What should we do now? On the basis of the epidemiological burden that we see in the United States, I would argue that it is long overdue to focus on men and women in the middle years of life in addition to youths and elders (5). Suicide often is the final punctuation of a long story of distress and disturbed relationships; in the middle years this story typically involves many others—spouses and partners, children, parents sometimes, and employers frequently. There is a heavy toll of alcohol and drug use, recurrent mood disturbances, family violence, and years (if not decades) of decline, and many opportunities for prevention and early intervention and for socially and environmentally focused mental health promotion (strength building in the face of challenges and adversities). Whether a smoking or a heart disease analogy is employed, which we have used previously, seeking to change life trajectories must begin decades before the immediate life-ending event.