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This chapter focuses on the assessment and treatment of suicidal behavior. First, it discusses the assessment of the severity and risk of suicidal ideation among youths. The typical areas covered in the clinical assessment of suicide risk are predisposing factors, precipitant stressors, symptoms of psychopathology, hopelessness, suicidal thoughts, previous suicidal behavior, impulsivity and self-control, and protective factors. Next, the chapter discusses the clinical interventions for suicidal youth, beginning with nonpsychotherapy interventions, followed by individual, group, and family therapies, as well as pharmacologic interventions. Finally, the chapter identifies some of the factors that affect the rate of compliance with treatment among suicidal adolescents.

This chapter examines suicide and suicidal behaviors among African American adolescent and young adult males. It shows that the odds for suicide were highest for African American males, even after controlling for the numerous clinical, geographic, and sociodemographic vulnerability factors associated with suicide. This finding supports previous risk factor studies and epidemiological research that illustrated a rise in suicide among African Americans, particularly the younger age groups. Consistent with prior analysis of suicidal behavior, the analyses reveal that African Americans are more likely to die at younger ages of suicide. The study also confirmed prior research showing that having a gun in the home substantially increases the risk for suicide. This is particularly true for males, as illustrated by the almost fourfold increase in the risk of suicide when a gun is known to be in the home.

This chapter explores the roles of various social relationships, including family, peer, and romantic relationships in the development of suicidal behavior. Much attention is given to family influences, including a review of family structure issues and evidence for genetic transmission of psychopathology and a predisposition to child and adolescent suicidal behavior. The chapter also discusses bullying and victimization by peers, and suicidal behavior among gay, lesbian, bisexual, and transgender adolescents.

This chapter examines theoretical models of suicide and nonfatal suicidal behaviors. The models of suicidal behavior include sociological, psychological, biological, family, and biopsychosocial models. Sociological models are categorized into egoistic, altruistic, anomic, and fatalistic suicides. Psychological models include psychodynamic, cognitive, social learning, and psychological and interpersonal models. The chapter also discusses the developmental theories that are applicable for constructing models of suicidal processes.

This concluding chapter discusses the prevention of suicidal behavior. It begins with a brief overview of the history of suicide prevention in the United States. It then discusses the major factors influencing the success of prevention programs. The chapter also discusses the theoretical basis for prevention. It proposes a theoretical model of the suicidal crisis that is common across suicidal individuals. This model includes four elements: emotional pain, difficulties regulating and coping with that pain, disconnection, and disillusionment. The theory is based on knowledge of the risk factors and is also reflective of research on suicide prevention.

Suicidal behavior can be a common end point for children and adolescents who are depressed and anxious, inhibited, avoidant, aggressive, or impulsive. This book focuses on suicidal behavior among children and adolescents. It describes the nature and problem of suicide and suicidal behavior, the theoretical models that explain suicide and nonfatal suicidal behavior, and examines research on the precursors, risk factors, causes, and clinical and preventive interventions that are helpful across a wide spectrum of suicidal youths.

This chapter explores the variability in the ways in which suicidal youths manage their emotions and cope with stress. First, it discusses the cognitive states associated with suicidal behavior, such as perceptions of low self-worth, cognitive diatheses, and perceived control. It then considers the coping responses and ways of regulating emotions that are associated with suicidal behavior. Finally, the chapter considers the relevance of impulsivity and anger among suicidal youngsters.

This chapter examines the role of psychopathology in the emergence of suicidal behavior. It evaluates which of three broad classes of psychopathology—mood, disruptive, and substance abuse disorders—poses the greatest risk of suicide in adolescents. The chapter also reviews studies that investigate serotonin factors and candidate genes that may be involved in suicidal behaviors.

Women on the Confederate homefront, living in a war zone, suffered psychologically. Socialized to believe in doctrines of paternalism, many women were ill-equipped and unaccustomed to new wartime roles household head that the absence of men required of them. Many southern white women found the added demands of war unbearable and too demanding, leading some to succumb to mental illness that sometimes led to institutionalization in insane asylums, and suicidal ideation or behavior. The most vulnerable women on the homefront were young mothers and widows who bore the heaviest burdens when their husbands were gone leaving them to care for families under trying circumstances. Also contributing to the psychological ailments of Confederate women were worries about male relatives on the battle front, fear of invading armies, scarcity, financial duress, deaths of loved ones, and management of slave labor. The war also exacerbated conditions of women with postpartum disorders rendering them vulnerable to institutionalization or suicidal behavior. The chapter also compares women’s suicidal activity to mens’ and concludes that women more actively thought and talked about ending their lives than men, with relatively few ending their lives, whereas the suicidal behavior of men was more often lethal when compared to women.

Suicidal behavior is a major health problem causing more than 1 million deaths worldwide each year. The risk of suicide-related behavior is supposed to be determined by a complex interplay of sociocultural factors, psychiatric history, personality traits, and genetic as well as neurobiological vulnerability. Personality traits like impulsivity, anger or aggression are valuable intermediate phenotypes in the search for the genetics of such a complex trait. This review will summarize genetic factors of phenotypes as risk factors for suicidal behavior. There is hope that simpler, quantifiable measures will be more elementary compared to clinical phenotypes. It is assumed that the number of genes required to produce variations in these traits may be fewer than those involved in producing a diagnostic entity. Further understanding of the genetics and pathophysiology of suicidal behavior is therefore very important.

This chapter focuses on the risk of suicide in all cases of severe personality disorder. It describes a treatment approach to patients with chronic characterological suicidal behavior without depression called transference-focused psychotherapy (TFP), along with additional and alternative treatment approaches.

This chapter examines the link between alcohol consumption and suicide. Alcohol consumption is one of the most important risk factors for suicidal behaviour and its effect reaches across the range of demographics in US society. The Alcohol-Related Disease Impact system is one method of estimating the number of alcohol-attributable deaths (AADs) and years of potential life lost (YPLLs) due to alcohol. From 2001 to 2005, an estimated annual 79,646 AADs and 2.3 million YPLL were attributed to the harmful effects of excessive alcohol use. An estimated annual 7,266 AAD and 243,018 YPLL were associated with suicide specifically. Some theories point to alcohol as a moderator for suicidal behaviour due to its link with psychiatric illness, depression, social isolation, and other significant suicide-related risk factors. These ideas make alcohol-related interventions a valid target for suicide prevention and intervention measures. Clinical research shows that brief interventions in a variety of settings, such as primary care, emergency departments, prenatal care, criminal justice system, and college, can decrease alcohol consumption, and these work in a variety of populations — younger and older adults, men and women.