers, 3, 23, 198, 204, 352 Big Horn Center for Public Policy, 303 Biological factors, x, 2, 119-155, 213-215, 424, 426, 429, 431-432 see also Brain and brain repositories; Genetic factors; Neurochemistry; Pharmaceuticals biological markers, 230 childhood trauma, 158, 170-172, 184 physiological stress system, 26, 75, 77, 89, 92, 94, 119, 120-122, 130, 131, 140 psychological autopsies and, 378 violence, 119, 120, 122, 125, 126, 128, 131, 136, 138, 140, 235-236, 241 Bipolar disorder, 71, 73, 346 see also Depression adolescents and youth, 87 electroconvulsive therapy, 242-243 inpatient care, 251 lithium treatment, 4, 233-235, 253, 348 mood stabilizers, 233-236, 253, 346, 348, 350 serotonin, 125 time factors, 74, 254 Black persons, see African-Americans Borderline personality disorder, 79-81 Brain and brain repositories, 10, 119, 120, 123-124, 127-130, 139-149, 425-426 , 428, 429 see also Hypothalamic-pituitary-adrenal axis; Neurochemistry; Serotonin antidepressants, negative effects, 240 cerebrospinal fluid, 123, 124-126 childhood trauma, 158, 171-173, 181-182 noradrenergic system, 122, 128-129, 140 psychological autopsies and, 378 Britain, see United Kingdom Call to Action, 27, 436 Canada, 35, 47, 48, 57, 207, 278, 284, 309-310 , 344 Carbamazepine, 235 Case-control studies, 142, 309, 356, 402 Case management, 254 Catecholamine, 92, 172 Center for Studies of Suicide Prevention, see Suicide Research Unit Center for the Study and Prevention of Suicide , 306 Centers for Disease Control and Prevention (CDC), 1, 9, 12, 14, 19-20, 307, 308 Internet site, 57 media coverage of suicides, 278 research centers, 406, 410, 411 surveillance, 12-13, 303, 382, 384, 385- 386, 387, 433-434 Cerebrospinal fluid, 123, 124-126 Child abuse, 4, 80, 158-159, 162-164, 174-178 , 182, 297, 432 memory of lacking, 163, 175 post-traumatic stress disorder, 172, 173

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Reducing Suicide: A National Imperative prevention programs, 176-177, 181, 182-183 , 184, 303-304 sexual, 132-133, 141, 158, 161-170 (passim), 173, 174, 175, 176, 177, 179-181, 183 Childhood trauma, xi, 3-4, 21, 22, 52, 80-81, 96-97, 131, 132, 141, 157-191, 199, 432 adolescents, 167, 173-174, 177, 179-180, 199 age of onset, 169, 179-180 alcohol abuse, 165, 167, 168, 179 animal studies, 158, 172 anxiety, 176, 178, 183 brain effects, 158, 171-173, 181-182 clinical trials, 164, 165, 167, 169, 183 cognitive-behavioral factors, 158, 170, 173, 174-177, 179, 181, 183, 184 community programs and studies, 166, 178, 179, 182, 183 crime, 165, 174, 176 depression, 3, 159, 165, 171-172, 176, 177-178, 183 epidemiology, 157-168 (passim), 178-179 , 184 gender factors, 160, 161, 166, 168, 169, 170, 183 hypothalamic-pituitary-adrenal axis (HPA), 171-172, 173 legal issues, 164, 182 longitudinal studies, 163, 177-178, 179-180 , 183, 184 memory of, 163 Native Americans, 162, 199 neurochemistry, 158, 171-172, 173, 184 pathway analysis, 157, 164, 179-182 physicians, 183 post-traumatic stress disorder (PTSD), 171-172, 173, 177, 178, 181-182 preventive measures, 176-177, 181, 182-183 , 184, 303-304 prisoners’ children, 159, 161, 165 prospective studies, 165, 166, 177 psychiatric and psychological factors, general, 3, 158, 159, 161, 165, 168, 170, 177-181, 183 psychological autopsies, 165, 167 race/ethnicity, 162 research methodology, 157-158, 162-164, 172-173 clinical trials, 164, 165, 167, 169, 183 epidemiology, 157-168 (passim), 178-179 , 184 pathway analysis, 157, 164, 179-182 prospective studies, 165, 166, 177 resiliency, 174 retrospective studies, 164, 179-180 self-efficacy and self-esteem, 169, 173, 174, 175, 181 sociocultural factors, 170, 173-177, 184 socioeconomic status, 159, 165, 179 substance abuse, 159, 161, 165, 173, 177-179 , 181 Surgeon General’s reports, 157, 176, 182, 295-296 time factors, 157, 163 treatment, general, 157, 176-178, 182-183, 184 Children, 87-89 see also Adolescents and youth; Genetic factors; School factors adoption, 2, 132, 133, 140-141 barriers to treatment, 336 educational interventions, 15 historical perspectives, 22 immigrants, 51 isolation from, 250 parental separation from/death of child, ix, 19 personality disorders, 80-81 psychological autopsies, 377 sexual orientation, 54-55 China, ix, 2, 7, 23, 33, 35, 36, 39, 69, 207-213 (passim), 360 Cigarette smoking, see Smoking City of God, 23 Clinical guidelines, 5, 13-14, 230, 231, 392 barriers to treatment, 336-349 (passim) elderly persons, 302, 339-340 emergency care, 345 follow-up care, 255 psychotherapy, 246 Clinical trials, 8, 12, 100, 257, 300-301, 317, 403-404, 423, 424, 429, 432, 433 antidepressant medications, 238-240, 241-242, 257 barriers to treatment, 336 childhood trauma, 164, 165, 167, 169, 183 dexamethasone suppression test, 121 elderly persons, 302 electroconvulsive therapy, 243, 257

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Reducing Suicide: A National Imperative ethical issues, 8, 164, 389-393, 412, 432 firearm use in suicide, 284 follow-up care, 255-256 inpatient care, 250, 251 legal issues, 8, 164 mood stabilizers, 233, 234, 235, 258 physicians, judgment of risk, 391-392 psychotherapy, 246-250 risk-based allocation, 8, 395, 402-404 serotonin, 127, 238-239, 240, 241-242 standards, 8, 389-391, 432 Clomipramine, 240 Clozapine, 4, 236, 257 Clusters, 41, 395-400 see also Imitation and contagion Cognitive-behavioral factors, 90, 231, 350, 432, 437 see also Adherence to treatment; Coping; Intelligence; Problem solving; Self-efficacy and self-esteem childhood trauma, 158, 170, 173, 174-177 , 179, 181, 183, 184 informed consent, 8, 292, 359, 389-392 locus of control, 93-94, 174, 181; see also Impulsivity school-based prevention programs, 294, 295-296 treatments, general, 4, 80, 92, 99, 100, 245-249, 258, 348 Cognitive behavioral therapy (CBT), 92, 245-249 Collaborative Depression Study, 238 Community programs and studies, 4-5 see also Local government; Outpatient care; Public education assessment of patients, 232 barriers to treatment, 335, 336, 345-346 childhood trauma, 166, 178, 179, 182, 183 committee recommendations, 11, 436 developing countries, 360 imitation and contagion, 277 military personnel, 6, 15, 304-307, 436-437 , 438 Native Americans, 308-309 prevention programs, 6, 15, 275, 304-305 , 436-437, 438; see also “military personnel” supra surveillance, 379, 381-382, 386, 411 violence, 162, 173, 175-176, 178, 215, 305 Computer applications see also Databases; Internet assessment of risk, 230 Confidentiality, 359, 388-389, 433 Consumer Product Safety Commission, 385 Contagion, see Imitation and contagion Contracts, no-suicide, see No-suicide contracts Convulsions, see Anticonvulsants Coping see also Problem solving coping style, 94-95, 183-184 coping training, 26, 94-95, 100, 274, 317, 437 school-based prevention programs, 294-295, 300-301 Coping and Support Strategy, 300-301 Coroners and medical examiners, 55, 304, 379, 380-381, 384, 411, 432 Correctional facilities, see Prisoners Corticosteriods, 120, 172 Counseling, 229, 255, 316, 350, 354 alcohol abuse, 342 crisis centers, 255, 275, 279, 289-290, 297 firearm use in suicide, 284 gatekeeper training 297-298 hotlines, 279, 288, 289-290, 304, 315-316 Native Americans, 308, 309 school-based prevention programs, 297-298 , 299-301, 309 Counselors CARE, 299-301 Crime and criminal behavior see also Child abuse; Prisoners; Sexual abuse; Substance abuse; Violence and aggressive behavior childhood trauma, 165, 174, 176 committee recommendations, 13 parental, 165 psychological autopsies, 377 Crisis response see also Emergency care centers, 255, 275, 279, 289-290, 297 hotlines, 279, 288, 289-290, 304, 315-316 primary care referral to, 344-345 school-based prevention programs, 301 Cross-sectional studies, 4, 141, 424 childhood trauma, 164, 167, 179-180 cost of suicide to society, 57 Cultural factors, see Immigrants; Race/ ethnicity; Social and cultural factors

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Reducing Suicide: A National Imperative Databases, 12, 383-389, 431, 432, 433, 434 see also Registries; Surveillance cost of suicide to society, 57 military personnel, 305, 306-307 overdose suicides, 287 Death Master Files, 236 Definitional issues, 27-28, 55, 58, 70-71, 375, 376, 379, 380, 411, 424 childhood trauma, 158-159, 163-164 lifetime risk, 394 psychic pain, 97 psychotherapy, 246 sociocultural factors, 193 stigma, 332 Demographic factors, 4, 10, 33-58, 206, 384, 428 see also Adolescents and youth; Age factors; Children; Educational attainment; Elderly persons; Epidemiology; Gender factors; Geographic factors; Immigrants and refugees; Marriage and intimate relations; Prisoners; Race/ethnicity; Rural areas; Sexual orientation; Social and cultural factors; Socioeconomic status; Urban areas definitional issues, 27 high-risk occupations, 15, 52-53 military personnel, 6, 15, 304-307, 436-437 , 438 veterans, 1, 12, 14, 20, 230, 336, 433, 438 psychological autopsies, 378 Denmark, 53, 85, 195, 276, 381 Department of Education, 14-15, 438 Department of Health and Human Services see also Centers for Disease Control and Prevention; National Institute of Mental Health Agency for Health Care Policy and Research, 302 Agency for Health Care Research and Quality (AHRQ), 14, 436 Food and Drug Administration, 392 Indian Health Service, 307, 308, 356 National Cancer Institute, 407, 408, 411 National Center for Injury Prevention and Control, 384 National Institute on Aging, 12, 407, 408, 433 National Institute on Alcohol Abuse and Alcoholism (NIAAA), 1, 12, 20, 433 National Institute on Drug Abuse (NIDA), 1, 12, 433 National Institutes of Health (NIH), 431 Social Security Administration, 236 Department of Veterans Affairs (DVA), 1, 12, 14, 20, 230, 336, 433, 438 Depression, ix, 5, 17-19, 72-73, 84, 86, 89, 90, 91-92, 95-96, 98, 231, 310, 400-401 , 462 see also Antidepressant medications; Bipolar disorder; Depression; Guilt and humiliation; Psychic pain; Self-efficacy and self-esteem adolescents and youth, 49, 87, 284, 300 anxiety disorders and, 76 barriers to treatment, 4-5, 73, 252-253, 335, 337, 339-342, 343, 349, 351-353 Beck Depression Inventory, 231, 400 bereavement, 4, 19, 22, 42, 352 elderly persons, 42, 352 widows and widowers, 3, 23, 198, 204, 352 childhood trauma, 3, 159, 165, 171-172, 176, 177-178, 183 committee recommendations, 11, 13, 435 dexamethasone suppression test, 121 diagnosis, 72, 99, 231, 339-341, 355 dysthmia, 72-73, 171-172, 176 elderly persons, 42, 43, 44, 301-302, 339-340 , 351-353, 438 electroconvulsive therapy, 242-244 family history of, 3, 86, 159, 165, 287 maternal, 3, 86, 159, 165 follow-up care, 72, 253, 256 gatekeeper training, 298-299 gender factors, 39-40 genetic factors, 132, 136 historical perspectives, 21-22 informed consent, 390 inpatient care, 73, 340 lithium treatment, 235 locus of control, 93-94 managed care, 337-338, 340 maternal, 3, 86, 159, 165 personality disorders and, 80

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Reducing Suicide: A National Imperative phenobarbital, epileptic patients, 287 psychotherapy, 246, 249 racial/ethnic factors, 49 religious influences, 203 serotonin, 123-125, 126-127 time factors, 72, 125, 240, 241, 248, 401 Desipramine, 287 Developing countries, 360-361, 431 see also specific countries Dexamethasone suppression test, 121 Diagnosis and screening, 5, 70-71, 99, 200, 230-233, 257-258, 297, 434-436, 438 see also Clinical guidelines; Coroners and medical examiners; Surveillance alcohol abuse, 81 anxiety disorders, 75-76, 77 barriers to, 331, 332, 339-356 (passim), 360, 361 bipolar disorder, 74 childhood trauma, 184 definitional issues, 27 depression, 72, 99, 231, 339-341, 355 developing countries, 360 elderly persons, 302, 339-340, 352, 353, 438 emergency care, 345 follow-up care, 230, 232, 250, 255 gatekeepers, 297-299, 336, 437, 438 historical perspectives, 273 Native Americans, 308 no-suicide contracts, 292 prisoners, 358 psychological autopsies, 378 schizophrenia, 77 school-based prevention programs, 299-301 serotonin, 123-124 sociocultural factors, 231, 232 standards, 170, 230, 231, 232; see also Clinical guidelines substance abuse, 71, 99, 335, 339, 342, 349 Diagnostic and Statistical Manual (DSM), 71-76 (passim), 79 Dialectical behavioral therapy, 80, 248, 249-250 Discrimination, 209-210, 214, 215, 332-334, 355, 358-359 Divalproex, 235 Divorce, ix, 3, 85, 165, 167, 196, 197, 198-199 Domestic gas poisoning, 288 Dopamine, 77, 122, 126, 127, 171, 172 Drowning, 22, 24 Drug abuse, see Alcohol abuse; Substance abuse Drug Abuse and Early Warning Network, 287 Drug treatment, see Pharmaceuticals DSM, see Diagnostic and Statistical Manual Durkheim, Emile, 25, 198, 201 Dysthmia, 72-73, 171-172, 176 Eastern Europe, ix, 3 E-codes, see External cause-of-injury codes Ecological-transactional approaches, 99 Economic factors, ix-x, 3, 69, 193, 196, 205-209 , 212, 214, 215 see also Employment; Funding; Health insurance; Socioeconomic status barriers to treatment, 5, 334-340, 350, 351; see also Health insurance cost of suicides, x, 55-57, 58, 423 historical perspectives, 21, 22 life insurance, 380 managed care, 336-339, 340, 341, 432 phenobarbital, 287 prisons, 357 research centers, 406 Education, see Professional education; Public education; School factors Educational attainment, 50 schizophrenia, 78-79 Elderly persons, 15, 41-44, 57, 256, 301-302, 317, 438, 452 adherence to treatment, 43, 353 barriers to treatment, 331-332, 333, 351-353 , 362 bereavement, 42, 352 cost of suicide to society, 56 depression, 42, 43, 44, 301-302, 339-340, 351-353, 438 firearms, 353 imitation and contagion, 278 inpatient care, 250 international perspectives, 41, 311 number of suicides, 1, 17, 39, 41, 44-45, 48, 425 personality characteristics, 95 pharmacotherapy, 302 physicians of, 43, 339, 352, 353

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Reducing Suicide: A National Imperative racial/ethnic factors, 44-45, 48, 57 surveillance, 386 Electroconvulsive therapy, 242-244, 251 Emergency care, 21, 38, 424 adolescents and youth, 345, 354 assessment of patients, 230, 255 barriers to treatment, 335, 345, 354 cost of, 56 crisis centers, 255, 275, 279, 289-290, 297 follow-up care, 255-256 hotlines, 279, 288, 289-290, 304, 315-316 number of attempted suicides, 17, 285-286 overdoses, 285-286 surveillance, 385, 386-387, 424, 426 Emergency Department Data Systems, 387 Employment, 3 bipolar disorder, 74 health insurance, employer-based, 337 high-risk occupations, 15, 52-53, 197, 205-206, 317 military personnel, 6, 15, 304-307, 436-437 , 438 psychological autopsies, co-workers, 378 race ethnicity, 205-206 sick leave for depression, 299 unemployed persons, 3, 40, 51, 52, 85, 196, 205, 207, 208, 215, 354 England, see United Kingdom Epidemiologic Catchment Area Study, 47, 169, 384 Epidemiology, 3, 4, 47, 258, 311, 313-316, 384-385, 424 see also Surveillance alcohol abuse, 85 antidepressant medications, 237-238 anti-psychotic medications, 236-237 centers for research, 10-12, 406-411, 425-431 childhood trauma, 157-168 (passim), 178-179, 184 committee recommendations, 10, 425-426 , 430 firearms, 280 follow-up care, 253 military personnel, 306-307 Native Americans, 308 occupational factors, 53 religious influences, 203 school-based prevention programs, 294-295 Epilepsy, anticonvulsants, 233, 235-236, 287 Ethical issues, 375, 389-393 see also Legal issues childhood trauma, 164 clinical trails, 8, 164, 389-393, 412, 432 committee recommendations, 12, 428 confidentiality, 359, 388-389, 433 informed consent, 8, 292, 359, 389-392 prisoners, 359 Ethnicity, see Race/ethnicity Ethnographic research, 10, 11-12, 426, 428, 431 Europe, ix, 3, 34, 210-211 see also specific countries alcohol abuse, 85 employment factors, 205 historical perspectives, 21-22, 210-211 Euthanasia/assisted suicide, 21, 44 External cause-of-injury codes (E-codes), 387 Faith-based interventions, see Religious influences Falls, see Jumping Family factors, 2, 3, 130-135, 141-142, 165, 174, 176-177, 182-183, 197-199, 200, 209, 212, 215, 316, 362 see also Child abuse; Childhood trauma; Children; Divorce; Genetic factors; Parenthood adoption, 2, 132, 133, 140-141 bipolar disorder, 74 brother’s suicide, 19 depression, history of, 3, 86, 159, 165, 287 maternal, 3, 86, 159, 165 domestic, 141, 159, 166, 173, 175, 178, 198-199, 297 elderly persons, 44 emergency care, 345 follow-up care, 255-256 military personnel, 305 prisoners, 358 problem solving, 247 psychological autopsies, 377, 378 racial/ethnic factors, 49 stigma of suicide, 334 substance abuse, 86 suicide note of woman, 18 Family History-Research Diagnostic Criteria, 378

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Reducing Suicide: A National Imperative Fatality Analysis Reporting System (FARS), 383 Federal government, 1, 12-15, 19-20, 278, 340, 381, 428, 438 see also Centers for Disease Control and Prevention; Funding; Surgeon General; terms beginning “Department...” and “National...” Agency for Health Care Policy and Research, 302 Agency for Health Care Research and Quality (AHRQ), 14, 436 historical perspectives, 1, 19-20, 273 Indian Health Service, 307, 308, 356 Fenfluramine, 122, 126, 137 Field dependence, 181 Finland, 35, 50, 73, 80, 85, 196, 205, 239, 279, 304, 310-311, 312, 313 Firearms, 6, 15, 33, 36, 280-285, 316, 437 adolescents and youth, 41, 167, 280, 283-284 alcohol abuse and, 40, 81, 83, 282 committee workshop agendas, 475 elderly persons, 353 gender factors, 280, 283, 285 gun control legislation, 283, 284-285, 316 racial/ethnic factors, 45, 48-49, 280 Russian roulette, 380 Fluoxetine, 238, 287 Follow-up care, 4-5, 251, 252-256, 259 see also Outpatient care adolescents and youth, 255-256, 345 assessment of patients, 230, 232, 250, 255 barriers to, 345 bipolar disorder, 74 contact letters, 254, 255, 259, 348 depression, 72, 253, 256 medications, 4-5, 251, 253 primary care and, 253, 335-336 schizophrenia, 78 telephone contacts, 254 time factors, 174(n.11), 231, 255, 259, 394, 425 Food and Drug Administration, 392 Ford Foundation, 407 Foreign countries, see International perspectives Funding, x, 9, 10, 11-12, 13, 14, 311, 317, 423, 424, 435, 436, 438 research centers, 406, 408-409, 410, 411, 427, 428, 431 school-based prevention programs, 304 state reporting programs, 13 surveillance, 12-13, 384, 433-434 uninsured persons, 362 Gas poisoning, see Auto exhaust; Domestic gas poisoning Gatekeepers, 297-299, 336, 437, 438 see also Health insurance; Managed care; Primary care Gay persons, see Sexual orientation Gender factors, ix, 7, 9, 33, 38, 39-40, 130, 136, 138, 197, 198, 208, 210-211, 396-400, 452-453 see also Marriage and intimate relations; Sexual orientation alcohol and substance abuse, 40, 84 assessment of patients, 231 barriers to treatment, 333, 351, 354 discrimination, 209-210 childhood trauma, 160, 161, 166, 168, 169, 170, 183 cost of suicide to society, 56 crisis centers and hotlines, 290 depression, 39-40 discrimination, 209-210 drug overdoses, 286 elderly persons, 17, 41-42, 43, 46, 351 employment factors, 206, 207 firearm use in suicide, 280, 283, 285 follow-up care, 255-256 genetic, 131, 136, 137-138 international perspectives, 39, 57, 195, 196, 208, 211, 212 maternal depression, 3, 86, 159, 165 mood disorders, 71, 72, 74, 136 notes by female suicide victims, 18-19 occupational factors, 53 pregnancy prevention, adolescents, 275 prisoners, 51, 52 racial/ethnic factors, 44-45, 46, 50, 170, 206, 215, 280, 290, 305, 355, 398-399 , 452 religious influences, 202 rural areas, young males, 36 schizophrenia, 77, 78 serotonin, 138 substance abuse, 40, 71 Generalized Estimating Equations, 397, 450-451

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Reducing Suicide: A National Imperative Genetic factors, 2, 89, 96, 127, 130-142, 214, 256, 406 adolescents and youth, 131-132 committee recommendations, 10, 11, 13, 426-427, 430, 431 depression, 132, 136 gender-related, 131, 136, 137-138 impulsivity, 130, 131, 132-133, 136, 138, 141-142, 430 mood disorders, 131, 135 psychological autopsies, 378-379 substance abuse, 131, 132 twin studies, 2, 132, 133-134, 140-142 violence and aggressive behavior, 2, 11, 130, 131, 136, 138, 141-142, 430 Geographic factors, 33, 34, 38-39, 196, 393, 395-400, 443, 451-459 see also International perspectives; Regions of the U.S.; Rural areas; Social and cultural factors; Urban areas Government role, see Federal government; Local government; State government Grief, see Bereavement Guilt and humiliation see also Stigma cultural influences, 23, 24, 69 historical perspectives, 21, 22, 24 notes of suicide victims, 18, 19 Guns, see Firearms Hamilton Rating Scale for Depression, 231, 232, 244 Hanging, 22, 24, 48, 49 prisoners, 51 Health insurance, 14, 334, 362, 434 depressive patients, 73 managed care, 336-339, 340, 341, 432 Medicaid, 353 Medicare, 351, 353 Native Americans, 356 Healthy People 2001, 20 Hispanics, 50-51, 199, 256, 304 Historical perspectives, , xi 21-25, 196, 376 alcohol abuse, 81, 85 childhood trauma, 161, 169, 182 corticosteriods, 120-121 depression, 21-22 Europe, 21-22, 210-211 federal government role, 1, 19-20, 273 firearm use in suicide, 282 guilt and humiliation, 21, 22, 24 imitation and contagion, 276 Native Americans, 307 number of suicides, 17, 34 preventive efforts, 1, 19-20, 302, 310-311 prisoners, 356-357 psychotherapy, 245 racial/ethnic factors, 45, 46, 47, 48 religious influences, 201-202 sociocultural factors, general, 21-25, 194- 195, 199, 201-202, 210-211, 214 surveillance, 385 theory, 25-28, 194, 198, 264, 273 unemployment, 207 HIV/AIDS, xi, 17 costs of care, 357 registries, 13 surveillance, general, 13, 388, 432, 433, 434 Homosexuality, see Sexual orientation Hopelessness, see Bipolar disorder; Depression; Personal suffering; Psychic pain Hospital Discharge Data Systems, 387 Hospitalization, see Emergency care; Inpatient care Hotlines, 279, 288, 289-290, 304, 315-316 Humiliation, see Guilt and humiliation Hungary, ix, 41, 196, 239 Hypothalamic-pituitary-adrenal axis (HPA), 2, 11, 92-93, 120-122, 140, 181-182 childhood trauma, 171-172, 173 Immigrants and refugees, 49-51, 58, 206, 209, 256, 304 Asian, 50, 51 religious influences, 202 Imipramine, 287 Imitation and contagion, 41, 131-132, 276- 278, 316, 385, 395-400, 475 adolescents and youth, 131-132, 278, 395 clusters, 41, 395-400 Impulsivity, 2, 13, 41, 42, 80, 95, 96, 99, 142, 212, 435 see also Bipolar disorder; Child abuse; Violence and aggressive behavior alcohol abuse, 81, 83-84, 99, 138 childhood trauma, 174, 177-178

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Reducing Suicide: A National Imperative coping style, 94 genetic factors, 130, 131, 132-133, 136, 138, 141-142, 430 insecticides as means of suicide, 280 lithium treatment, 235 serotonin, 126, 127-128 substance abuse, 86, 99 India, 212-213 Indian Americans, see Native Americans Indian Health Service, 307, 308, 356 Inpatient care, 230, 250-253, 345-346, 386, 394-395 see also Emergency care; Follow-up care alcohol abuse, 84 anxiety, 250 barriers to treatment, 4-5, 73, 252-253, 335, 337, 338, 340, 345 bipolar disorder, 74 committee recommendations, 11, 430 depression, 73, 340 discharged patients, 4-5, 73, 252-253, 335, 345; see also Follow-up care medications, 4-5, 251, 253 time factors, 4, 74, 84, 255, 259, 345-346 , 425, 430, 434 gatekeeper training, 299 involuntary hospitalization, 250 managed care, 337, 338 schizophrenia, 78 time factors, 43, 345-346, 373 discharged patients, 4, 74, 84, 255, 259, 345-346, 425, 430, 434 length of stay, 11, 249, 259, 337, 338, 400, 401, 430, 462-464 Insecticides, see Pesticides Insurance, see Health insurance; Life insurance Intelligence childhood trauma, 174, 175 schizophrenia, 78-79 Interdisciplinary approaches, 20, 25-27, 273, 375, 423, 434 centers for research, 10-12, 406-411, 425-431 childhood trauma, 184 school-based prevention programs, 274 International Classification of Diseases, 387 International perspectives, ix, 3, 21-22, 69, 196, 210-213, 215-216, 275, 302-303 , 310-312, 423, 424, 425 see also Immigrants and refugees; specific countries and world regions alcohol abuse, 81, 83, 85, 211 anxiety disorders, 75, 76 bipolar disorder, 73-74 childhood trauma, 164 crisis centers, 289 developing countries, 360-361, 431; see also specific countries elderly persons, 41, 311 employment factors, 205 gender factors, 39, 57, 195, 196, 208, 211, 212 means of committing suicide, 282-286 (passim), 288, 289 media reporting of suicides, 278-280 number of suicides, 17, 33, 35-36, 39, 41, 57, 58, 425 occupational factors, 53 professional education, 12 registries, 7, 212 research centers, 410, 425-426, 428, 431 school-based prevention programs, 296, 437 serotonin reuptake inhibitors (SSRIs), 239 socioeconomic status, 207-208, 212-213 surveillance, 360-361, 381, 387, 411, 431, 434 unemployment, 207, 208 United Nations, 90, 302, 303, 305, 310, 312 World Bank, 428 World Health Organization, 35, 211, 212, 275, 278, 296, 302, 303, 305, 310, 312, 387, 428 Internet cost of suicide to society, 57 crisis services, 290 media coverage of suicides, 278 Interpersonal relations, see Marriage and intimate relations Interval estimation, 401-402, 464-467 Israel, 198 Japan, 23, 204, 207, 210, 278, 288 Jumping, 33, 287-288 Latinos, see Hispanic persons Legal issues, 357, 358 see also Crime and criminal behavior; Ethical issues; Prisoners childhood trauma, 164, 182

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Reducing Suicide: A National Imperative clinical trials, 8, 164 confidentiality, 359, 388-389, 433 informed consent, 8, 292, 359, 389-392 litigation, 357 malpractice claims, 346-347 military personnel, 306-307 no-suicide contracts, 292 surveillance, 380, 385-386 Legislation firearms, 283, 284-285, 316 means of suicide, reducing access to, 280 preventive efforts, 273 prisoners, 357 proscriptions against suicide, 23, 25, 212, 215 surveillance, 382, 383, 384, 386, 387 Lesbians, see Sexual orientation Life insurance, 380 LINK, 304-307 Lithium, 4, 233-236, 254, 258, 348 LivingWorks Suicide Intervention Workshop , 297-298 Local government, 438 see also Community programs and studies childhood trauma, 162 surveillance, 379, 381-382, 386, 411 see also Coroners and medical examiners Locus of control, 93-94, 174, 181 see also Impulsivity Longitudinal studies, 6, 10, 72, 91, 99, 206, 210-211, 259, 317, 412, 424, 431-432 centers for research, 406, 426, 428, 429, 430 childhood trauma, 163, 177-178, 179-180 , 183, 184 cost of suicide to society, 56-57 firearm use in suicide, 280 marital status, 198 neurochemistry, 140 parenthood, 199 personality characteristics, 95 religious influences, 203 school-based prevention programs, 294-295 sexual orientation, 54-55 unemployment, 207 youth, 87-88 Low-base rate events, 27, 232, 290, 313, 344, 375, 376-377, 423, 424, 425-426, 431 Managed care, 336-339, 340, 341, 432 Manic-depression, see Bipolar disorder Marriage and intimate relations, 165, 167, 175, 197-199, 208, 212-213 alcohol abuse, 83-84 death of spouse, 198, 204 dowry deaths, 212 divorce, ix, 3, 85, 165, 167, 196, 197, 198-199 immigrants, 50-51 religious influences, 202 single persons, 197, 198, 250 widows and widowers, 3, 23, 198, 204, 352 Mass media, 6, 15, 276-280, 289, 294, 304, 310, 316, 437 Means of completing suicide, reducing access to, 21, 52, 206, 274, 280- 289, 313, 316, 347, 437 see also Firearms alcohol abuse and, 83 acetaminophen, 285-286 auto exhaust, 19, 288-289 domestic gas poisoning, 288 hanging, 22, 24, 48, 49, 51 jumping, 33, 287-288 overdoses, 15, 241, 285-287, 340 pesticides, 280 poisons, other, 15, 33 psychological autopsies, 377 railway suicides, 289 suffocation, 33 Measure of Adolescent Potential for Suicide, 299-300 Media, see Mass media Medicaid, 353 Medical examiners, see Coroners and medical examiners Medicare, 351, 353 Medications, see Pharmaceuticals Memory, 91, 350 child abuse, 163, 175 Men, see Gender factors Methodology, see Research methodology Mianserin, 287 Military personnel, 6, 15, 304-307, 436-437, 438 veterans, 1, 12, 14, 20, 230, 336, 433, 438

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Reducing Suicide: A National Imperative Million Clinical Multiaxial Inventory, 400 Minorities, see Race/ethnicity Mixed-effects regression models, 400-401, 448-450, 451-454, 458-464 Moclobemide, 240 Mood disorders, 70, 71-75, 80, 84, 86, 92, 339, 394 see also Bipolar disorder; Depression; Impulsivity anxiety disorders and, 75, 247 childhood trauma, 174 coping style, 94 gender factors, 71, 72, 74, 136 genetic factors, 131, 135 psychotherapy, 247 school-based prevention programs, 301 Mood stabilizers, 233-236, 346, 350 anticonvulsants, 235-236 clinical trials, 233, 234, 235, 258 lithium, 4, 233-236, 253, 348 Motor vehicle deaths, 48, 276, 383, 432 auto exhaust, 19, 288-289 surveillance, 380 National Bioethics Advisory Commission, 389 National Cancer Institute, 407, 408, 411 National Center for Injury Prevention and Control, 384 National Child Abuse and Neglect Data System, 160 National Comorbidity Survey, 47, 71 anxiety disorders, 75, 76-77 childhood trauma, 178, 179-180 National Death Index, 231, 236 National Electronic Disease Surveillance System, 387 National Electronic Injury Surveillance System (NEISS), 385 National Health Interview Survey, 72 National Highway Traffic Safety Administration, 383 National Institute of Drug Abuse, 20 National Institute of Mental Health (NIMH), 1, 9, 20, 238, 376, 435, 436, 438 Center for Studies of Suicide Prevention (Suicide Research Unit), 19, 27 committee recommendations, 10, 12-15 (passim), 427-431, 433 elderly persons, 302 media coverage of suicides, 278 Native Americans, 307 racial/ethnic factors, 47 research centers, 406, 410, 411 National Institute on Aging, 12, 407, 408, 433 National Institute on Alcohol Abuse and Alcoholism (NIAAA), 1, 12, 20, 433 National Institute on Drug Abuse (NIDA), 1, 12, 433 National Institutes of Health (NIH), 431 National Prescription Audit, 287 National Strategy for Suicide Prevention, 20, 90, 278, 338, 340, 342, 346 National Violent Death Reporting System, 13, 383-384, 432-434 Native Americans, 1, 17, 45, 47-49, 57, 307-310 , 313, 317, 355-356 alcohol abuse, 81, 82, 83, 308, 309-310 childhood trauma, 162, 199 Netherlands, 198 Neurochemistry, 2, 92-93, 119-142 see also Alcohol abuse; Brain and brain repositories; Pharmaceuticals; Serotonin; Substance abuse; Tissue samples anxiety disorders and, 77, 92-93 catecholamine, 92, 172 cerebrospinal fluid, 123, 124-126 childhood trauma, 158, 171-172, 173, 184 committee recommendations, 13, 426, 429 corticosteriods, 120-122, 172 dopamine, 77, 122, 126, 127, 171, 172 hypothalamic-pituitary-adrenal axis (HPA), 2, 11, 92-93, 120-122, 140, 181-182 childhood trauma, 171-172, 173 memory, 91 pathway analysis, 77, 119, 121, 122, 130, 142 prospective studies, 140, 141 psychological autopsies, 378 violence and aggressive behavior, 119, 120, 122, 125, 126, 128, 131, 136, 138, 140, 235-236, 241; see also Genetic factors New Zealand, 40, 55, 73, 86, 164, 180-181, 278, 282-283

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Reducing Suicide: A National Imperative Noradrenergic system, 122, 128-129, 140 Nortriptyline, 287 No-suicide contracts, 291-292 Norway, 35, 85, 195, 276, 312 Notes by suicide victims, 18-19, 28, 32, 132, 380 Nursing homes, 43 Oregon State Adolescent Suicide Attempt Data System (ASADS), 386, 388 Outcome measures, 6, 393, 403 childhood trauma, 162, 164, 177 clinical trials, 8 committee recommendations, 11 coping training, 94-95 elderly persons, 302 lithium treatment, 235 managed care, 337 personality disorders, 79 school-based prevention programs, 294-296 surveillance, 386 Outpatient care, 249, 250, 251, 252-253, 395 see also Emergency care; Follow-up care assessment of patients, 230, 232 bipolar disorder, 74 childhood trauma, 169 crisis centers, 255, 275, 279, 289-290, 297 depression, 73 schizophrenia, 78 Overdose suicides, 15, 241, 285-287, 340 Pain, see Physical pain; Psychic pain; Terminal illness Panic disorder, 76 Paracetamol, see Acetaminophen Parenthood, 3, 159, 160, 168, 175-176, 199 see also Child abuse; Childhood trauma; Children; Family factors adoption, 2, 132, 133, 140-141 death of, 167 firearm use in suicide, 284 maternal depression, 3, 86, 159, 165 preventive measures, 275 suicide of parent, 165 Paroxetine, 238, 242 Pathway analysis, 89, 90, 97, 100, 119, 141 childhood trauma, 157, 164, 179-182 genetic, 141 neurological, 77, 119, 121, 122, 130, 142 school-based prevention programs, 276 Peer influences, 275, 304, 305 see also Imitation and contagion psychological autopsies, 378 Personal suffering, ix, xi, 2, 17-19 psychological autopsies, 377 Personality disorders, 79-81, 95-97 borderline personality disorder, 79-81 childhood trauma, 177 psychological autopsies, 377, 378 serotonin, 123-124 Pesticides, 280 Pharmaceuticals, 5, 11, 80, 128, 229, 230, 233-242, 248(n.7), 250, 258, 259, 425, 437 see also Antidepressant medications; Mood stabilizers; Substance abuse Acetaminophen, 285-286 adherence to treatment, 43, 234-235, 253-254, 255, 337-338, 350, 353 Amitriptyline, 287 anticonvulsant medications, 233, 235-236 , 287 anti-psychotic medications, 4, 236-237, 350 anxiolytics, 240, 242, 258, 299 benzodiazepines, 242 bipolar disorder, 74 Carbamazepine, 235 Clomipramine, 240 Clozapine, 4, 236, 257 Desipramine, 287 dexamethasone suppression test, 121 Divalproex, 235 education of practitioners, 99 electroconvulsive therapy and, 243-244 fenfluramine, 122, 126, 137 fluoxetine, 238, 287 genetic factors, 140, 256 hospitalization, 250-251 hospitalization discharge follow-up care, 4-5, 251, 253 Imipramine, 287 lithium, 4, 233-236, 254, 258, 348 managed care, 337-338 medication resistant patients, 243, 254 Mianserin, 287 overdose suicides, 15, 241, 285-287, 340 Paroxetine, 238, 242 serotonin reuptake inhibitors (SSRIs), 238-239, 240, 241-242, 342

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Reducing Suicide: A National Imperative special mental health care providers, 99, 347, 349 time factors, 234, 235, 240, 241, 242, 244, 248, 254, 350 vaproic acid, 235 Physical pain, 21 elderly persons, 44 Physician assistants, 344-345 Physicians, 5, 13-14, 205 adolescents, 354-355 alcohol abuse, 99 barriers to treatment and intervention, 331, 335-346 (passim), 348, 358, 359, 360, 435 childhood trauma, 183 clinical trials, judgment of risk, 391-392 education of, 99, 297, 298-299, 317, 344-345 , 436 elderly persons, 43, 339, 352, 353 managed care, 336-337, 340, 341 prisoners, 358, 359, 360 Physiological stress system, 26, 75, 77, 89, 92, 94, 119, 120-122, 130, 131, 140 Pituitary gland, see Hypothalamic-pituitary-adrenal axis Poison, 15, 33 auto exhaust, 19, 288-289 domestic gas, 288 pesticides, 280 Poisson regression, 7, 396-400, 445-459, 465- 467 Political factors, x-xi, 3, 196, 209-210 committee recommendations, 11, 431 martyrdom, 195, 204 surveillance, 379 terrorists, 195 violence, x, 3, 195, 209 Population Council, 407 Population laboratories, see Research methodology Population studies, see Epidemiology Populations at risk, see Demographic factors Post-traumatic stress disorder (PTSD), 43, 51, 70, 71, 75, 76-77, 89 childhood trauma, 171-172, 173, 177, 178, 181-182 psychotherapy, 246 Pregnancy prevention, 275 Preventive measures, xi, 2-4, 6-7, 89-90, 273-317, 428 see also Clinical trials; Coping; Crisis response; Diagnosis and screening; Means of committing suicide, reducing access to; Pharmaceuticals; Specialty mental health care; Treatment barriers to, 331-373 centers for, xi childhood trauma, 176-177, 181, 182-183 , 184, 303-304 committee recommendations, 10-11, 15, 21, 423, 424, 436-438 federal role, historical perspectives, 19- 20 historical perspectives, 1, 19-20, 302, 310-311 military personnel, 6, 15, 275, 304-305, 436-437, 438 veterans, 1, 12, 14, 20, 230, 336, 433, 438 research methodology, 6-7, 80, 89-90, 273-275, 290, 295, 304, 313-316 school-based, 181, 273, 274, 275-276, 293-297, 299-301, 304, 306, 317, 436, 437, 438 gatekeeper training, 297-298 Native Americans, 308-309 social support, 194-196, 200 state government, 276, 279, 303-304, 312, 313, 436, 438 Universal, Selective, and Indicated model, 274-275 Primary care adolescents, 354-355 alcohol abuse, 99 assessment of patients, 230 barriers to treatment and intervention, 331, 335-337, 339-345, 348, 352, 353, 434-435 childhood trauma, 182-183 clinical trials, judgment of risk, 391-392 education of practitioners, 99, 297, 298-299 , 317, 344-345, 436 elderly persons, 43, 339, 352, 353 follow-up care, 253, 335-336 managed care, 336-337, 340, 341 time factors, pre-suicide contacts with, 43-44, 301, 331-332, 341, 342-343, 344, 346, 353, 434 Prison Litigation Reform Act, 357

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Reducing Suicide: A National Imperative Prisoners, 51-52 assessment of patients, 230 barriers to care, 356-360 children of, 159, 161, 165 Privacy, see Confidentiality Problem solving, 70, 89-90, 91, 95, 99, 194 see also Coping childhood trauma, 175, 181 family-based, 247 school-based prevention programs, 275, 301 treatments, 4, 245, 246-247, 249 Professional education, 99, 273, 316, 344-345 , 436 see also Clinical guidelines autopsies, 55 committee recommendations, 12, 13, 14, 36, 431, 437 coroners and medical examiners, 380-381 developing countries, 360 gatekeeper training, 297-299, 344-345, 437, 438 physicians, 99, 297, 298-299, 317, 344-345 , 436 research centers, 12, 406, 431 school-based prevention programs, 296, 297 supportive therapists, 297 surveillance, 380-381, 386 Professional organizations American Academy of Pediatrics, 14, 183, 436 American Association of Suicidology, 14, 278, 290 American College of Family Physicians, 14, 436 American College of Physicians, 14, 436 American Foundation for the Prevention of Suicide, 14, 278, 438 American Medical Association, 5, 339-340 American Psychiatric Association, 14, 71, 438 American Psychological Association, 14 American Society of Internal Medicine, 14, 436 committee recommendations, 14, 436, 438 Prospective studies, 6, 11, 141, 412, 430, 432 childhood trauma, 165, 166, 177 neurochemistry, 140, 141 Psychiatric and psychological factors, 2, 4, 11, 68-118, 119, 199, 200, 212, 230-233 , 426, 429, 437 see Alcohol abuse; Anxiety disorders; Diagnosis and screening; Guilt and humiliation; Mood disorders; Pharmaceuticals; Psychological autopsies; Specialty mental health care; Substance abuse adherence to treatment, 253-254, 255 adolescents and youth, 40-41 autopsies, 5, 7 barriers to treatment, 331-362 (passim) childhood trauma, 3, 158, 159, 161, 165, 168, 170, 177-181, 183 electroconvulsive therapy, 242-244, 251 employment factors, 205 genetic factors, 130 interventions, 229-270 prisoners, 51-52 psychotherapy, 2, 4, 11, 52, 80, 94, 203-204 , 229, 244-250, 258, 259, 437 clinical trials, 246-250 cognitive behavioral therapy, 92, 245-249 coping training, 26, 94-95, 100, 274, 294-295, 300-301, 317, 437 dialectical behavioral therapy, 80, 248, 249-250 elderly persons, 302 no-suicide contracts, 291 resiliency training, 2, 17, 100, 275, 302, 424 school-based prevention programs, 294-295, 300-301 see also Cognitive-behavioral factors racial/ethnic factors, 46-47, 49, 356 religious influences, 203-204 statistical analysis, 69, 71-100 (passim), 393-395, 400-401 theory, general, 25-26 Psychic pain, 17-19, 68, 87, 91-92, 93, 97-99, 100, 214-215, 350 see also Depression; Guilt and humiliation; Personal suffering assessment of patients, 231, 232 Beck Hopelessness Scale, 231 childhood trauma, 167, 175 elderly persons, 302

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Reducing Suicide: A National Imperative follow-up care, 253 medication for, 236 Native Americans, 309 primary care, 339 prisoners, 357 psychological autopsies, 378 Psychological autopsies, 230-231, 343, 349, 377-379 anxiety disorders, 75 childhood trauma, 165, 167 elderly persons, 43 international perspectives, 212 military personnel, 306 Psychosis, 68, 70, 73, 79 see also Schizophrenia anti-psychotic medications, 4, 236-237, 350 electroconvulsive therapy, 242-243 Public education, 15, 274, 310, 316 see also School factors mass media, 6, 15, 276-280, 289, 294, 304, 310, 316, 437 military personnel, 305, 307 Public opinion, see Attitudes and beliefs; Mass media; Stigma Race/ethnicity, 1, 7, 10, 11, 38, 44-51, 57, 58, 138, 200, 214, 256, 396-400, 424, 425, 452-453 see also Immigrants and refugees; specific racial/ethnic groups adolescents and youth, 45, 46, 47-48, 49, 256 alcohol abuse, 81, 82, 83, 84, 308, 309-310 barriers to treatment, 332-334, 336, 346, 355-356 centers for research, 406, 428 childhood trauma, 162 cost of suicide to society, 56-57 crisis centers and hotlines, 290 discrimination, 209-210, 214, 215, 332-334 , 355, 358-359 elderly persons, 44-45, 48, 57 employment factors, 205-206 firearm use in suicide, 45, 48-49, 280 gender factors, 44-45, 46, 50, 170, 206, 280, 290, 305, 315, 355, 398-399, 452 genetic factors, 130 historical perspectives, 45, 46, 47, 48 prisoners, 51, 358-359 psychiatric and psychological factors, general, 46-47, 49, 356 religious influences, 46, 50-51, 202 urban areas, 45, 356 Railway suicides, 289 Reasons for Living Inventory, 231 Refugees, see Immigrants and refugees Regions of the U.S., 36, 37, 39, 48, 81, 428 childhood trauma, 169 surveillance, 379, 380, 382, 385-386 Registries, 9, 12, 13, 55, 237, 285, 361, 378, 406, 411, 426, 431, 433 international perspectives, 7, 212 Regression analysis, 7, 341, 396-401, 403 mixed-effects regression models, 400-401 , 448-450, 451-454, 458-464 Poisson regression, 7, 396-400, 445-459, 465-467 Religious influences, 3, 98, 195, 201-204, 214, 256-257 elderly persons, 43 gender factors, 46 historical perspectives, 23 martyrdom, 195, 204 racial/ethnic factors, 46, 50-51, 202 surveillance, 380, 381 terrorists, 195 Reporting, 7, 8, 12, 380, 384, 424 see also Definitional issues; Surveillance childhood trauma, 162-164 coroners and medical examiners, 55, 304, 379, 380-381, 384, 411, 432 developing countries, 361 state government, 13, 379 Research methodology, , x 4, 8-9, 213, 246, 348-349, 375-412 see also Animal studies; Clinical trials; Databases; Definitional issues; Epidemiology; Interdisciplinary approaches; Pathway analysis; Psychological autopsies; Registries; Reporting; Statistical analysis; Surveillance case-control studies, 142, 309, 356, 402 centers for research, 10-12, 406-411, 425-431 childhood trauma, 157-158, 162-164, 172-173 committee recommendations, 10-15, 99-100 , 139-142, 216-217, 257-259, 425-438

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Reducing Suicide: A National Imperative cost of suicide to society, 56-57 crisis centers and hotlines, 290 electroconvulsive therapy, 243 follow-up care, 255 genetic studies, 135-142 historical perspectives, 273-274 imitation and contagion, 277 interval estimation, 401-402, 464-467 mood stabilizer use, 233-234 no-suicide contracts, 291 preventive measures, 6-7, 80, 89-90, 273-275 , 290, 295, 304, 313-316 regression analysis, 7, 341, 396-401, 403 mixed-effects regression models, 400-401, 448-450, 451-454, 458-464 Poisson regression, 7, 396-400, 445-459 , 465-467 risk-based allocation, 8, 395, 402-404 sample size considerations, 10, 56, 138, 248, 394, 397, 404-406, 410, 411, 425, 426, 428, 441-442 low-base rate events, 27, 232, 290, 313, 344, 375, 376-377, 423, 424, 425-426, 431 school-based prevention programs, 295 time factors, 395, 401, 402, 406, 429, 462-464 Resiliency, 87-88, 89, 90, 97 childhood trauma, 174 training, 2, 17, 100, 275, 302, 424 Retrospective studies, 4, 424 childhood trauma, 164, 179-180 Risk-based allocation, 8, 395, 402-404 Risk factors, general, xi, 2-4, 9, 12, 21, 26-27, 55, 273, 384-385, 423, 425, 426 see also Diagnosis and screening; Preventive measures; Treatment assessment of, 229-233 barriers to treatment and intervention, 331-373 clinical trails, 8, 258, 391-392, 425 committee recommendations, 10, 13-15, 140-142, 423, 425, 426, 429 definitional issues, 28 informed consent, 8, 292, 359, 389-392 occupations, high-risk, 15, 52-53, 197, 205-206, 317 school-based prevention programs, 276 Robert Woods Johnson Foundation, 407 Rockefeller Foundation, 407 Rural areas, 209, 210, 307-310, 336, 356 firearm use in suicide, 283-284 insecticides as means of suicide, 280 number of suicides, 36, 38, 425 Russia, 3, 85, 196, 210-211 Russian roulette, 380 Samaritans, 290 Sample size considerations, 10, 56, 138, 248, 394, 397, 404-406, 410, 411, 425, 426, 428, 441-442 low-base rate events, 27, 232, 290, 313, 344, 375, 376-377, 423, 424, 425-426 , 431 SAMSHA, see Substance Abuse and Mental Health Services Administration Scale for Suicide Ideation, 230 Schizophrenia, 68, 71, 77-79, 80, 123-124, 138-140, 394 anti-psychotic medications, 236 electroconvulsive therapy, 242-243 inpatient care, 250 lithium treatment, 235 time factors, 78, 237, 254 School factors assessment of students, 232 barriers to treatment, 335, 354 childhood trauma, 174-175 cognitive-behavioral factors, 294, 295-296 counseling, 297-298, 299-301, 309 dropouts, 299, 300, 354 international perspectives, 296, 437 prevention programs, 181, 273, 274, 275-276 , 293-297, 299-301, 304, 306, 317, 436, 437, 438 gatekeeper training, 297-298 Native Americans, 308-309 professional education for programs, 296, 297 psychological autopsies, 378 self-efficacy and self-esteem, 275, 293, 299-300, 301, 309, 437 surveillance, 381-382, 387 time factors, 293, 295, 298, 299, 301 Screening, see Diagnosis and screening Seizures, see Anticonvulsants Self-destructive behavior, general, 181 definitional issues, 71 elderly persons, 43

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Reducing Suicide: A National Imperative follow-up care, 253 personality disorders, 79 psychosis and, 68 serotonin, 126 Self-efficacy and self-esteem, 74, 92-93, 99 see also Coping; Depression; Stigma childhood trauma, 169, 173, 174, 175, 181 family factors, 334 Native Americans, 309 psychotherapy, 245 school-based prevention programs, 275, 293, 299-300, 301, 309, 437 Serotonin, 2, 121-122, 123-129, 132, 135, 136, 137-138, 142 alcohol abuse, 123-124, 137 anxiety disorders and, 77 clinical trials, 127, 238-239, 240, 241-242 depression, 123-125, 126-127 impulsivity, 126, 127-128 lithium treatment, 235 psychological autopsies, 378 serotonin reuptake inhibitors (SSRIs), 238-239, 240, 241-242, 342 Sex differences, see Gender factors Sexual abuse, 132-133, 141, 158, 159 adolescents and youth, 161, 179-180 prisoners, 357, 358 Sexual orientation, 53-55, 176, 378 Shame, see Guilt and humiliation Single persons, 197, 198, 250 Smoking, 84 Social and cultural factors, ix-x, 2, 3, 4, 10, 11, 33, 58, 141, 193-227, 256-257, 311, 317, 424, 431, 432, 435 see also Community programs and studies; Demographic factors; Family factors; Immigrants and refugees; International perspectives; Race/ethnicity; Religious influences; Stigma alcohol abuse, 83 assessment of patients, 231, 232 centers for research, 406, 425-426, 428 childhood trauma, 170, 173-177, 184 cost of suicide to society, x, 55-57, 58, 423 discrimination, 209-210, 214, 215, 332-334 , 355, 358-359 ethnographic research, 10, 11-12, 426, 428, 431 guilt and humiliation, 23, 24, 69 historical perspectives, 21-25, 194-195, 199, 201-202, 210-211, 214 imitation and contagion, 276-278 isolation, 25, 42, 50, 175, 176, 194-195, 196, 197, 198, 200, 208-209, 250, 253, 274, 309, 350 mass media, 6, 15, 276-280, 289, 294, 304, 310, 316, 437 military personnel, 304-305 peer influences, 275, 304, 305, 378 personality disorders, 79 prisoners, 356-357, 358 psychological autopsies, 377 psychotherapy, 245, 249 safety net, 194-196, 200 self-efficacy, 93 substance abuse, 86 widows and widowers, 23, 198, 204 Social Security Administration, 236 Socioeconomic status, 3, 53, 196, 205-206, 207-209, 214, 215 see also Educational attainment; Employment childhood trauma, 159, 165, 179 committee recommendations, 10, 11, 428, 431 educational attainment, 50 immigrants, 50 international perspectives, 207-208, 212-213 psychological autopsies, 377 religious influences, 202 Soviet Union, ix see also Russia Spanish-speaking persons, see Hispanics Specialty mental health care barriers to, 335, 336-340 (passim), 342, 345-349, 357-359 clinical guidelines, 5, 346, 348-349 cognitive-behavioral aspects, general, 4, 80, 92, 99, 100, 245-249, 258 coping training, 26, 94-95, 100, 274, 317, 437 school-based prevention programs, 294-295, 300-301 diagnosis, 346-348 education of, 345, 346 malpractice claims, 346-347 medications, prescription of, 99, 347, 349

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Reducing Suicide: A National Imperative prisoners, 358-359 problem solving, 4, 245, 246-247, 249 Standards see also Clinical practice guidelines; Definitional issues; Ethical issues assessment of patients, 170, 230, 231, 232 clinical trials, 8, 389-391, 432 informed consent, 389 media coverage of suicides, 278-279, 289, 304, 310, 437 no-suicide contracts, 291 surveillance, 387 see also Definitional issues State government childhood trauma, 162 drinking, minimum age laws, 276 firearms, 283, 284-285, 316 prevention programs, 276, 279, 303-304, 312, 313, 436, 438 reporting, 13, 379 surveillance, 379, 381-384, 386, 433 Statistical analysis, 25, 55, 85-86, 160-162, 375, 393-406, 411, 441-468 see also Databases; Epidemiology; Reporting; Surveillance alcohol use, 81-86 (passim) anxiety disorders and, 76-77 clustering, 41, 395-400 ethical issues, 375 interval estimation, 401-402 lifetime risk, 394-395 low-base rate event, 27, 232, 290, 313, 344, 375, 376-377, 423, 424, 425-426 , 431 number of suicides, x, xi, 1, 2, 9, 17, 20, 33, 34-58 , (passim) 375, 423, 424 psychiatric and psychological factors, 69, 71-100 (passim), 393-395, 400-401 regression analysis, 7, 341, 396-401, 403 mixed-effects regression models, 400-401, 448-450, 451-454, 458-464 Poisson regression, 7, 396-400, 445-459, 465-467 risk-based allocation, 8, 395, 402-404 sample size considerations, 10, 56, 138, 248, 394, 397, 404-406, 410, 411 low-base rate event, 27, 232, 290, 313, 344, 375, 376-377, 423, 424, 425-426, 431 Stigma, 5, 53-54, 216, 244, 312, 316, 332-334, 349-350, 351, 352, 361, 434 see also Guilt and humiliation child abuse, denial, 163, 175 developing countries, 360-361 media coverage of suicides, 279 Substance abuse, ix, 2, 3, 5, 39, 69, 70, 85-86, 96, 99-100, 435 see also Alcohol abuse adolescents and youth, 40-41, 49, 88-89, 276 anxiety disorders, 75 barriers to treatment, 339, 342, 349, 350, 361 bipolar disorder, 74 childhood trauma, 159, 161, 165, 173, 177-179, 181 diagnosis, 71, 99, 335, 339, 342, 349 firearm use in suicide, 280 gender factors, 40, 71 genetic factors, 131, 132 historical perspectives, 21 impulsivity, 86, 99 lithium treatment, 235 media portrayals of, 278 Native Americans, 308 overdoses, 15, 241, 285-287, 340 personality disorders, 79, 80 religious influences, 202, 203 school-based prevention programs, 275 surveillance, 384 Substance Abuse and Mental Health Services Administration (SAMHSA), 1, 9, 12, 14-15, 20, 411, 433, 438 media coverage of suicides, 278 Suffocation, 33 Suicide, Options, Awareness and Relief (Project SOAR), 298 Suicide Research Unit, 27 Supportive therapy, 6, 245, 247, 248, (n.7) 258, 274-275, 297, 299-301, 437 Surgeon General, 1, 27, 193, 340, 344-345, 353, 436 childhood trauma, 157, 176, 182, 295-296 emergency care, 345 managed care, 337, 338 media coverage of suicides, 278 specialty mental health care, 346 substance abuse, 384

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Reducing Suicide: A National Imperative Surveillance, 12-13, 303, 379-389, 432-434 see also Databases; Registries; Reporting Centers for Disease Control and Prevention, 12-13, 303, 382, 384, 385-386, 387, 433-434 childhood trauma, 160 coroners and medical examiners, 55, 304, 379, 380-381, 384, 411, 432 emergency rooms, 385, 386-387, 424, 426 funding, 12-13, 384, 433-434 HIV/AIDS, 13, 388, 432, 433, 434 international perspectives, 360-361, 381, 387, 411, 431, 434 legal issues, general, 380, 385-386 legislation, 382, 383, 384, 386, 387 local government, 379, 381-382, 386, 411 professional education, 380-381, 386 regional factors, U.S., 379, 380, 382, 385-386 religious influences, 380, 381 school factors, 381-382, 387 standards, 387 state government, 379, 381-384, 386, 433 Sweden, 5, 76, 207-208, 239, 296, 343-344 Switzerland, 278, 279 Telephone contacts follow-up services, 254 hotlines, 279, 288, 289-290, 304, 315-316 Television, 277 Temperament, 70, 95-97, 214 see also Attitudes and beliefs; Depression; Impulsivity; Personality disorders Terminal illness attitudes toward suicide, 333 elderly persons, 42, 43-44 euthanasia/assisted suicide, 21, 44 Terminology, see Definitional issues Terrorists, 195 Time factors, 400, 401, 462 see also Age factors; Historical perspectives; Longitudinal studies; Prospective studies; Retrospective studies African-Americans, mental disorders, 47 bipolar disorder, 74, 254 childhood trauma, 157, 163 depression, 72, 125, 240, 241, 248, 401 discharge from inpatient care, suicide following, 4, 74, 84, 255, 259, 345-346 , 425, 430, 434 elderly, death following attempt, 42 electroconvulsive therapy, 243 euthanasia, consideration of, 44 Fatality Analysis Reporting System, 383 follow-up, 174(n.11), 231, 255, 259, 394, 425 gun control, 283, 284-285 health service contacts prior to suicide, 5, 255, 331, 348, 361, 377, 434 hypothalamic-pituitary-adrenal axis dysregulation, 172 imitation and contagion, 41, 131-132, 276-278, 316, 385, 395-400, 475 inpatient care, 43, 345-346, 373 discharge from inpatient care, suicide following, 4, 72, 74, 255, 259, 345-346, 425, 430, 434 length of stay, 11, 249, 259, 337, 338, 400, 401, 430, 462-464 locus of control, 93-94 media reporting of suicides, 279-280 medication, 234, 235, 240, 241, 242, 244, 248, 254, 350 primary care providers, pre-suicide contacts with, 43-44, 301, 331-332, 341, 342-343, 344, 346, 353, 434 psychological autopsies, 377-378, 383 psychotherapy visits, 349 research methodology, 395, 401, 402, 406, 429, 462-464 schizophrenia, 78, 237, 254 school-based prevention programs, 293, 295, 298, 299, 301 serotonin reuptake inhibitors (SSRIs), 240 Time series analysis, 77 Tissue samples, 12, 119, 426-427 see also Brain and brain repositories Tobacco use, see Smoking Training, see Professional education; Public education Trauma, see Childhood trauma Treatment, general, 4-6, 79-80, 99, 275 see also Adherence to treatment; Clinical trials; Emergency care; Follow-up care; Health insurance; Inpatient care; Outpatient care; Pharmaceuticals; Preventive measures; Specialty mental health care barriers to, 331-373

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Reducing Suicide: A National Imperative discrimination, 209-210, 214, 215, 332-334 managed care, 336-339 see also Health insurance; Stigma childhood trauma, 157, 176-178, 182-183 , 184 cognitive-behavioral factors, 4, 80, 92, 99, 100, 245-249, 258, 348 committee recommendations, 10-11, 141, 423, 424, 428, 429 coping training, 26, 94-95, 100, 274, 317, 437 school-based prevention programs, 294-295, 300-301 cost of, 56; see also Health insurance developing countries, 360-361 elderly persons, 302 electroconvulsive therapy, 242-244, 251 fragmentation of services, 5, 332, 335-336 , 350, 355, 361, 434 media coverage of suicides, 279 no-suicide contracts, 291-292 psychological autopsies, 377 religious influences, 203-204, 256-257 supportive therapy, 6, 245, 247, 248(n.7), 258, 274-275, 297, 299-301, 437 Tricyclic antidepressants, 239, 240, 287 Trytophan hydroxylase, 135 Twin studies, 2, 132, 133-134, 140-142 Ukraine, 35, 36, 206, 210 Unemployment, 3, 40, 51, 52, 85, 196, 205, 207, 208, 215, 354 Uniform Crime Reports, 384 United Kingdom, 35, 50, 194-195, 212, 251, 276, 286, 288, 312, 381 United Nations, 90, 302, 303, 305, 310, 312 Universal, Selective, and Indicated model, 274-302, 436-438 Urban areas, 209, 210, 299-300, 336 alcohol abuse, 82 drug overdoses, 286-287 firearm use in suicide, 283-284 jumping as means of suicide, 287-288 number of suicides, 36, 37, 38, 425 racial/ethnic factors, 45, 356 railway suicides, 289 U.S. Air Force, 6, 15, 304-307, 313, 436-437, 438 Vaproic acid, 235 Veterans Administration, see Department of Veterans Affairs Violence and aggressive behavior, 40, 58, 72, 95, 119, 120, 122, 240, 315, 377, 435 see also Child abuse; Crime and criminal behavior; Firearms; Impulsivity; Sexual abuse domestic, other than child abuse, 141, 159, 166, 173, 175, 178, 198-199, 297 genetic factors, 2, 11, 130, 131, 136, 138, 141-142, 430 neurobiological factors, 119, 120, 122, 125, 126, 128, 131, 136, 138, 140, 235-236, 241 political violence, , x 3, 195, 209 prisoners, 357 Widows and widowers, 3, 352 cultural influences, 23, 198, 204 Women, see Gender factors World Bank, 428 World Health Organization, 35, 211, 212, 275, 278, 296, 302, 303, 305, 310, 312, 387, 428 World Wide Web, see Internet Youth, see Adolescents and youth Youth Risk Behavior Survey (YRBS), 385-386