This third edition offers updates on many topics and new chapters devoted to sleep and suicide risk, neuromodulation treatments, and teaching psychiatry residents about suicide. It balances the most high-yield topics while giving attention to scenarios that need more research but are immediately clinically relevant. The community pharmacy and telehealth settings are newer areas for exploring suicide risk and management, which may be included in future editions. This is critical reading for all psychiatrists. -- Daniel M Tuinstra, M.D. * Doody's Book Reviews * Even as suicide rates have decreased globally in recent years, and despite significant prevention efforts, US suicide rates have risen 35% since 2000.1 Some predict that rates will increase still further in the wake of the economic stress and social isolation brought about by the coronavirus disease 2019 (COVID-19) pandemic.2,3 Thus, publication of the third edition of the American Psychiatric Association Publishing Textbook of Suicide Risk Assessment and Management is both welcome and timely. This edition's structure parallels that of the previous edition, including sections on risk assessment and treatment, major disorders, treatment settings, prevention, and special topics. Each chapter provides a useful conclusion paragraph and summary bullet points. Notably, this volume is significantly smaller than its predecessor (477 vs. 744 pages), specifics of which are discussed below. Considering recent failures to reduce the toll of suicide in the United States, it is encouraging that the scientific field of suicide studies has recently begun to see much-needed change, with movement from the traditional view of suicide as simply a symptom of mental illness to newer models that approach suicide as a transdiagnostic issue of primary clinical focus. In this framework, interventions are designed specifically around the unique needs of suicidal individuals, with similarities in suicidal processes across diagnoses outweighing the differences. These processes include such transdiagnostic vulnerabilities as cognitive rigidity, hopelessness, deficient problem-solving, emotion dysregulation, acquired capability, and sleep disturbance.4,5 The third edition of this textbook commendably reflects this evolution, although not to the extent that one might wish. For example, an excellent chapter on depressive disorders contains a lengthy section on transdiagnostic considerations, yet the book continues with separate chapters on various disorders, without much discussion of how suicidal and nonsuicidal patients with the same diagnosis differ in terms of treatment needs. A transdiagnostic approach, on the other hand, would help explain why only a small percentage of people with a given psychiatric disorder die by suicide and how they differ from patients who do not. The reduced size of the new edition is especially noticeable in the area of risk assessment, where 5 chapters are reduced to only 1; largely missing is guidance beyond what information one should gather regarding risk factors and warning signs to coverage of how to obtain valid information in such a sensitive area. Few details are provided on systems such as the Chronologic Assessment of Suicide Events (CASE) approach6 or The Collaborative Assessment and Management of Suicidality (CAMS) framework,7 both of which provide structured, evidence-based methods for addressing a topic that most patients (and many clinicians) would prefer to avoid. Similarly, treatment chapters such as the one on cognitive-behavior therapy are quite brief and primarily descriptive, with little in the way of "how-to's" to guide the clinician. The presentation of information improves considerably in later portions of the book. For example, the chapter on sleep and suicide not only presents an overview of relevant theory and research but also provides detailed discussions of the management of insomnia and nightmares. Likewise, the chapter on firearms and suicide provides excellent guidance for practitioners on navigating the challenging waters of reducing access to firearms by people at risk for suicide. The chapter, perhaps most likely to show the reader that "times have changed" is the updated chapter on social media and the internet. In it, we see the 2-edged sword of the digital world, which includes both potentially life-saving resources and darker areas where bullying, taunting, and even "digital self-harm" lurk. Included in this chapter is a highly useful list of suggested clinical interview questions and prompts regarding internet issues of possible relevance to suicide risk. Despite its reduced size, the new edition does add chapters on topics that were not present in the previous edition, including chapters on college and university students, self-injurious behavior (including nonsuicidal self-injury), and physicianassisted dying. The last of these commendably considers whether the term "physician-assisted suicide" should be retired in cases of terminally ill individuals who typically do not wish to die but also do not want themselves or their families to go through a lingering, painful dying process. This chapter includes an excellent overview of the status of assisted dying laws across the United States and internationally. Overall, the American Psychiatric Association Publishing Textbook of Suicide Risk Assessment and Management, Third Edition, follows in the footsteps of previous editions as a quality reference volume. It is authoritative, digestible, and applicable to practice in multiple settings, whether academic, correctional, inpatient, outpatient, or emergency care. In areas where it is lacking in detail, it provides the reader with ample ideas on where one might obtain further information or training. As such, it continues to be an important resource in the libraries of practicing psychiatrists, other mental health professionals, and professionals in training. -- Thomas E. Ellis, PsyD, ABPP * Journal of Psychiatric Practice *
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