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      Looking to the Future: A Synthesis of New Developments and Challenges in Suicide Research and Prevention

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          Abstract

          Suicide and attempted suicide are major public health concerns. In recent decades, there have been many welcome developments in understanding and preventing suicide, as well as good progress in intervening with those who have attempted suicide. Despite these developments, though, considerable challenges remain. In this article, we explore both the recent developments and the challenges ahead for the field of suicide research and prevention. To do so, we consulted 32 experts from 12 countries spanning four continents who had contributed to the International Handbook of Suicide Prevention (2nd edition). All contributors nominated, in their view, (i) the top 3 most exciting new developments in suicide research and prevention in recent years, and (ii) the top 3 challenges. We have synthesized their suggestions into new developments and challenges in research and practice, giving due attention to implications for psychosocial interventions. This Perspective article is not a review of the literature, although we did draw from the suicide research literature to obtain evidence to elucidate the responses from the contributors. Key new developments and challenges include: employing novel techniques to improve the prediction of suicidal behavior; testing and applying theoretical models of suicidal behavior; harnessing new technologies to monitor and intervene in suicide risk; expanding suicide prevention activities to low and middle-income countries; moving toward a more refined understanding of sub-groups of people at risk and developing tailored interventions. We also discuss the importance of multidisciplinary working and the challenges of implementing interventions in practice.

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          Most cited references126

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          Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research.

          Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record
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            The interpersonal theory of suicide.

            Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs-thwarted belongingness and perceived burdensomeness (and hopelessness about these states)-and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory's hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory's hypotheses. PsycINFO Database Record (c) 2010 APA, all rights reserved.
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              Suicide and suicidal behaviour.

              Suicide is a complex public health problem of global importance. Suicidal behaviour differs between sexes, age groups, geographic regions, and sociopolitical settings, and variably associates with different risk factors, suggesting aetiological heterogeneity. Although there is no effective algorithm to predict suicide in clinical practice, improved recognition and understanding of clinical, psychological, sociological, and biological factors might help the detection of high-risk individuals and assist in treatment selection. Psychotherapeutic, pharmacological, or neuromodulatory treatments of mental disorders can often prevent suicidal behaviour; additionally, regular follow-up of people who attempt suicide by mental health services is key to prevent future suicidal behaviour.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                27 November 2018
                2018
                : 9
                : 2139
                Affiliations
                [1] 1Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow , Glasgow, United Kingdom
                [2] 2Unit for Suicide Research, Flemish Centre of Expertise in Suicide Prevention, Ghent University , Ghent, Belgium
                Author notes

                Edited by: Raffaella Calati, Mount Sinai Hospital, United States

                Reviewed by: Sabrina Cipolletta, Università degli Studi di Padova, Italy; Said Shahtahmasebi, The Good Life Research Centre Trust, New Zealand; Gianluca Serafini, Ospedale San Martino (IRCCS), Italy; Guoqing Hu, Central South University, China

                *Correspondence: Rory C. O’Connor, rory.oconnor@ 123456glasgow.ac.uk

                This article was submitted to Clinical and Health Psychology, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2018.02139
                6277491
                30538647
                02cdfa46-f2a2-44ba-9595-3479d77fec6f
                Copyright © 2018 O’Connor and Portzky.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 24 May 2018
                : 17 October 2018
                Page count
                Figures: 0, Tables: 4, Equations: 0, References: 123, Pages: 14, Words: 0
                Funding
                Funded by: U.S. Department of Defense 10.13039/100000005
                Award ID: W81XWH-12-1-0007
                Categories
                Psychology
                Perspective

                Clinical Psychology & Psychiatry
                suicide,theory,challenges,clinical,risk factors,new technologies
                Clinical Psychology & Psychiatry
                suicide, theory, challenges, clinical, risk factors, new technologies

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