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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
Support for this project was provided by the Centers for Disease Control and Prevention, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, the Substance Abuse and Mental Health Services Administration and the Veterans Administration. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. In general, any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
THE NATIONAL ACADEMIES
National Academy of Sciences
National Academy of Engineering
Institute of Medicine
National Research Council
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M.Alberts is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A.Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I.Shine is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A.Wulf are chairman and vice chairman, respectively, of the National Research Council.
Committee on Pathophysiology and Prevention of Adolescent and Adult Suicide
WILLIAM E.BUNNEY, JR., M.D., (Co-Chair),
University of California, Irvine, California
ARTHUR M.KLEINMAN, M.D., (Co-Chair),
Harvard University, Cambridge, Massachusetts
CARL C.BELL, M.D.,
Community Mental Health Council and University of Illinois, Chicago, Illinois
DAVID A.BRENT, M.D.,
Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
LEONA EGGERT, PH.D.,
FAAN, University of Washington, Seattle, Washington
JAN FAWCETT, M.D.,
Rush Institute for Mental Well-Being, Chicago, Illinois
ROBERT D.GIBBONS, PH.D.,
University of Illinois, Chicago, Illinois
KAY REDFIELD JAMISON, PH.D.,
The Johns Hopkins University School of Medicine, Baltimore, Maryland
JILL E.KORBIN, PH.D.,
Case Western Reserve University, Cleveland, Ohio
J.JOHN MANN, M.D.,
New York State Psychiatric Institute and Columbia University, New York, New York
PHILIP A.MAY, PH.D.,
University of New Mexico, Albuquerque, New Mexico
CHARLES F.REYNOLDS, III, M.D.,
Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
MING T.TSUANG, M.D., PH.D.,
Harvard Medical School, Boston, Massachusetts
RICHARD G.FRANK, PH.D.,
(liaison to the Board on Neuroscience and Behavioral Health), Harvard Medical School, Boston, Massachusetts
Staff
TERRY C.PELLMAR, PH.D., Board Director,
NBH
SARA K.GOLDSMITH, PH.D., Study Director
SANDRA P. AU, Research Associate
ALLISON M.PANZER, Project Assistant
MIRIAM DAVIS, PH.D., Consultant
Board on Neuroscience and Behavioral Health
ANN M.GRAYBIEL, PH.D., (Chair),
Massachusetts Institute of Technology, Cambridge, Massachusetts
KENNETH B.WELLS, M.D., M.P.H., (Vice-Chair),
Neuropsychiatric Institute, University of California, Los Angeles, California
NANCY E.ADLER, PH.D.,
University of California, San Francisco, California
RICHARD J.BONNIE, LL.B.,
University of Virginia School of Law, Charlottesville, Virginia
WILLIAM E.BUNNEY, M.D.,
University of California, Irvine, California
RICHARD G.FRANK, PH.D.,
Harvard Medical School, Boston, Massachusetts
JEROME KAGAN, PH.D.,
Harvard University, Cambridge, Massachusetts
HERBERT D.KLEBER, M.D.,
Columbia University and New York State Psychiatric Institute, New York, New York
BEVERLY B.LONG, M.S., M.P.H.,
World Federation for Mental Health, Atlanta, Georgia
KATHLEEN R.MERIKANGAS, PH.D.,
Yale University, New Haven, Connecticut
STEVEN M.MIRIN, M.D.,
American Psychiatric Association, Washington, D.C.
STEVEN M.PAUL, M.D.,
Lilly Research Laboratories, Indianapolis, Indiana
DAVID REISS, M.D.,
George Washington University Medical Center, Washington, D.C.
RHONDA J.ROBINSON-BEALE, M.D.,
Blue Cross/Blue Shield of Michigan, Southfield, Michigan
STEPHEN WAXMAN, M.D., PH.D.,
Yale Medical School, New Haven, Connecticut
NANCY S.WEXLER, PH.D.,
Columbia University, New York, New York
ANNE B.YOUNG, M.D., PH.D.,
Massachusetts General Hospital, Boston, Massachusetts
Staff
TERRY C.PELLMAR, PH.D., Director
CAROLE A.CHRVALA, M.A., PH.D., Senior Program Officer
SARA K.GOLDSMITH, PH.D., Senior Program Officer
JANET E.JOY, PH.D., Senior Program Officer
SANDRA P.AU, Research Associate
ALLISON L.FRIEDMAN, Research Assistant
LORA K.TAYLOR, Administrative Assistant
AMELIA MATHIS, Project Assistant
ALLISON M.PANZER, Project Assistant
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
CARL C.BELL, Community Mental Health Council, University of Illinois, Chicago, Illinois
JAN FAWCETT, Rush Institute for Mental Well-Being, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois
DAVID A.JOBES, Department of Psychology, the Catholic University of America, Washington, D.C.
GREGORY A.ORDWAY, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by John Kalafat, Graduate School of Professional Psychology, Rutgers University. Appointed by the National Research Council and Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution.