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Book Forum: Suicide   |    
Suicide Prevention—The Global Context
GIOVANNI B. CASSANO, M.D.
Am J Psychiatry 1999;156:966a-967.
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edited by Robert J. Kosky, Hadi S. Eshkevari, Robert D. Goldney, and Riaz Hassan. New York, Plenum, 1998, 412 pp., $115.00.

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This volume contains a selection of the papers and abstracts presented at the XIXth Congress of the International Association for Suicide Prevention held in 1997 in Adelaide, Australia. The editors note in their preface that they intend "to give a flavor of the diversity as well as the information on the work [on suicide] that is currently being done around the world." However, more than a third of the chapters are contributed by researchers from Australia and New Zealand. The book is divided into three sections: Suicide, Attempted Suicide, and Prevention.

The section titled Suicide begins with a chapter addressing the longstanding problem of the lack of a standardized nomenclature for suicide-related behavior. Two interesting contributions by Brent’s group on the familial risk for adolescent suicidal behavior follow. The key role of a positive history for psychiatric disorders in parents in increasing the risk of suicidal behavior in their children is discussed in a clear fashion. However, the liability to suicidal behavior appears to be transmitted in families partially as a trait independent from any psychiatric disorder. The sad reality of youth suicide in Australia is the topic of two chapters that report interesting findings on risk factors for completed suicide among youngsters. A number of other chapters are devoted to the state of the art on suicide and suicide prevention in several countries throughout the world, including rural and aboriginal communities such as the Canadian Inuit and the Aboriginal Australians. I agree with the editors’ statement in the preface that "the publication of these interesting papers will remind the reader that attitudes toward suicide and attempted suicide differ from community to community, and that we cannot take contemporary Western attitudes in the area for granted when we are thinking about the problem of suicide in other parts of the world."

Psychopathological features, life events, and psychiatric disorders associated with attempted suicide and self-inflicted injury are discussed in the section titled Suicide Prevention. Dr. Beautrais provides a comprehensive case-control study on risk factors for suicide attempts among young people in New Zealand. This work strongly suggests that suicide attempts "represent the culmination of adverse life course sequences which have been marked by accumulation of risk factors from the domains of social disadvantage, childhood adversity, personality factors, psychiatric disorders and adverse life events." This section continues with a chapter by Kerryn L. Brain on the psychophysiology of self-mutilative behavior, which shows that the reduction of psychophysiological arousal, rather than the emotional response, reinforces self-mutilative behavior. This study suggests that self-mutilative behavior is not significantly associated with the level of psychiatric symptoms the individual is experiencing. Lil Träskman-Bendz concludes the section with a comprehensive review article on the biological markers of suicidal behavior.

The last section provides an overview of suicide intervention programs in different countries. Among many interesting strategies proposed for suicide awareness and prevention, an original idea comes from Graham Stoney, an Australian volunteer counselor who has developed a "suicide-prevention mailing list" on the Internet that currently has about 100 members. However, it is unfortunate that no chapters in this section were devoted to the psychotherapeutic and psychopharmacological approaches to the prevention of suicidal behavior.

Overall, this book, which has the strengths and the weaknesses of all proceedings, provides a good overview on the latest studies of suicide and suicide prevention and will be of interest to researchers in the field of suicidology. However, I would not recommend this volume to a reader interested in a general and comprehensive overview on suicidology.

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