Introduction Every year more than eight hundred thousand people die by suicide, and more than twenty times that number attempt suicide (World Health Organization [WHO], 2014). In addition to the confusion and pain generated by the loss of a beloved family member or friend, suicide has major consequences for society. The WHO estimates the actual burden of suicide to be twenty million life-years and predicts that, by 2020, suicide could be responsible for 2.4 percent of the total burden of disease (WHO, 2006). These statistics not only clearly show the importance suicide has on society but also highlight our inability to properly implement prevention strategies. Suicide represents the extreme of a behavioral continuum comprising different forms and severities of self-injurious behaviors (van Heeringen, 2001). It is generally assumed that suicide is a complex behavior resulting from the interaction of different distal and proximal risk factors. Distal risk factors such as familial history of suicide, genetic and epigenetic factors, early life adversity, and personality traits confer vulnerability to suicide, while proximal risk factors like psychopathology, recent life events, hopelessness, and acute substance intoxication are better understood as precipitants of the suicidal crisis. The presence of comorbid major depressive disorder (MDD) and substance abuse are among the strongest proximal risk factors. Indeed, studies suggest that 50 to 70 percent of suicide completers die during an episode of MDD (Arsenault-Lapierre, Kim, & Turecki, 2004; Cavanagh, Carson, Sharpe, & Lawrie, 2003), although most individuals who are affected by MDD and other mood disorders will not die by suicide (F. Angst, Stassen, Clayton, & Angst, 2002; J. Angst, Angst, & Stassen, 1999; J. Angst, Degonda, & Ernst, 1992; Blair-West, Cantor, Mellsop, & Eyeson-Annan, 1999). Age and other sociodemographic factors such as educational level, employment, and income moderate the impact of proximal factors on suicide risk (Brezo, Paris, Tremblay, et al., 2007; Brezo, Paris, & Turecki, 2006; van den Bos, Harteveld, & Stoop, 2009). Among risk factors influencing suicide more distally are personality traits and familial history of suicidal behavior, both considered strong predictors of suicide (Hawton & van Heeringen, 2009; Suominen et al., 2004).