bluuebunny/crossref_metadata_2025 huggingface dataset:
Restrictions of access to pesticides in suicide prevention
Authors: Phillips Michael R , Gunnell David
Published: January 2012

Intentional pesticide ingestion is one of the most common methods of suicide, accounting for up to one-third of all suicides worldwide. The importance of intentional ingestion of pesticides was initially recognized in Asia and the Western Pacific but it is becoming evident that it is also a significant problem in Africa and, to some extent, in Latin America. Pesticides are employed in about 300,000 suicides annually—primarily in the rural areas of low-and middle-income countries (LAMIC)—so limiting access to these lethal agents could, theoretically, substantially reduce the global burden of mortality due to suicide. Organophosphate pesticides are responsible for a large proportion of pesticide self-poisonings and the majority of deaths.
Prevention of metropolitan and railway suicide
Authors: Ladwig Karl-Heinz , Ruf Esther , Baumert Jens , Erazo Natalia
Published: January 2012

Railway suicides account for a minority of <10 per cent of all suicides, although they are considered a major public health issue because of their tremendous consequences on functioning of the transportation system and their deteriorating impact on the mental health of staff and bystanders. Railway suicide is a particularly violent method, and case fatality is 90 per cent of all attempts. However, case fatality in metro systems of >60 per cent are rare. More men than women choose the track as a means of suicide with a trend towards a balanced distribution in metro systems. Victims are predominately young with a median age stratum in the range of 25–34 years. For men, a prevalence peak in April and a low in December has been observed. The weekly distribution shows a peak at the beginning of the week and a low on weekends. Railway suicide behaviour patterns include jumping, lying and wandering, some individuals present deviant behaviour prodromal to the attempt. Attractiveness of the method derives from high levels of opportunity and low levels of self-perceived costs.

Prevention may rely on a package of different structural and communicative tools. Inhibiting access to the track, by providing barriers at places of advanced risk and surveillance systems, are among structural means. Inhibiting media coverage and education of gatekeepers to increase awareness and skilfulness in contact with potentially vulnerable subjects on station platforms are among communicative tools. Railway suicide prevention is a realistic option: however, enhancement of research in this field is urgently needed.
Prevention of suicide due to charcoal burning
Authors: Yip Paul
Published: January 2012

A new method for suicide, charcoal-burning poisoning, was initiated in Hong Kong in 1998, and has replaced hanging as the second most commonly used method of suicide in the last five years. It has also spread to other regions, for example, Taiwan and Japan. Furthermore, the use of charcoal-burning suicide has drawn a new cohort of individuals into the suicide population. The profiles of the charcoal-burning poisoning death are different from the non-charcoal-burning deaths: there are more males, less psychiatric illness and more financial problems among these cases. Restricting access to charcoal has been proposed to reduce the number of charcoal-burning deaths. The idea is not to completely remove it from the market, but rather to set up barriers to obtaining the suicide means. This means that there is a wider window of opportunity for intervention.
Why suicide loss is different for the survivors
Authors: Dunne Edward J , Dunne-Maxim Karen
Published: January 2012

People who are bereaved by suicide are confronted with a number of unique circumstances which hold the potential for complicating or even completely derailing their recovery process. First, they must work through the considerable stigma, which still surrounds this type of death. This chapter examines some of the historical and contemporary manifestations of societal reactions to death by suicide as a way of establishing a background for understanding the aspects of suicide bereavement, which distinguish it from other types of bereavement. These reactions are described based on the authors’ work with more than 2000 survivors over the past 25 years. Not all survivors experience all of these reactions, and the intensity of the reactions will differ for each individual and even over time for the same individual. Yet, their common appearance in many survivors warrants special attention to them as a way of understanding the grieving process of those bereaved by suicide. Particular attention is paid to the tasks of the treating clinician when intervention is initiated. They are directed specifically at stigma reduction as a means of avoiding complicated mourning as well as familial discord. The chapter also draws attention to the special needs of young children who survive a loved one’s suicide.
Therapists as survivors of suicide loss
Authors: Grad Onja T
Published: January 2012

When a patient in an inpatient or outpatient setting—whether in therapy or after ending it—commits suicide, this act provokes a lot of distressful feelings in their therapist. Besides very personal reactions of shock, grief and regret, therapists often feel guilt, failure and incompetence connected to their professional performance. They are afraid of being blamed by their colleagues and/or of legal litigation from the family of the deceased. If they work in an institution they fear how the management will react to this event. Therapists need help and support, preferably in a form of standardized procedure, which is also presented in this chapter.
Suicide on all the continents in the young
Authors: Apter Alan , Bursztein Cendrine , Bertolote José M , Fleischmann Alexandra , Wasserman Danuta
Published: January 2012

This chapter reviews the epidemiology of suicidal behaviours in young people in selected countries on the five continents. The chapter indicates that suicide is a global public health problem, and an issue of major concern in developing countries as much as it is in the well-studied developed parts of the world. Patterns of suicidal behaviours in the various continents have some similarities and some differences in aspects such as male:female ratio, cultural and societal risk factors and relative rates in different age groups. For example, in North America, Australia and New Zealand all indigenous populations show the same pattern of high suicidality. Also, after a long period of increasing rates among males in the West, there is now a significant drop in rates of young male suicides. In contrast to the other continents, Asia shows a unique pattern of higher suicide rates in young women compared to young men. Furthermore, a high use of self-poisoning with pesticides can be found in this part of the world.
Psychopathology and risk factors for suicide in the young
Authors: Orbach Israel , Iohan-Barak Maya
Published: January 2012

In the first section risk factors along the categories of pathology, emotional states, personality traits, cognitive deficits, deficits in self-regulation, stressors and facilitators and inhibitors of suicidal behaviour are classified. The second section consists of a presentation of several theoretical perspectives of self-destructive behaviour in adolescents. The third section provides a review of theoretical and empirical models that try to track the interactions between the various risk factors leading to suicidal behaviour. The last section focuses on different pathways, based on different major dynamics, showing that there is more than one way to approach suicidal behaviour in adolescents.

Many risk factors have been implicated in suicidal behaviour. In order to gain some clarity in this web of multiple risk factors, a meaningful organization of the existing data is needed. In this chapter we will rely on Orbach’s (1997) taxonomy of risk factors in order to facilitate in the organization of data related to suicidal behaviour in adolescents.
Psychodynamic and family aspects of youth suicide
Authors: King Robert A
Published: January 2012

The psychodynamic approach to suicide examines the meaning and origins of suicidal behaviour in terms of the vicissitudes of feelings, motives, self-concept, and interpersonal relationships. Negative or poorly differentiated self-concept; maladaptive defensive or attachment style; and isolative, avoidant, or self-critical personality traits appear to be important risk factors for suicidality in youth.

Across diverse national contexts, adolescent suicidality is associated with family factors such as parental psychopathology, negative life events, family discord, negative parent–child relationship (including abuse and neglect), and low perceived family support. Further research is needed to understand the intervening variables linking such family factors to suicide, including delineating the relative contributions of shared genetic risk (e.g. for psychopathology or maladaptive traits) versus the negative developmental impact of adverse family environment.

The developmental challenges of adolescence increase the vulnerability to suicidal ideation and behaviour. How specific national or cultural contexts mitigate or exacerbate these factors remains an important area for further study.
Psychiatric disorders in suicide and suicide attempters
Authors: Apter Alan , Krispin Orit , Bursztein Cendrine
Published: January 2012

This chapter reviews common psychiatric disorders and conditions which appear to be major risk factors for all types of suicidality, both non-fatal and fatal, among children and adolescents. These psychiatric conditions include personality disorders, conduct disorder, affective disorder, bipolar disorder, anxiety disorder, obsessive–compulsive disorder, schizophrenia, substance abuse, and eating disorders. Each psychiatric condition is described and discussed in terms of its unique features that are associated with suicide behaviours and its risk for suicide behaviour.
Suicidal behaviours on all the continents among the elderly
Authors: De Leo Diego , Krysinska Karolina , Bertolote José M , Fleischmann Alexandra , Wasserman Danuta
Published: January 2012

Despite tremendous variability across countries, suicide rates among the elderly, especially elderly males, remain globally the highest. On average, suicide rates increase with age, with the global suicide rate among those aged 75 and over being approximately three times higher than the rate among youth under 25 years of age. This chapter gives an overview of the epidemiology of fatal and non-fatal suicidal behaviour among people over 65 years of age on the five continents. The purpose is to facilitate a better appreciation of the extent of the differences among nations (where possible data from continents are provided), collectively with an example from a country from each of the continents: South Africa, China, Australia, Italy, and Brazil.
Suicidal elderly people in clinical and community settings
Authors: De Leo Diego , Draper Brian , Krysinska Karolina
Published: January 2012

Suicide in old age is still exposed to misunderstandings and controversies. From one side, in fact, it is the object of idiosyncratic interpretations (e.g. if subjects of advanced age are so close to their natural exit from life, why should they decide to hasten it?). From the other, the very answers to this question have fed a rationalistic view of elderly suicide that is widespread among community members: that self-killing may become an acceptable solution when facing the pains and miseries of old age (De Leo 1988).
The World Health Organization's role in suicide prevention
Authors: Saraceno Benedetto
Published: January 2012

Suicide is not only a personal tragedy, but a serious international public health problem. The majority of suicides in the world (85 per cent) occur in low- and middle-income countries (Krug et al. 2002). Suicide is among the top three causes of death in the young population aged 15–34 (World Health Organization 2001).

Whereas national data about completed suicide exists for many countries, similar statistics on attempted suicide are largely missing, reflecting a lack of official or systematic national data collection. Hence, the scale of suicide attempts is not clearly known. Relying on hospital records and population surveys, it is estimated that attempted suicides are 10–20 times more frequent than completed suicides (Wasserman 2001).

The Secretary-General of the United Nations in his report to the General Assembly in 1991 drew attention to the fact that suicide was a significant and growing problem, particularly among youth. The ensuing monitoring process revealed a lack of comprehensive national strategies for preventing suicide and, in many countries, rapidly rising suicide rates. In 1993, a United Nations (UN) and World Health Organization (WHO) International Expert Meeting on Guidelines for the Formulation and Implementation of Comprehensive National Strategies for the Prevention of Suicidal Behaviour was held in Canada, which culminated in a report (United Nations 1996) that included a comprehensive set of guidelines, together with a case study of the Finnish national strategy. These guidelines encouraged the development of national suicide-prevention strategies around the world, for instance, in the United States (US Department of Health and Human Services 2001), where suicide was recognized as a national problem, and suicide-prevention as a national priority, as well as in Europe (WHO 2002b; Wasserman et al. 2004). In 1999, WHO launched the worldwide initiative for suicide prevention (SUPRE) with the overall goal of reducing the mortality and morbidity of suicidal behaviours.

The WHO, a specialized agency of the UN, is an intergovernmental organization, established by the formal agreement of, and ultimately governed by, 193 Member States. As the directing and coordinating authority on international health work, WHO stimulates international action on health issues of global concern with the ultimate objective of the attainment by all people of the highest possible level of health (WHO 2003). The WHO’s normative function and advocacy role, as well as its convening power in establishing global partnerships, places it in a unique position to provide leadership at global, regional and country levels.
The International Association for Suicide Prevention
Authors: Mehlum Lars
Published: January 2012

The International Association for Suicide Prevention (IASP) was founded by the Austrian suicidologist Erwin Ringel in Vienna in 1960, with the aim of preventing suicidal behaviour, to alleviate its effects, and to provide a forum for academicians and mental health professionals, later embracing also crisis workers, volunteers, and suicide survivors. Today, IASP has grown to become the leading international organization concerned with suicide prevention. It is in official relations with the World Health Organization (WHO), and as an umbrella organization, embraces members from nearly fifty national and international organizations on all continents. In its first decade, IASP held its conferences mainly in Europe and North America, but gradually, countries in other regions have been involved in hosting these world conferences. IASP and its international network of people, activities and resources has an important role to fill in a world that seems to be becoming gradually more aware of suicide as the huge societal problem it indeed is. Members from more than sixty different countries, with extensive knowledge and diverse experience, form a truly unique network that will be indispensable for the development of suicide preventive work worldwide.
The European Psychiatric Association Section on Suicidology and Suicide Prevention
Authors: Wasserman Danuta , Sarchiapone Marco , Carli Vladimir
Published: January 2012

European scholars historically pioneered research on suicide. Attitudes towards suicide dramatically changed during nineteenth and twentieth centuries, mainly due to the recognition of psychiatry as an autonomous discipline, which allowed treatment for disorders causing suicide, such as ‘melancholy’ or ‘hysteria’, for instance, and thanks to the original contribution of illustrious scientists such as Enrico Morselli (1882) and Emile Durkheim (1897/1951). As Durkheim, in his work, regarded suicide as a social illness reflecting alienation, anomy and other side-effects of modern times, Morselli, in his earlier moral statistics comparative essay, had already stressed the influence of biological, individual, and social factors on the development of suicide, and emphasized the importance of treatment, and the role of psychic suffering in suicidal persons.

As the study of suicidal behaviours in the twenty-first century has been engaging with the novel impulse of the biological trajectory of causation, taking advantage of new perspectives which stem from recent advances in scientific technology, European psychiatrists still achieve notable results: European contribution to scientific knowledge on suicide parallels with the huge commitment in the field by North America and the recent involvement of nations from other continents. With the aim of highlighting European contribution to this specific area of psychiatry, providing cohesion and coordinating individual European researchers, a new Section on Suicide and Suicide Prevention within the European Psychiatric Association (EPA), previously known as the Association of European Psychiatrists (AEP), was conceived and established by the General Assembly during the Annual Congress held in March 2006 in Nice.
The American Association of Suicidology
Authors: Berman Lanny
Published: January 2012

The American Association of Suicidology (AAS) (http://www.suicidology.org) was founded by clinical psychologist Edwin S. Shneidman, PhD, in 1968. After co-directing the Los Angeles Suicide Prevention Center (LASPC) since 1958 with Norman Farberow, PhD, Dr Shneidman was appointed Chief of The Center for Suicide Prevention at the National Institute of Mental Health (NIMH). There he had the opportunity to closely observe the limited available knowledge-base regarding suicide. Consequently, with the support of the NIMH, he organized a meeting of several world-renowned scholars, determined the need for and fathered a national organization devoted to research, education, and practice in suicidology, and advancing suicide prevention.

Given his leadership at the LASPC Shneidman was quick to recognize the contemporaneous and rapid expansion of the crisis centre/ hotline movement across the United States. The newly established AAS embraced these centres as sources of research information on suicidal clients. Soon, the relationship between the AAS and these centres was symbiotic. AAS became the central clearing house for support and the hub of a many-spoked wheel, networking these centres to common needs, training materials, and goals.

As a result of this marriage of research and crisis counselling, the AAS developed a set of standards and criteria for certification of crisis centers throughout the United States and Canada. Since certifying its first center in 1976, the AAS has accredited more than 160 centres meeting what has been described as ‘the gold standard’ of service and training accreditation programmes. In 1989, the AAS began a certification programme for individual crisis workers as well. More than 400 individuals to date have passed a rigorous examination of their knowledge and application of crisis theory to their work
Suicide Prevention International
Authors: Hendin Herbert
Published: January 2012

With one million suicides a year and several hundred million people suffering from serious depression worldwide, depression and suicide are now recognized as major global health problems. Our ability to treat depression and prevent suicide has improved significantly over the past few decades, but proven suicide prevention measures have still not reached people both in developing countries and in large areas of many industrialized countries. Suicide Prevention International is uniquely positioned to address this problem.

Utilizing its international network of experts, Suicide Prevention International (SPI) undertakes projects that are most likely to prevent suicide, selects qualified investigators, and works with them in developing and implementing the projects from beginning to end. SPI’s focused approach and broad base of expertise are at work implementing a wide range of projects. The following are a few examples.
Suicide Prevention in South Africa
Authors: Burrows Stephanie , Schlebusch Lourens
Published: January 2012

Suicidal behaviour is an increasingly significant public health concern on the African continent. Although there is an obvious, urgent need for comprehensive national suicide prevention programmes, only a handful of local or regionalized efforts exist and to the best of our knowledge there are no national programmes. In South Africa, a framework for a national suicide prevention programme has been proposed (Schlebusch 2005; Burrows and Schlebusch 2008), and a statement of intent to implement such plans has been issued by government representatives and South African suicidologists (Burrows 2005).

In some ways, South Africa has set the lead in contemporary suicide research in Africa (Kinyanda and Kigozi 2005; Schlebusch 2005). For example, the twenty-third World Congress of the International Association for Suicide Prevention (IASP) was held for the first time on the African continent and hosted in Durban (a major harbour city on the east coast of South Africa) in 2005. South Africa has unique features compared to many other countries on the continent in that it is fairly prosperous with many well-established universities, research institutes and research infrastructures. It is one of the few countries in the African region to regularly monitor and update data on suicidal behaviour (Matzopoulos 2005; Schlebusch 2005) and researchers have developed a framework for the management (Schlebusch 2005) and prevention of suicidal behaviour (Burrows and Schlebusch 2008).
Suicide Prevention in Hong Kong
Authors: Yip Paul
Published: January 2012

Hong Kong, formerly a British Colony, returned to People’s Republic of China and has been a special administrative region of that country since 1997. In 2006, Hong Kong had a population of 6.9 million people with a living area of about 1000 square kilometres: it is one of the most densely populated areas on Earth. Economic development in Hong Kong has been impressive during the past two decades with a GDP of about 25,000 US dollars per year. However, Hong Kong’s suicide rate has increased from 9.6 to 18.6 deaths per 100,000 from 1981 to 2003, and is well above the global average of 14.5 per 100,000. In 2003, 1264 people committed suicide with an average of about 3.5 persons per day. It is the sixth leading cause of death, and has accounted for 3 per cent of the deaths annually. Moreover, suicide is the leading cause of death among the 15–24 age group, and the rate has increased by more than 70 per cent since 1997. Due to the increase in suicides among young people and adults, the proportion of life of years lost due to suicide has contributed to about 8 per cent of the total loss (Yip et al. 2005a). In 2003, the estimated loss of labour productivity on account of suicide was about US$175 million.
Suicide prevention in Singapore
Authors: Hock Chia Boon
Published: January 2012

Singapore is a small island nation (pop: 3.3 million), which is centrally located in South East Asia. The resident population comprises a mixture of cultures including Chinese (77 per cent), Malay (14 per cent) and Indian (8 per cent). Over the last decades, suicide rates in Singapore have fluctuated between 8–10/100,000 populations per year (Chia and Chia 2008). Between 2000 and 2004, suicide accounted for 2.2 per cent of all deaths. These rates were highest in those aged >65 years (29.9/100,000); amongst ethnic Chinese (13.5/100,000), followed by ethnic Indians (13.2/100,000) and ethnic Malays (2.8/100,000). The male:female ratio of completed suicide was 1.5:1. The most common mode of suicide was by jumping from high-rise buildings, with 23 per cent having attempted suicide before. In 55 per cent of the cases, the victims had provided warnings that they were contemplating suicide.
Suicide prevention in Vietnam
Authors: Tran Thi Thanh Huong , Pham Thi Minh Duc
Published: January 2012

Although the highest suicide rates are currently found in Eastern Europe, the largest number of suicides take place in Asia (Bertolote 2001). Unfortunately, in Vietnam, as in many other Asian countries, national strategies for suicide prevention have not yet been developed. Suicide was among the ten leading causes of death in Vietnam during 2002, and according to the Ministry of Health, the estimated suicide rate (based on hospital records of mortality is 0.98/100,000 (Ministry of Health in Vietnam 2002). The real suicide rate in Vietnam is still unknown, because the number of deaths reported by the Ministry of Health is based only on hospital data. However, most suicides occur outside the hospital system. There is no national system to monitor causes of death, including suicide, in Vietnam.
Suicide prevention in Estonia
Authors: Värnik Airi
Published: January 2012

Mortality data on suicide were kept in secret behind the doors of statistical offices in the former Soviet Union. All the draft articles for scientific journals were censored in special ministerial departments, and information considered as state secrets or data liable to ruin the illusory image of consummate welfare, was deleted or rejected.

In 1988, during the Gorbachev reform era, permission was given to form a Suicide Research Group within the framework of the re-established Estonian Medical Association (EMA), and to have access to statistical data (Wasserman and Värnik 1998). According to calculations, the suicide rate was approximately 33–35 per 100,000 inhabitants.

The Baltic republics regained their independence in 1991, and were granted creative freedom. The assistance from the National Swedish Prevention of Suicide and Mental Ill-Health (NASP) resulted in the growth of the EMA Suicide Research Group into the Estonian-Swedish Institute of Suicidology (ERSI), in Tallinn, in 1993 (Estonian–Swedish Mental Health and Suicidology Institute 2008), with economic support from Stockholm Care, an agency of Stockholm County Council and the Swedish Eastern European Committee.
Suicide prevention in France
Authors: Narboni Véronique , Soubrier Jean-Pierre
Published: January 2012

France has often been described as an ideal place to live: fine wining and dining, lovely villages and cities, where the pursuit of happiness defines the quality of life. Despite this positive image, another face of French society emerges in a country with one of the highest suicide rates in Europe.

Every year, more than 10,000 people commit suicide in France; representing 1 suicide every 50 minutes. However, recent publications from the High Level Committee on Public Health (Haut comité de Santé publique), state that these figures are underestimated by about 20 per cent. Reasons for underestimation are mainly due to the fact that most suicides are ‘hidden’ behind other more obvious causes of death, such as accidents and drug poisoning, or the simple fact that suicide is not identified as such.

After a significant increase in the 1980s, suicide rates in France have been gradually dropping since 1993. However, today, death by suicide remains high, which is double of that by car accidents. Furthermore, it has been reported that between 160,000 and 180,000 suicide attempts take place every year, representing 16–18 times the number of completed suicides.

In France, suicide is the first cause of death in the 35–44 age group, and the second cause of death in the 15–24 age group, according to the latest statistical analysis (INSERM 2005).
Suicide prevention in Romania
Authors: Cozman Doina
Published: January 2012

Romania, located in south-eastern Europe, has 41 counties and the District of Bucharest, with a population in 2000 of 21.7 million, 45 per cent of whom reside in rural settings. Loss of financial stability during the transition to free market economy is a characteristic of contemporary Romanian society. Dramatic shifts within the 1990s have generated interest in mental health and prevention in psychiatry, which includes the legislative Mental Health Law, which was passed through Parliament in 2002 (Jane-Llopis and Anderson 2006). Reporting suicide statistics to the WHO, which was banned during the communist regime, became possible after the political changes in December 1989 (Schmidtke et al. 2004).

Suicide statistics were not reported to the international medical or political structures, a ‘strategy’, which was employed to cover up the sad reality that the totalitarian regime restricted human rights (Cozman 2004).
Suicide prevention in Russia
Authors: Krasnov Valery , Voitsekh Vladimir
Published: January 2012

The suicide rate is considered a statistically stable phenomenon for certain countries, regions and ethnicities. However, recently suicide rates have been increasing all over the world, especially among young people. Moreover, they are the prevalent cause of death in the 15–34 age group (World Health Organization 2001). In this sense, Russia is no different from other countries. Suicide is the fifth cause of all deaths in this country, and this fact calls for preventive measures.

On the basis of suicide rate, the WHO has recognized Russia as a country in an emergency situation, and the noticeable correlations between the prevalence of suicides and homicides seems to confirm this statement.
Suicide prevention in Ukraine
Authors: Rozanov Vsevolod , Mokhovikov Alexander
Published: January 2012

According to the WHO official data, for the period from 1986 to 1996, there was a dramatic rise in suicide rates in the Ukraine, from 18.47 to 29.43 per 100,000. Since 1997, there has been a steady lowering of suicide rates, and the latest available data, in 2006, is 19.54. per 100,000. Nevertheless, today, the Ukraine remains the country with ‘high’ suicide rates, where suicide in males is almost five times higher than in females, and in rural areas suicide rates are almost twice as high as in the urban environment.
Suicide prevention in Canada
Authors: Turecki Gustavo , Séguin Monique
Published: January 2012

Suicide is a major public health problem in Canada. While several different initiatives have been made since 2000 to develop and implement a national strategy, the Canadian Government still has no public suicide-prevention programme. However, a few Canadian provinces and/or jurisdictions currently have or previously had a defined and/or implemented suicide prevention programme or targeted strategy. This chapter describes the major points of these strategies and identifies areas of concern.
Suicide prevention in the United States of America
Authors: Reed Jerry , Silverman Morton M
Published: January 2012

In May 1993, the United Nations convened a meeting of fifteen experts from twelve countries (Australia, Canada, China, Estonia, Finland, Hungary, India, Japan, Netherlands, Nigeria, United Arab Emirates and the United States) to draft guidelines for the development of national strategies for the prevention of suicidal behaviours (Ramsay and Tanney 1996). These guidelines were subsequently published as Prevention of suicide: guidelines for the formulation and implementation of national strategies (United Nations 1996).

The UN Guidelines emphasized that the development of a national strategy required:

1 A government-initiated national policy that declares suicide prevention as a public health priority; 2 Broad involvement from different sectors and segments of society, and

3 The establishment of a coordinating body to formulate and implement the strategy (Ramsey 2001).

In 1997, following the United Nations Guidelines, advocates pressed for resolutions to be introduced in the 105th Congress of the United States to recognize suicide as a national problem, worthy of a national solution, and calling for the development of a national strategy. Both resolutions specifically urged the development of ‘an effective national strategy for the prevention of suicide’, and were critical steps in moving suicide prevention efforts in the United States forward.
Suicide prevention in South America
Authors: Alterwain Paulo , Basile Héctor , Fränkel Daniel , Greif Jaime , Hernandez Silvia , Paparamborda María del Carmen
Published: January 2012

South America is a major region in the world, which includes many countries on the continent of South America, Central America and Mexico. The historic origin, cultural development, and various populations, which share similar characteristics, are reasons why this major region is also known as Latin America.

Psychosocial and economical related problems are prominent in South America. Diverse trauma including loss of cultural values and traditional beliefs, poverty, hunger, discrimination, violence, natural disasters, and poor working and social conditions are influencing mental health.

Suicide, as well as suicidal behaviour, is an individualistic phenomenon. However, suicidal actions are multifaceted and cluster-based, and often determined by poor social conditions. Accumulation of negative life events can be triggering factors for suicidal conditions.

Cultural differences with regard to style and characteristics can be found in suicides that are committed in both urban and rural areas. In South America particularly, the general beliefs and penalties regarding suicides are quite similar to those of the Judeo-Christian European cultural perspectives. Europe originated legal features (mainly from The Netherlands and Italy) in the nineteenth century are maintained, and can be seen in their respective penal codes. Suicide is not penalized. Suicidal behaviours are referred to either psychiatric or psychological treatment.

Uruguayan laws date from 1889, with some adjustments in 1934. The law recognizes and protects the right to life and any stimulus, cooperation or help to any person attempting suicide is punished.

In 2006, suicide rates in South America were 6.4/100,000 (Paparamborda 2007). Suicides in different South American countries vary among age groups: adolescents, young people, and the elderly (Granados 1977; World Health Organization 2000).

Epidemiologic information on completed suicide is still scarce in South and Central America, and the magnitude of so-called uncertain cases of suicide is not known (Bertolote and Fleischmann 2002).
Suicide prevention in Brazil
Authors: Botega Neury J , D'Oliveira Carlos Felipe Almeida , Bertolote José M
Published: January 2012

Brazil is the largest, and most populous, country in South America (population estimated in 2005 at 185 million). The low suicide rate in Brazil (around 4 per 100,000 inhabitants/year) is similar to those of most South American countries; however, in some population groups, such as farmers and male adolescents in the Rio Grande do Sul state, and for youngsters living in urban areas and indigenous groups, the rates are considerably higher. In spite of the low national suicide rate, the total number of suicides in 2005 was 8550, which places Brazil amongst the countries with the highest number of suicide deaths (Souza et al. 2002; Oliveira and Lotufo Neto 2003; Brasil—Ministerio da Saude 2006a).
Suicide prevention in Cuba
Authors: Perez Barrero Sergio A
Published: January 2012

In Cuba, family and forensic doctors determine the diagnosis for the cause of death as suicide, although in uncertain cases, the police and official services of forensic medicine contribute to the diagnosis. This procedure prevents problems of concealment of suicide death that are connected to religious or life insurance issues, and strengthens the reliability of the diagnosis of the cause of death as suicide in Cuba.

Suicide ranks among the top ten leading causes of death in the country (Perez Barrero 1996), and although suicide rates have decreased substantially, they continue to be high in comparison with other countries in South America (World Health Organization 1999, 2000a). The truth is that suicide rates in Cuba are often misinterpreted. Mortality statistics in Cuba are highly reliable, and this may partially explain why Cuba has higher suicide rates than other South American countries. Moreover, the high suicide mortality dates back to the nineteenth century.
Suicide prevention in Peru
Authors: Pettersén Rossana , Vasquez Freddy
Published: January 2012

Peru has a multi-ethnic population and an estimated 28 million inhabitants spread across a national territory, which comprises three principal regions: the coast, the highlands, and the Amazon rainforest.

Peru has started to recover from the effects of two decades of extensive human rights violations due to civil war, which has mentally affected the entire population. There are at least about 22,000 families or 132,000 individuals in need of mental health care as a result of the violence generated by terrorist and military actions. Psychological effects such as prolonged fear, distrust of neighbours, the breakdown of families, loss of property, postponed grief and desperation (Fraser 2004) have contributed to the deterioration of the mental health of the general population, including increased rates of post-traumatic stress disorder, depression, and associated health disorders. The Harvard University Gazette reported that the reduction of the social capital created higher rates of hopelessness, demoralization, diminished quality of life, and waves of forced migration, mainly from rural areas to the cities; and this has had its effect on the mental health of the Peruvian population (Harvard Gazette Archives 2006).
The epidemiology and pathophysiology of coronary artery disease
Authors: Henderson Robert A. , Lee Leong
Published: January 2012

Advances in the prevention and treatment of coronary heart disease (CHD) have led to significant improvements in prognosis and quality of life, but globally CHD remains a leading cause of premature death and disability. In 2001 CHD was responsible for 11.8% of all deaths in low- and middle-income countries and 17.3% in high-income countries, accounting for over 7 million deaths worldwide. By 2020 CHD is projected to be the leading cause of death and disability-adjusted life years, reflecting a rapidly increasing prevalence in developing countries and Eastern Europe, and the rising incidence of obesity and diabetes in the Western world.
The history of interventional cardiology
Authors: Kent Kenneth
Published: January 2012

The rich history of interventional cardiology is befitting this subspecialty which is now responsible for treating over a million patients each year. These procedures improve quality of lives and reduce mortality. Interventional cardiology recently celebrated its third decade, in September, 2007.
Vascular access: femoral versus radial
Authors: Roberts David H. , Wiper Andrew
Published: January 2012

Gruentzig performed the first intracoronary balloon angioplasty in 1977. In 1993 intracoronary stent deployment became widely accepted. This was in the era before oral dual antiplatelet therapy. The use of intensive antithrombotic therapy at that time led to a dramatic rise in the incidence of femoral arterial access complications. Campeau had already performed the first transradial coronary angiogram in 1989. As the radial artery runs a more superficial course, haemostasis was easier to achieve in a fully anticoagulated patient. Kiemeneij described the first transradial stent deployment in 1995. In 2007 in the UK, 223 638 diagnostic coronary angiograms and 77 373 percutaneous coronary interventions (PCI) procedures were performed. Radial access accounts for less than 10% of procedures performed worldwide and is performed even less frequently in the United States (1%).
Radiation and percutaneous coronary intervention
Authors: Bhatia Gurbir , Nolan James
Published: January 2012

Fluoroscopic procedures comprise a major component of the range of diagnostic and therapeutic measures available to the cardiologist. In contemporary practice, coronary angiography and percutaneous coronary intervention (PCI) are performed increasingly frequently. With greater availability of adjunctive techniques, the complexity of PCI procedures has also increased. Against this background, it should be appreciated that the amount of radiation that patients, physicians, and other staff are exposed to will increase accordingly. Cardiologists should be aware that increasing procedural radiation carries significant risks to both patients and catheter laboratory staff. This is vital in providing informed consent to patients prior to performing PCI procedures. Although there are legal obligations for employers to limit radiation exposure, it may be argued that cardiologists do not receive adequate training in radiation awareness. This chapter aims to provide an overview of basic radiation physics and biology, and discusses factors influencing procedural radiation doses. Particular attention is given to the potential hazards associated with increasing radiation exposure, and to methods enabling the physician to reduce delivered doses.
Angiography: indications and limitations
Authors: Adlam David , Prendergast Bernard D.
Published: January 2012

The technique of coronary angiography provides and records an instantaneous real-time fluoroscopic assessment of coronary luminal anatomy. It is used both as a diagnostic tool for the assessment of coronary disease and to provide the images which guide percutaneous coronary intervention (PCI). The procedure involves the injection of a bolus of radio-opaque contrast agent through a catheter placed in the coronary ostium, thereby delineating the luminal structure of the epicardial coronary arteries when viewed using simultaneous fluoroscopy. Angiography allows the identification of areas of intimal atheroma which impinge on the vessel lumen with potential to impair blood flow. In conjunction with clinical assessment and non-invasive investigation, the number, extent, location, and distribution of these coronary stenoses are pivotal in determining the optimal revascularization strategy, whether by surgical or percutaneous techniques.
Coronary physiology in clinical practice
Authors: Muller Olivier , De Bruyne Bernard
Published: January 2012

The goal of any treatment is to improve patients’ prognosis and/or symptoms. Accordingly, the goal of any diagnostic tool is to guide decision-making to apply optimal treatment in individual patients. Any diagnostic tool not fulfilling these requirements should not be used in patients. Keeping this in mind, this chapter will briefly review what is often referred to as ‘invasive coronary physiology’.

As opposed to anatomical (also referred to as ‘morphologic’) approaches, physiological (‘functional’) measurements assess the function of the coronary circulation. The function of the coronary arterial circulation is to provide nutrients to the myofibrils. Accessorily, the coronary arteries play a role in diastolic function (turgor effect). No other organ is so dependent on the function of the organ it perfuses.

The combination of an accurate anatomic assessment and precise functional information is indispensable to tailor the treatment of patients with suspected or known coronary artery disease.
Coronary computed tomography for the interventionalist
Authors: de Feijter P.J. , Schultz C.
Published: January 2012

In recent years coronary computed tomography (CT) has developed as a spectacular non-invasive technique to visualize the coronary arteries and its manifestations of coronary atherosclerosis. The coronary CT scanner has rapidly evolved from the initial 4-and 16-slice CT scanners, to the now considered state-of-the-art 64-slice CT scanners, while 256- and 320-slice CT-prototype scanners have now been introduced for clinical evaluation. It is expected that the CT technique will further evolve and eventually will become of sufficient diagnostic quality that it may replace invasive coronary angiography (CA) to reliably assess both non-obstructive and obstructive coronary lesions.
Cardiovascular magnetic resonance
Authors: Karamitsos Theodoros D. , Neubauer Stefan
Published: January 2012

Over the past decade, cardiovascular magnetic resonance (CMR) has undergone significant advancement in terms of imaging capabilities, ease of use, and speed of acquisition. A study of cardiac anatomy, function, and viability can now be completed in less than 30min with superb image quality and excellent reproducibility. This has led to widespread adoption of CMR in clinical practice. New CMR specialists and dedicated CMR units are rapidly emerging. The interventional cardiologist can now use CMR to find answers to many common clinical questions (e.g. inducible ischaemia, viability, coronary artery disease versus non-coronary causes of chest pain, etc.). Moreover, with the development of combined CMR-interventional units, interventional cardiologists are becoming an integral component of this evolving technology.
Primary percutaneous coronary intervention for ST elevation myocardial infarction
Authors: Adam Zulfiquar , de Belder Mark A.
Published: January 2012

One of the first reports on the use of intravenous thrombolysis in the treatment of acute myocardial infarction (AMI) was published 50 years ago when Fletcher and colleagues described the use of intravenous streptokinase to restore the patency of arteries occluded by thrombus. However, it was not until the early 1980s that the real impetus towards the ‘open artery’ concept was realised when an angiographic study defined the high prevalence of total coronary occlusion in the early hours of AMI. By this time, the era of interventional cardiology had begun and in 1978 there had already been pilot studies of mechanically opening the infarct-related artery (IRA) as well as selective use of intracoronary streptokinase. In 1983, Hartzler and colleagues reported a small case series on the feasibility of percutaneous transluminal coronary angioplasty (PTCA) during AMI in patients treated with and without prior thrombolysis. The use of angioplasty as the main means of opening an occluded vessel (i.e. instead of thrombolysis) was termed ‘primary angioplasty’ but now, in the era of intracoronary stents and other devices, is referred to as primary percutaneous coronary intervention (PPCI).

During the early 1980s, interventional cardiology was in its infancy and with the lack of suitably trained operators and interventional facilities there was limited development of PPCI. Instead, a number of trials published in the mid-1980s demonstrated a significant benefit from intravenous thrombolytic therapy. A meta-analysis of nine trials with 58 600 patients showed a reduction in mortality at 35 days from 11.5% in control subjects to 9.6%. Although thrombolysis became a mainstream treatment, its limitations also became apparent and with the development of interventional techniques there was renewed interest in primary angioplasty. The simultaneous publication of the Primary Angioplasty in Myocardial Infarction (PAMI), Zwolle, and Mayo clinic trials in 1993 paved the way for PPCI as the preferred therapy for the treatment of ST elevation myocardial infarction (STEMI).