and Smith, 1991; Koivumaa-Honkanen et al., 2001; Malone et al., 2000, see also Chapter 6). Positive coping self-efficacy beliefs can directly reduce psychic distress (e.g., Benight et al., 1999b; Catanzaro and Mearns, 1999). Self-efficacy enhancement can be provided through a number of psychotherapeutic approaches such as mastery experiences, verbal persuasion, and modeling/teaching. Studies examining phenomenological and neuroscience variables (e.g., social cognitive neuroscience) have been neglected, but some researchers suggest such integrative studies would be useful for prevention (e.g., Beskow et al., 1999).
Approximately 50 percent of those who complete suicides are not in treatment, despite that the vast majority are suffering from psychiatric disorders. Those that are in treatment are often inadequately medicated, insufficiently followed after acute treatment, and/or do not adhere to treatment plans.
Adequate training is essential so that primary care physicians and specialty care physicians understand the appropriate doses of psychopharmacological medications to prescribe and how to follow up to ensure adherence.
Suicide most commonly is associated with a diagnosis of depression. Recent research has increasingly established anxiety disorders and borderline personality disorder as significantly elevating suicide risk. Comorbidity of psychiatric disorders and/or substance abuse is common and further increases suicide risk. About 90 percent of suicides are associated with mental illness, but over 95 percent of those afflicted never even attempt suicide.
Additional research, especially prospective, longitudinal, and ecological-transactional research, is necessary to understand the etiological pathways to suicide and what identifies those who are at risk.
About one fourth of all suicides in the U.S. are individuals with alcohol use disorders. Alcohol inebriation is indicated in up to 64 percent of suicide attempts. Abuse of illicit substances also is associated with a significant increase in suicide rate.
Alcohol and substance abuse are important risk factors for suicide and should be heeded by physicians as indicators of potential for suicide.