Reducing Suicide A National Imperative (2002) / Chapter Skim
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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, 4041, 42, 70, 87-89, 131, 200, 211, 425, 438, 452 see also School factors adherence to treatment, 354 alcohol and substance abuse, 4041, 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, 283284 follow-up care, 255-256, 345 genetic factors, 131-132 475 imitation and contagion, 131-132, 278, 395 military personnel, 305 Native Americans, 308-309 number of suicides, xi, 1, 17, 40, 46, 5758, 425 physicians of, 354-355 pregnancy prevention, 275 preventive efforts, 20, 333, 336, 343, 354355, 362, 475 psychological autopsies, 378 racial/ethnic factors, 45, 46, 4748, 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-pituitaryadrenal axis; Noradrenergic system African-Americans, 44-47, 57, 256, 397-398, 452 childhood trauma, 162 employment factors, 205-206
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, 1, 12, 20, 433 Native Americans, 81, 82, 83, 308, 309310 race/ethnicity, 81, 82, 83, 84, 308, 309310 religious influences, 202, 203 INDEX 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, 237242, 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, 400401, 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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INDEX 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, 332334, 355, 358-359 gatekeeper training, 299 school-based prevention programs, 294295 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, 140 477 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, 425426, 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, 309310, 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, 385386, 387, 433-434 Cerebrospinal fluid, 123, 124-126 Child abuse, 4, 80, 158-159, 162-164, 174178, 182, 297, 432 memory of lacking, 163, 175 post-traumatic stress disorder, 172, 173
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, 171-172, 173, 177, 178, 181-182 preventive measures, 176-177, 181, 182183, 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 INDEX epidemiology, 157-168 (passim) , 178179, 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, 177179, 181 Surgeon General's reports, 157, 176, 182, 295-296 time factors, 157, 163 treatment, general, 157, 176-178, 182183, 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)
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pope 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, 297298, 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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, 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, 400401, 462 see also Antidepressant medications; Bipolar disorder; Depression; Guilt and humiliation; Psychic pain; Self-efficacy and selfesteem 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, 351353 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, 339340, 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, 3940 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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, 7176 (passim) , 79 Dialectical behavioral therapy, 80, 248, 249250 Discrimination, 209-210, 214, 215, 332-334, 355, 358-359 Div alp roex, 235 Divorce, ix, 3, 85, 165, 167, 196, 197, 198-199 481 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, 205209, 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, 4144, 57, 256, 301-302, 317, 438, 452 adherence to treatment, 43, 353 barriers to treatment, 331-332, 333, 351353, 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, 4445, 48, 425 personality characteristics, 95 pharmacotherapy, 302 physicians of, 43, 339, 352, 353
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, 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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. 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, 3940, 130, 136, 138, 197, 198, 208, 210-211, 396-400, 452453 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, 3940 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, 4445, 46, 50, 170, 206, 215, 280, 290, 305, 355, 398399, 452 religious influences, 202 rural areas, young males, 36 schizophrenia, 77, 78 serotonin, 138 substance abuse, 40, 71 Generalized Estimating Equations, 397, 450451
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484 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, 451459 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 INDEX 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, 194195, 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, 276278, 316, 385, 395400, 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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, 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, 401402, 464467 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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486 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, 431432 centers for research, 406, 426, 428, 429, 430 childhood trauma, 163,177-178,179180, 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, 294295 sexual orientation, 54-55 unemployment, 207 youth, 87-88 INDEX Low-base rate events, 27, 232, 290, 313, 344, 375, 376-377, 423, 424, 425426, 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, 165,167,196,197,198199 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, 280289, 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, 436437, 438 veterans, 1, 12, 14, 20, 230, 336, 433, 438
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, 1, 12, 433 National Institutes of Health (NIH) , 431 National Prescription Audit, 287 National Strategyfor Suicide Prevention, 20, 90,278,338,340,342,346 National Violent Death Reporting System, 13, 383-384, 432-434 Native Americans, 1, 17, 45, 4749, 57, 307310, 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)
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, 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, 235236, 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 Div alp roex, 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)
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, 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, 24, 6-7, 89-90, 273-317, 428 489 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, 182183, 184, 303-304 committee recommendations, 10-11, 15, 21, 423, 424, 436-438 federal role, historical perspectives, 1920 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 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, 298299, 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, 4344, 301, 331-332, 341, 342-343, 344, 346, 353, 434 Prison Litigation Reform Act, 357
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, 393-395, 400401 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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INDEX 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, 4748, 49, 256 alcohol abuse, 81, 82, 83, 84, 308, 309310 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, 332334, 355, 358-359 elderly persons, 4445, 48, 57 employment factors, 205-206 firearm use in suicide, 45, 4849, 280 gender factors, 4445, 46, 50, 170, 206, 280, 290, 305, 315, 355, 398-399, 452 genetic factors, 130 historical perspectives, 45, 46, 47, 48 prisoners, 51, 358-359 491 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, 396401, 403 mixed-effects regression models, 400401, 448-450, 451454, 458464 Poisson regression, 7, 396400, 445-459, 465467 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, 375412 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, 406411, 425431 childhood trauma, 157-158, 162-164, 172-173 committee recommendations, 10-15, 99100, 139-142, 216-217, 257-259, 425438
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492 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, 401402, 464467 mood stabilizer use, 233-234 no-suicide contracts, 291 preventive measures, 6-7, 80, 89-90, 273275, 290, 295, 304, 313-316 regression analysis, 7, 341, 396401, 403 mixed-effects regression models, 400-401, 448-450, 451454, 458464 Poisson regression, 7, 396400, 445459, 465-467 risk-based allocation, 8, 395, 402404 sample size considerations, 10, 56, 138, 248, 394, 397, 404406, 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, 462464 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, 402404 Risk factors, general, xi, 24, 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 INDEX 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, 425426, 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, 295296 counseling, 297-298, 299-301, 309 dropouts, 299, 300, 354 international perspectives, 296, 437 prevention programs, 181, 273, 274, 275276, 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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, 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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, 375, 423, 424 psychiatric and psychological factors, 69, 71-100 (passim) , 393-395, 400401 regression analysis, 7, 341, 396401, 403 mixed-effects regression models, 400-401, 448-450, 451454, 458464 Poisson regression, 7, 396400, 445459, 465-467 risk-based allocation, 8, 395, 402404 sample size considerations, 10, 56, 138, 248, 394, 397, 404406, 410, 411 low-base rate event, 27, 232, 290, 313, 344, 375, 376-377, 423, 424, 425-426, 431 INDEX 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, 4041, 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)
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, 240 Time series analysis, 77 Tissue samples, 12, 119, 426427 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; Followup care; Health insurance; Inpatient care; Outpatient care; Pharmaceuticals; Preventive measures; Specialty mental health care barriers to, 331-373
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Air Force, 6, 15, 304-307, 313, 436437, 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)
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