In his editorial, De Leo (Reference Beardslee, Versage and Gladstone2002) cites important papers of the past 8 years. He does not mention that over 100 years ago the great sociologist, Emile Durkheim (1897), stated that the suicide rate reflected patterns of social relationships within communities and that individual mental disorder had little bearing on this behaviour. His view has never been effectively refuted.

De Leo does, however, observe that ‘socio-economic events’ such as wars and economic fluctuations may ‘provoke effects’ that ‘would be incomparably bigger than any well-targeted anti-suicide initiative’. He recognised that in most Western countries, there is currently a ‘remarkable decline’ in youth suicide, which cannot be attributed to suicide prevention activities. Over the past 50 years, there have been synchronous, international trends in suicide (La Vecchia et al, 1994). All of these events are probably due to sociocultural influences rather than fluctuations in the prevalence of mental disorders, and substantiate Durkheim's view.

De Leo states that suicidal behaviour attracts little interest among contemporary psychiatrists, as judged by the low number of contributions to suicidology journals. But this would seem to be the wrong yardstick. If Durkheim's view is accepted, the most profitable approach to the prevention of suicide would be the creation of full employment and supportive environments, and the reduction of family breakdown and drug misuse. Such an approach would call for increased attention from sociologists, economists, clergy, educators and governments. In the defence of psychiatrists, in the psychiatric literature there is considerable interest in suicide prevention among people with mental illnesses.

De Leo sees promise for suicide prevention in antidepressants, functional neuroimaging and psychometric testing, but surely this would apply only in the clinical setting. It is important to reveal the alternative to identifying and intervening with people at high risk (which has been described as ineffective and even wasteful), that is, the public health approach, in which efforts are made to reduce the risk of suicide across the community (Rosenman, 1998).