Preventing Suicide: An Evidence-Based Approach

Suicide is a significant health concern.In 2024, over 2 million people attempted suicide and nearly 50,000 thousand died by suicide in the United States alone. 1 Among those who died by suicide, 75% had contact with their primary care physician within 1 year of death. 2 Thus, it is critical that family physicians are equipped with a strong understanding of and skills to assess and manage suicidality as part of their daily clinical practice and teaching activities.This book focuses on information pertaining to the "development and implementation of suicide prevention" (p. 1) and examines both antecedents and systemic efforts to address suicide in the global context.The three editors of the Preventing Suicide are psychiatrists who are actively involved with the South Asian Self-Harm Initiative (SASHI) -a research partnership project via the Centre for Mental Health and Society that includes researchers from the United Kingdom, India, and Pakistan.SASHI concentrates on registry research as well as "qualitative exploration of professional understanding of self-harm and suicide prevention." 3 Preventing Suicide is organized into 16 chapters.Most focus on either a distinct dimension of suicide within a specific population (eg, males, young people, minority groups), or in association with other phenomena (eg, media coverage, violence, community action, decriminalization, occupation, substance use disorders).Additionally, emphasis on the role and impact of various policies, programs, and initiatives for suicide surveillance and management runs through all chapters.Thus, the book incorporates multiple suicide-related phenomena and contextualizes these within broader efforts for suicide surveillance and management.Within the book, two chapters are particularly valuable.Chapter five, "Using Evidence in Suicide Prevention," by Rob Poole, offers a nuanced and insightful synthesis of information that should inform suicide prevention efforts across different contexts.The chapter highlights the importance of relying on evidence and ongoing critical evaluation of suicide prevention efforts and offers historical illustration of well-intentioned efforts associated with poor outcomes.Additionally, chapter 15, "Surveillance," explains key aspects of suicide surveillance and helps the reader understand natural limitations of surveillance methodologies as well as alternative strategies utilized when suicide surveillance data are not available.This chapter also introduces the SASHI project and an overview of its procedures, challenges faced, and goals.Although Preventing Suicide offers readers a wealth of information, it has several limitations.First, while the book takes a broad international perspective, its focus seldom shifts to unique, population-specific factors and challenges in the United States.Secondly, the book offers little practical guidance in navigating a spectrum of suicidal behaviors within primary care practice.While chapter 13 ("Suicide Prevention in Clinical Practice") discusses general factors in inquiry and assessment, it does not offer clear guidance for interpretation of risk assessment findings, stratification, and management, which are central to the work of family physicians.Finally, the book can be challenging to use as a reference resource; while each chapter offers a unique perspective of its authors, no chapter offers a comprehensive but succinct review of key aspects of suicide prevalence rates, risks, and moderating factors.This is unfortunate, as given the rapidly growing