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Night Falls Fast—Understanding Suicides.
  1. Les Fisher
  1. Archivist, American Public Health Association, Injury Control and Emergency Health Services Section Management/Safety Consultant, Delmar, New York, USA

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    By Kay Redfield Jamison. (Pp 432; $26.00.) Alfred A Knopf, NY, 1999. ISBN 037540145.

    In the early 1980s, the US Department of Health and Human Services (DHHS) issued a Request for Proposals for new public health injury prevention projects of potential national significance. I responded from the New York State Department of Health with a proposal to prevent adolescent suicides. Our application, based on consultation with state and national injury control associates, was judged acceptable but not funded. Subsequently, at a meeting with some of the Washington DHHS staff a senior official stated that suicides were not a public health issue! Little more was done for another five years until Governor Cuomo organized hearings on adolescent suicides. Some new reports were written but little else transpired. Even my PhD dissertation on the role of serotonin screening for violence, fell by the wayside (see Injury Prevention, March 1999: 13).

    Between 1987 and 1996, almost 15 000 American children under age 15 committed suicide. The need to prevent suicides in all age groups, but especially among young adults and the aged, seems to come onto the public health horizon about once every decade. The current thrust in the US is led by Surgeon General David Satcher and by Senator Harry Reid, whose state has the highest suicide rate in the US. This initiative is supported by testimony from Kay Redfield Jamison, the author of Night Falls Fast who is, herself, a manic depressive and suicide attempter.

    Jamison is an internationally recognized authority on depressive illnesses and their treatment. Night Falls Fast is one of the first major books to focus on suicide in this quarter century. It mostly addresses children and young adults, but the approach adopted is also applicable to the elderly, where rates are also high. Her work, though designed for the general reader, offers those involved in injury prevention new insights into recent professional work.

    The book offers an international perspective on the history, epidemiology, prevention, control, and treatment of suicides. The first chapter includes a historical overview on international attitudes and values. The main benefit to public health workers is the scholarly assessment that follows, along with the well annotated references in the chapter on definitions and magnitude. Case studies, including suicide notes, make the book a bit emotionally draining. A discussion of the medical community's own high suicide rate, the role of prescription drugs, assessment tools, screening for suicide risks, and weaknesses of school and community based programs are all included in the public health chapter. In spite of these elements, this chapter is too short and omits many preventive issues—only some of which are covered in other chapters. Nevertheless, the author uses the available material well and ends with the promise of a resolution by the US Senate.

    This book should be read not only for its own sake but also to encourage researchers to help find more ways to prevent suicides. As is true for injury control in general, suicide prevention needs to be better institutionalized. A book such as this provides the basis on which to build. It may be the modern day equivalent of Chadwick's or Sledgwick's seminal work in England and Boston on housing and public health.

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