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Book Review   |    
Michael B. Sheikman
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.9.1348
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edited by Diego de Leo, Unni Billi-Brahe, Ad Kerkhof, and Armin Schmidtke; Gottinggen, Germany, Hogrefe and Huber Publishers, 2004, 336 pages, $49.95

Dr. Sheikman lives in Shrewsbury, Massachusetts.

This book describes current views of research, theory, and practice in the prevention of suicide. It is based on the experiences gained, over many years, from different populations during the World Health Organization (WHO)/European Multicenter Study on Suicidal Behavior.

Over the past 15 years, data were collected in 45 large and medium-sized European cities on the epidemiology, demography, clinical aspects, associated risk, protective factors, and methods employed in a vast number of cases of suicide attempts. From these data the authors recommend a definition for suicidal behavior as a nonhabitual act with a nonfatal outcome. They propose theories of attempted suicide that can better explain its etiology and suggest treating the desire to die with cognitive therapy. Specifically, interpersonal problems should be treated with assertiveness training, and the fear of losing a partner should be treated with relationship therapy. Lifelong vulnerability should be treated with self-esteem-enhancing therapies.

The WHO European network on suicide prevention is developing a database to continuously assess the suicide situation in Europe and to facilitate national mental health planning on suicide prevention strategies. Research findings indicate that interrelated psychological and biological characteristics constitute a sensitivity to stress and determine the behavioral reaction to psychosocial stressors among depressed individuals, thus contributing to the occurrence of suicide. Suicidality was found to be higher among separated and divorced people than among single and married people. The presence of addiction to alcohol and other substances is a poor prognostic factor when assessing risk of suicidal behaviors.

Suicidal behavior remains a considerable public health problem. Recent major epidemiological studies reveal that about 3 to 5 percent of the general population have made a suicide attempt, and almost one-fifth have reported suicidal ideation at some time in their lives. Contact with health services before the act is common among those who attempt suicide. Prevention of suicidal behavior has been on the agenda for years in most Western countries, and numerous treatment and aftercare programs for suicide attempters have been tried. Recent overviews of studies designed to measure the effects of various treatments and programs have shown that, in general, beneficial effects are not easy to prove.

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