vidual psychological traits such as hopelessness and impulsiveness all increase the risk. The presence of multiple risk factors further increases the risk. Yet, simply identifying the risk factors is not adequate for the development of effective interventions.

The Surgeon General’s 1999 Call to Action (PHS, 1999) and subsequent reports on mental illness in the United States (US DHHS, 1999; US DHHS, 2001) raised public awareness of the complexity of the issue and the need for multifaceted approaches.

The lack of universally accepted definitions for suicide and suicidal behaviors hampers progress. Comparisons across studies that are critical for a low-base rate behavior such as suicide are critical but difficult with the use of variable terminology. The Committee consensus was that universally accepted definitions of suicide, suicide attempts, suicidal ideation, and suicidal communications are needed to facilitate efforts in the field. Early classifications of suicidal behavior were typologies with implied causal relationships, but were not evidence-based. These efforts incorporate useful clinical and sociological observations, but do not serve the need for a classification system. For the purpose of this study, the Committee chose a classification system that does not speak to causal hypotheses. Rather, it selected the system initiated at the National Institute of Mental Health Center for the Studies of Suicidal Prevention meeting in 1972–1973 that has been refined through subsequent research (O’Carroll et al., 1996). These definitions, listed below, best described how the committee chose to think about the terms used throughout the report. This choice allowed them to move forward with their task but is not meant as a recommendation for the field. The terms are defined here to provide guidance to the reader in understanding what is meant in the report when this terminology is used.

Suicide: Fatal self-inflicted destructive act with explicit or inferred intent to die. Multiaxial description includes: Method, Location, Intent, Diagnoses, and Demographics.

Suicide attempt: A non-fatal, self-inflicted destructive act with explicit or inferred intent to die. (Note: important aspects include the frequency and recency of attempt(s), and the person’s perception of the likelihood of death from the method used, or intended for use, medical lethality and/or damage resulting from method used, diagnoses, and demographics.)

Front Matter (R1-R16)

Executive Summary (1-16)

1 Introduction (17-32)

2 Magnitude of the Problem (33-68)

3 Psychiatric and Psychological Factors (69-118)

4 Biological Factors (119-156)

5 Childhood Trauma (157-192)

6 Society and Culture (193-228)

7 Medical and Psychotherapeutic Interventions (229-272)

8 Programs for Suicide Prevention (273-330)

9 Barriers to Effective Treatment and Intervention (331-374)

10 Barriers to Research and Promising Approaches (375-422)

11 Findings and Recommendations (423-438)

Appendix A: Statistical Details (439-468)

Appendix B: Consultants (469-471)

Appendix C: Workshop Agendas (472-474)

Index (475-496)