Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.

There is much work to be done to better understand suicidal thoughts and behaviors among youth. We strongly encourage future research to: (1) continue improving the conceptualization and operationalization of suicidal thoughts and behaviors; (2) improve etiological understanding by focusing on individual (preferably malleable) mechanisms; (3) improve etiological understanding also by integrating findings across multiple units of analyses and developing short-term prediction models; (4) demonstrate greater developmental sensitivity overall; and (5) account for diverse high-risk populations via sampling and reporting of sample characteristics. These serve as initial steps to improve the scientific approach, knowledge base, and ultimately prevention of suicidal thoughts and behaviors among youth.

A long-standing challenge for scientific and clinical work on suicidal behavior is that people often are motivated to deny or conceal suicidal thoughts. We proposed that people considering suicide would possess an objectively measurable attentional bias toward suicide-related stimuli, and that this bias would predict future suicidal behavior. Participants were 124 adults presenting to a psychiatric emergency department who were administered a modified emotional Stroop task and followed for six months. Suicide attempters showed an attentional bias toward suicide-related words relative to neutral words, and this bias was strongest among those who had made a more recent attempt. Importantly, this suicide-specific attentional bias predicted which people made a suicide attempt over the next six months, above and beyond other clinical predictors. Attentional bias toward more general negatively-valenced words did not predict any suicide-related outcomes, supporting the specificity of the observed effect. These results suggest that suicide-specific attentional bias can serve as a behavioral marker for suicidal risk, and ultimately improve scientific and clinical work on suicide-related outcomes. Keywords suicide; attentional bias; Stroop task; predictionSuicide is a leading cause of death in the United States and worldwide (Nock et al., 2008). Mortality data indicate that one person dies by suicide somewhere around the world every 40 seconds (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). The high rate of suicide results in part from the fact that assessment primarily depends on people's explicit self-report, Correspondence to Matthew K. Nock, Ph.D., Department of Psychology, Harvard University, 33 Kirkland Street, 1280, Cambridge, MA 02138, nock@wjh.harvard.edu.. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/ABN NIH Public Access which is unreliable because people often are motivated to deny their suicidal thoughts (Busch, Fawcett, & Jacobs, 2003). Developing more objective and scientifically rigorous ways of determining who is at risk for suicidal behavior is essential for both scientific and clinical work addressing this devastating behavior problem.The National Institute of Mental Health (NIMH) Strategic Plan lists as one of its primary objectives the identification of biological and behavioral markers associated with mental disorders and clinical behavior problems (NIMH, 2009). Behavioral markers are objectively observable, behavior-based factors that indicate some underlying disease process and can aid in c...

This study examined nonsuicidal self-injury (NSSI) in a community sample of young adolescent girls. Potential moderators of the relationships between different types of distress (internal and interpersonal) and particular functions of NSSI (emotion-regulation and interpersonal) were explored. Participants included 94 girls (49% Hispanic; 25% African American) ages 10-14 years who completed questionnaires regarding self-injurious behavior and other constructs of interest. Fifty-six percent of girls (n = 53) reported engaging in NSSI during their lifetime, including 36% (n = 34) in the past year. Internal distress (depressive symptoms) was associated with engaging in NSSI for emotion-regulation functions, and rumination moderated the relationship between depressive symptoms and engaging in NSSI for automatic positive reinforcement. Interpersonal distress (peer victimization) was associated with engaging in NSSI for social reinforcement, and quality of peer communication moderated this relationship. The clinical implications of these findings include designing preventions that address the particular contexts of self-injurious behavior.

Self-injurious thoughts and behaviors (SITBs) are major public health concerns impacting a wide range of individuals and communities. Despite major efforts to develop and refine treatments to reduce SITBs, the efficacy of SITB interventions remains unclear. To provide a comprehensive summary of SITB treatment efficacy, we conducted a meta-analysis of published randomized controlled trials (RCTs) that have attempted to reduce SITBs. A total of 591 published articles from 1,125 unique RCTs with 3,458 effect sizes from the past 50 years were included. The random-effects meta-analysis yielded surprising findings: The overall intervention effects were small across all SITB outcomes; despite a near-exponential increase in the number of RCTs across five decades, intervention efficacy has not improved; all SITB interventions produced similarly small effects, and no intervention appeared significantly and consistently stronger than others; the overall small intervention effects were largely maintained at follow-up assessments; efficacy was similar across age groups, though effects were slightly weaker for child/adolescent populations and few studies focused on older adults; and major sample and study characteristics (e.g., control group type, treatment target, sample size, intervention length) did not consistently moderate treatment efficacy. This meta-analysis suggests that fundamental changes are needed to facilitate progress in SITB intervention efficacy. In particular, powerful interventions target the necessary causes of pathology, but little is known about SITB causes (vs. SITB correlates and risk factors). The field would accordingly benefit from the prioritization of research that aims to identify and target common necessary causes of SITBs.