The authors present a comprehensive review on U.S. Pacific Islander suicide and suicide-related behaviors to extend the knowledge and understanding of suicide and suicide-related behaviors among the indigenous peoples of the state of Hawai'i, the territories of American Samoa, Guam, Commonwealth of the Northern Mariana Islands, and the Pacific Island Nations of Micronesia (Federated States of Micronesia, the Republic of Belau [Palau], and the Republic of the Marshall Islands). Historical, geographic, epidemiological, social, and cultural information is presented on these Pacific Island populations. Suicide behavioral data are presented for Pacific Islanders living within the U.S. and affiliated Pacific territories and nations from the existing scientific literature along with archival data and 2 epidemiological studies that assess suicidal behaviors and related psychosocial factors and measures of psychopathology among large community samples of youth in Hawai'i. The authors describe common patterns and differences among these populations, along with social-cultural practices that may explain suicide phenomenology among these U.S. indigenous peoples who - while small in numbers when compared with the total U.S. population - possess striking health disparities when compared to other populations within the U.S. and in their island homelands. (Contains 3 tables.)