IDENTIFICATION OF SUICIDE RISK FACTORS USING EPIDEMIOLOGIC STUDIES
Section snippets
Methodologic Issues
The coding of a death as suicide is relatively uniform in developed countries, making international comparisons possible.124 Most member nations of the World Health Organization currently use the standardized ninth revision of the International Classification of Diseases (ICD-9) 123 to code mortality data. In the United States, national mortality data are compiled on an annual basis from standardized death certificate information submitted by the States to the National Center for Health
Methodologic Issues
The study of nonfatal suicidal behavior has been hampered by the lack of a consistently applied standard nomenclature among investigators, 37, 86 and by the failure to use clear operational definitions when collecting data or reporting on clinical outcomes.79, 86 The need to apply standardized terminology in the study of suicidal behavior was identified in the literature more than 20 years ago 8 but, with few exceptions (e.g., reference 86), has remained largely unaddressed.37, 38, 79
RISK FACTORS FOR COMPLETED AND ATTEMPTED SUICIDES
Most suicidal behaviors occur on a continuum of severity that proceeds from less serious and more prevalent behaviors through increasingly severe and less prevalent behaviors.66, 86 At one end are included behaviors, such as casual ideation without specific plans. These behaviors may progress in some individuals through persistent, intense ideation that includes a plan, self-inflicted injury without intent to die, and, for a very small proportion of persons at the other end of the continuum, to
IMPLICATIONS FOR PREVENTION
The epidemiologic evidence consistently has shown that suicide has multiple, interacting causes, and risk factors that frequently co-occur. Mental disorders, especially mood, personality, and substance use disorders, underlie the vast majority of completed and attempted suicides. Suicide is a complex, long-term outcome that requires complex theoretical models for appropriate study and complex interventions for effective prevention.
The best method for preventing suicide is likely to be one that
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