Why Are Suicide Rates Increasing in the United States? Towards a Multilevel Reimagination of Suicide Prevention
Suicide, a major public health concern, takes around 800,000 lives globally every year and is the second leading cause of death among adolescents and young adults. Despite substantial prevention efforts, between 1999 and 2017, suicide and nonfatal self-in
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ontents 1 Introduction 2 Recent Trends in Suicide and Nonfatal Self-Harm 2.1 Global Trends in Suicide and Nonfatal Self-Harm 2.2 Trends in Suicide and Nonfatal Self-Harm in the United States 2.3 Why Are Suicide Rates Increasing in the United States? 3 Individual-Level Suicide Prevention 3.1 Individual-Level Suicide Risk Prediction 3.2 Individual-Level Interventions for Suicide Risk Prevention 4 Population-Level Suicide Prevention 4.1 Population-Level Suicide Risk Factors: The Logic in Ecological 4.2 Population-Level Suicide Prevention 5 Conclusion 5.1 Towards a Multilevel Approach to Suicide Prevention References
Abstract Suicide, a major public health concern, takes around 800,000 lives globally every year and is the second leading cause of death among adolescents and young adults. Despite substantial prevention efforts, between 1999 and 2017, suicide and nonfatal self-injury rates have experienced unprecedented increases across the United States – as well as in many other countries in the world. This chapter reviews the existing evidence on the causes behind increased suicide rates and critically evaluates the impact of a range of innovative approaches to suicide prevention. First, we briefly describe current trends in suicide and suicidal behaviors G. Martínez-Alés (*) Columbia University Mailman School of Public Health, New York, NY, USA Universidad Autónoma de Madrid School of Medicine, Madrid, Spain e-mail: [email protected] D. Hernández-Calle La Paz University Hospital, Madrid, Spain N. Khauli and K. M. Keyes Columbia University Mailman School of Public Health, New York, NY, USA © Springer Nature Switzerland AG 2020 Curr Topics Behav Neurosci https://doi.org/10.1007/7854_2020_158
G. Martínez-Alés et al.
and relate them to recent time trends in relevant suicide risk markers. Then, we review the existing evidence in suicide prevention at the individual and the population levels, including new approaches that are currently under development. Finally, we advocate for a new generation of suicide research that examines causal factors beyond the proximal and clinical and fosters a socially conscious reimagining of suicidal prevention. To this end, we emphasize the need for the conceptualization of suicide and suicidal behaviors as complex phenomena with causes at several levels of organization. Future interdisciplinary research and interventions should be developed within a multilevel causal framework that can better capture the social, economic, and political settings where suicide, as a process, unfolds across the life course. Keywords Multilevel epidemiology · Prevention · Self-harm · Suicide
1 Introduction Suicide, the “only one really serious philosophical problem” (Camus 1955), is a major public health concern that takes around 800,000 lives globally every year. Death by suicide is the second leading cause of death among youth and accounts for 57% of all violent deaths and roughly 1.5% of all mortality – more than malaria or breast cancer (World Health Organization 2019). Because suicide “is of all m
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