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more common predictors. Therefore, previous attempters who at the
time had high intentions of dying should be considered serious risks
for many years. It is important to understand in depth the reasons
why a person wants to die and why it is so important to them.
Another innovative approach to predicting suicide has recently
been reported by Silverman and Simon (2001). One of the problems in
studying suicide is that the main source of information is dead and
unable to provide a history of the event. The Houston Case-Control
Study of Nearly Lethal Suicide Attempts is a partial solution to this
problem. By selecting 153 cases who used highly lethal methods (e.g.
a gun shot to the head that ricocheted off the skull) but survived or
who were saved only by extraordinary medical attention, the
investigators hoped to get better insight into suicide. These highly
lethal attempters were both compared to 47 less lethal attempters and
sometimes with a matched non-suicidal control group. This study did
find different relationships. For example, although many experts and
earlier studies have associated suicide with serious psychiatric
problems, this study found that less lethal suicide attempters had
more serious psychological problems. That is, the somewhat less
serious attempters had a history of making more previous suicide
attempts, had more serious psychiatric symptoms, reported more
hopelessness, and were more likely to have phobias or panic disorders.
There is, thus far, no explanation of these different results. There was
no evidence, in term of telling someone their plans, calling someone
for help, picking a place where you might be discovered, and expecting
to die less, that the lethal attempts were a “cry for help.” In addition,
lethal attempters were more likely than less lethal attempters to have
frequently changed residence, to be alcoholic, and to have been
drinking within 3 hours of the suicide attempt.
With much more careful, innovative research, like what we have
just reviewed, we can acquire the knowledge needed to reduce the
4,500 yearly deaths caused by completed suicides (12% of all deaths
among 10-24-year-olds) and the 125,000 yearly ER visits caused by
non-fatal suicides in the same age group.
Prevention and treatment
Sometimes suicide prevention should have started at a very young
age, because self-concept, mood level, and attitudes (e.g. optimism
and trust) usually have a long history closely related to family and
early experiences. It may be possible to deal with some of those long-
term difficulties later. The best prevention is quick attention to
emotional problems when they occur, and to maintaining good mental
health.
In the last section about prediction, many of the more common
signs of risk or warning signs for suicide were mentioned. Each of
those warning signs that seem to be especially troubling spots for you
could be contributing to a self-destructive tendency and could be
worked on in counseling to reduce the risk of self-harm. In addition to
