The present review focuses on recent literature that pertains to self-destructive behavior. Recent major epidemiological studies have suggested lifetime prevalences of suicidal ideation between 10 and 18%, and of suicide attempts of 3-5%, highlighting the great public health importance of self-destructive behavior. Virtually all studies of health care contacts by suicide completers and attempters have demonstrated undertreatment of such individuals, however. Controlled psychological autopsy studies of suicide completers have confirmed the major impact of clustering of mental syndromes and psychosocial problems on suicide risk. Clinical studies of long-term lithium and clozapine treatments have suggested reduced rates of completed and attempted suicide.
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
Correspondence to Dr Erkki T Isometsä, Department of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland; e-mail: email@example.com