Int. J. Environ. Res. Public Health 2012, 9 1. Introduction 986 Knowledge of the risk factors for suicidal behavior in youth has burgeoned during the past 20 years. Converging evidence points to psychiatric or mental disorders as well as a past history of suicidal behavior as the strongest predictors of suicidal behavior and death by suicide [1]. However, the role of social and cultural factors is less clear and remains a topic of theoretical and practical interest. Given that social contextual factors can significantly impact well-being, they might also serve as predictors of suicidal behavior and a basis for formulating preventive measures [2]. The present review focuses on recent developments in our understanding of the social and cultural aspects of youth suicide and suicidal behavior and their implications for prevention. Suicidal behavior is a set of noncontinuous and heterogeneous spectra of behaviors, such that suicidal ideation, suicidal threats, gestures, self-cutting, low lethal suicide attempts, interrupted suicide attempts, near-fatal suicide attempts, and actual suicide may or may not be related to each other, depending on the context in which they are studied [3]. We used the definitions of suicide and suicidal behavior suggested by O’Carroll et al. [4] and adopted by the Institute of Medicine, as follows: suicide attempt (SA)—a potentially self-injurious behavior with a non-fatal outcome, for which there is evidence (explicit or implicit) that the person intended at some level to kill himself/herself [4]; non-suicidal self-injury (NSSI)—direct, deliberate destruction of body tissue without lethal intention. [5]; suicidal ideation—any self-reported thoughts of engaging in suicide-related behavior [4]. NSSI and SA are grouped in this review under the term deliberate self-harm (DSH). 2. Social Theories of Suicide According to several major theorists in the field of suicidology, social and cultural variables need to be taken into account in the understanding of suicide. Durkheim, considered the founder of empirical research in sociology and suicidology, hypothesized in his 1897 book Suicide that suicide rates vary negatively with the level of social integration (conceptualized as the opposite of anomia, isolation and egoism) of individual groups [6]. He also highlighted the roles of religious integration and varying family circumstances [6]. Since then many biosocial models of self-harmful behavior have incorporated family processes and social support networks [7,8] and support the promotion of social cohesion and identification with societal values in the enhancement of mental health in general and the prevention of suicide in particular. In adolescents, in whom identity is a vital element of well-being [9], this could be accomplished through participation in youth movements, social clubs, sports activities, and national service. Other theories, such as the relational approach of Joiner [10], have implications for the potential benefits of socio-cultural interventions, but these are beyond the scope of this review. 3. Epidemiology: Cultural and Ethnic Issues Adolescent suicidal behaviors are widespread and produce a significant burden on healthcare systems. In the United States, suicide is the fourth most common cause of death among 10–14-year-olds, and the third most common cause of death among 15–24-year-olds [11]. The epidemiology of adolescent suicide has shown striking changes over the last 100 years, with a steady decline in recent