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Argues that social forces and social pathologies figure prominently in the dynamics of suicide. Gives several examples of "social suicide," including mass suicide, organizational self-destruction, social analogues to individual suicide, and military suicide. Claims that suicide prevention requires social, economic, and cultural transformations at the primary prevention level. (RJM)

To predict suicide, explicit causal models of suicide outcome are needed in which predictors are temporally ordered and then tested statistically. Because suicide is a dichotomous, nominal scale outcome, only certain statistics for prediction are appropriate. Logistic regression, which utilizes the likelihood ratio test of statistical inference, is the optimum method for most suicide prediction problems. (LLL)

Suicidology finds itself confused and stagnated for lack of a standard nomenclature. This paper proposes a nomenclature for suicide-related behavior in the hope of improving the clarity and precision of communications, advancing suicidological research and knowledge, and improving the efficacy of clinical interventions.

Mental health physicians are paying more attention to the demographic aspects of suicidal behavior to develop more effective suicide prevention programs. They continue to conduct studies designed to determine the risk factors to suicide to understand better the behavior of suicide victims across all age groups. Likewise, the physicians also identified the need for increased community participation in suicide intervention programs.

The authors elaborate on the standards of care for the assessment, management, and treatment of hospitalized suicidal patients. The authors attempt to synthesize the concepts of the minimal standard of care with clinical risk management and clinical judgment. They point out the areas of overlap and where optimum care diverges from legal standards of care. Case examples are provided to illustrate major areas of concern. Alleged failures of omission and commission are discussed. Tables are provided that differentiate duties and responsibilities between and among clinicians, hospital staff, and hospital administration.

The most common legal action involving psychiatric care is the failure to reasonably protect patients from harming themselves. In this regard it is critical to understand that courts have tended to impose much stricter standards on inpatient than on outpatient care; that at the present time, most malpractice actions involve clinical activities related to inpatient care (negligent admission, treatment, supervision, discharge, etc.). This article reviews the current climate in the legal and clinical formulation of standards of care for hospitalized adult suicidal patients. It suggests general guidelines for effective assessment, management, and treatment procedures that balance the need for high-quality care by a reasonable and prudent practitioner with the requirements of court-determined and statutory standards. The authors specifically discuss court cases that show common failure situations in inpatient care, discharge planning, and follow-up (e.g., problems in pharmacotherapy, the decision to hospitalize, the assessment of imminence and lethality, etc.). The paper also emphasizes the crucial element of clinical judgment in developing any inpatient standard of care.

This article is a review of the legal and clinical literature on standards of care for nonhospitalized adult suicidal patients. The authors discuss effective assessment, management, and treatment procedures that balance the need for high-quality care by a reasonable and prudent practitioner with the requirements of court-determined and statutory standards. Through a review of malpractice claims data and through an examination of the clinical literature we detail the essential guidelines for sound assessment, intervention, and management procedures. The authors specifically discuss common failure situations in outpatient care (e.g., problems in pharmacotherapy, the decision to hospitalize, inappropriate and dual relationships, the assessment of imminence and lethality, and so on). Details regarding practical considerations in developing an outpatient standard of care are provided, as are suggestions that such a standard of care must include an ongoing assessment of the therapeutic alliance.

Lists seven issues in suicide prevention, gives Thomas Szasz's libertarian perspective on those issues, and argues against Szasz's perspective. (ABB)

ABSTRACT: Psychotherapeutic interactions in crisis situations are analyzed in terms of the 'sociodynamic' concepts of exchange, balance, and formal organization. It is argued that psychodynamic interpretations of crisis intervention therapy tend to be incomplete and nonsystematic and, thus, fail to produce adequate predictions, explanations, and control of psychotherapeutic outcomes. Small-group principles and methods are applied to selected crisis cases to illustrate gains in prediction and control over psychiatric approaches. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A Historical Note on Suicide During the Course of Treatment for Depression," by Robert D. Goldney.

Presents letter to the editor in reference to the article on the review of "The Moral Justification of Suicide," by Jerry Jacobs, published in September 1984 issue of the journal "Contemporary Sociology."