Sociocultural factors are of great importance in suicide, and the deliberate manipulation of the sociocultural milieu (social engineering?) would evoke a meaningful change in suicide mortality. However, this concept is theoretical and, like most approaches to suicide prevention among high-risk individuals, lacks rigorous scientific evidence. It is important to point out that while Emile Durkheim's theories have never been effectively refuted, neither have they been supported by convincing empirical evidence.

My main contention is that the prevention of suicide, like other types of preventable death, requires a multifaceted approach that should incorporate interventions specific to high-risk individuals as well as public health approaches. As far as I am aware, this principle guides all existing national strategies, including the recently launched National Plan in England (September 2002). There is little doubt that strategies exclusively targeting high-risk subjects would produce only minimal reductions in mortality rates. Dr Pridmore maintains that counteracting unemployment and drug misuse, and improving community cohesiveness, would be profitable approaches to population-based suicide-prevention tactics. Once more, although shareable on the basis of common sense, convincing evidence for the effectiveness of these interventions is non-existent. For example, I recently reported in this journal on the impact of a telephone support service on suicide mortality among the elderly (Reference De Leo, Dello Buono and DwyerDe Leo et al, 2002). The supportive environment provided by that service had a significant impact only among female clients. Elderly men, who suffer from far higher rates of suicide than women, reported very little benefit. Similarly, full employment would surely positively affect suicide attempt rates, but maybe not suicide mortality.

The multi-disciplinary approach to suicide seems to me the conditio sine qua non under which prevention of this human tragedy can be effectively pursued. Given their professional exposure to suicidal individuals, psychiatrists are often in a privileged position to positively interfere with a suicidal process. To do it more consistently and on a larger scale, they should contribute more to suicide research, particularly within multi-disciplinary teams in collaboration with psychologists and sociologists, demographers and anthropologists. Complexity of causes requires complexity of remedies; there are no short cuts.