Future Perspectives

© 2000 John Wiley & Sons, Ltd. All rights reserved. This Handbook has covered the major areas in the field of suicide and attempted suicide. In this chapter we take the opportunity to look into the future in terms of areas of need and likely fruitful developments. We consider, first, how knowledge of causes of suicidal behaviour might be advanced. There are many challenging areas for future research. These particularly include investigation of how biological, psychological and social factors interact during the process of the development of suicidal ideation and its translation into suicidal acts. It is argued that the limitations of the standard psychological autopsy approach, especially for the investigation of psychological, social, biological and genetic factors, necessitate more of a focus on survivors of serious suicide attempts defined in terms of physical danger and/or suicidal intent associated with their acts. Genetics research should probably focus on the genetic basis of personality risk factors for suicidal behaviour, such as aggression and impulsivity. Current brain imaging techniques should allow substantial steps to be taken to investigate the morphological and functional substrates that may be relevant to suicidal behaviour. The reasons why co-morbidity is so important in suicide and attempted suicide require elucidation, particularly the chronological sequence of development of disorders and the extent to which they have a common biological or psychological basis. It is clear that there are several important subgroups of people at high risk of suicidal behaviour which require further close examination. We highlight developments that are needed with regard to treatment of suicide attempters and other people at risk, especially investigation of pragmatic therapies in studies with sufficient statistical power to advance our knowledge of what psychosocial and pharmacological approaches are truly effective. We go on to make a plea for improved care of those who have suffered the impact of suicidal behaviour in someone close to them. Finally, we examine key aspects of programmes for the prevention of suicide and attempted suicide, particularly the importance of integration of population-based strategies with strategies targeted towards highrisk groups.