Social modeling in the transmission of suicidality

Evidence from twin, adoption, and family studies suggests that there is strong aggregation of suicidal behaviors in some families. By comparison, the role of social modeling through peers has yet to be convincingly established. This paper uses data from four large studies (the WHO/EURO Multicentre Study on Suicidal Behaviour, the WHO/SUPRE-MISS, the CASE study, and the Queensland Suicide Register) to compare the effects of exposure to fatal and nonfatal suicidal behavior in family members and nonfamilial associates on the subsequent suicidal behavior of male and female respondents of different ages. Across all studies, we found that prior suicidal behaviors among respondents' social groups were more important predictors of suicidal behavior in the respondents themselves than previous research had indicated. Community-based suicide attempters in the WHO SUPRE-MISS had higher rates of exposure to prior suicide in nonfamilial associates than in family members. In an adolescent population, exposure to prior fatal suicidal behavior did not predict deliberate self-harm when exposure to nonfatal suicidal behavior (both familial and social) were controlled for, but exposure to nonfatal suicidal behaviors in family and friends was predictive of deliberate self-harm and suicide ideation, even after controlling for exposure to fatal suicidal behavior. The potential impact of "containment" of information regarding suicidal behaviors as a prevention initiative is discussed, in light of information behavior principles of social marketing.     

Self-reported suicidal behavior in juvenile offenders in custody: prevalence and associated factors

Suicide rates in prisons in England and Wales are high, including those in juvenile detention centers. Previous deliberate self-harm (DSH) is the strongest predictor of suicide in the general population. There is limited information on how many juvenile offenders (15 to 18 year-olds) have a history of DSH at the time of entering custody, or on factors associated with previous DSH. We aimed to determine the prevalence of previous DSH and suicidal ideation in a population of juvenile offenders in custody and to identify factors associated with DSH and suicidal ideation. Seven out of 45 subjects (15.6%) reported an act of DSH in the past. Twelve (26.6%) reported past suicidal ideation. Peer relationship difficulties and sexual abuse were significantly associated with DSH (p < 0.05). Other factors showed a trend toward being more common among those with DSH, but the premature ending of the project by the juvenile detention center prevented full investigation of the extent of DSH and associated factors. Nevertheless, the results indicated a much higher rate of DSH in this population than in young males in the community. A larger joint project with juvenile detention centers is required to confirm the extent of previous DSH at the time young offenders are admitted, and the associated risk factors, in order to assist prevention and intervention strategies.     

Negative life events associated with deliberate self-harm in an African population in Uganda

Negative life events associated with deliberate self-harm (DSH) were investigated in an African context in Uganda. Patients admitted at three general hospitals in Kampala, Uganda were interviewed using a Luganda version (predominant language in the study area) of the European Parasuicide Study Interview Schedule I. The results of the life events and histories module are reported in this paper. The categories of negative life events in childhood that were significantly associated with DSH included those related to parents, significant others, personal events, and the total negative life events load in childhood. For the later-life time period, the negative life events load in the partner category and the total negative life events in this time period were associated with DSH. In the last-year time period, the negative life events load related to personal events and the total number of negative life events in this time period were associated with DSH. A statistically significant difference between the cases and controls for the total number of negative life events reported over the entire lifetime of the respondents was also observed, which suggests a dose effect of negative life events on DSH. Gender differences were also observed among the cases. In conclusion, life events appear to be an important factor in DSH in this cultural environment. The implication of these results for treatment and the future development of suicide interventions in this country are discussed.     

A comparative study of young and adult deliberate self-harm patients

Research has shown that the prevalence of deliberate self-harm (DSH) is higher in adolescents than in adults, but little is known about other differences. In this study we compare adolescent and adult DSH-patients regarding factors contributing to the suicidal act. In two regions in Norway, 98 persons under 20 years of age and 83 older persons were interviewed following an act of DSH. They were compared regarding intentions involved in the DSH, precipitating circumstances, level of suicidal intent, medical seriousness of the act, depression, hopelessness, and self-esteem. Few differences were found. The adults more often wanted to escape from unbearable thoughts or situations, or to receive care and attention. Adults also reported a slightly higher level of medical seriousness of the DSH act, more psychiatric problems, and substance abuse. The similarities between young and adult DSH-patients are striking. The differences found are most likely related to factors of age itself, such as cognitive immaturity, impulsivity, and lack of experience in enduring problems.     

Psychological and psychosocial interventions after attempted suicide: an overview of treatment studies

A literature search was conducted to collect randomized controlled studies evaluating the outcome of psychological and psychosocial interventions after attempted suicide and deliberate self-harm. Twenty-five studies meeting the inclusion criteria were identified. The studies are grouped according to the psychological approach chosen for the intervention. They are discussed with regard to both the various therapeutic strategies and models used, and the repetition of self-harming behavior as the main outcome.     

Assessment and aftercare for deliberate self-harm patients provided by a general hospital psychiatric service

We report on a sample of 135 deliberate self-harm (DSH) patients who were assessed by a general hospital DSH service, and on those who were offered aftercare by, or telephone open access to, the service. Patients' satisfaction with assessment and treatment, and their outcome were investigated at follow-up 12-20 months later. Four-fifths of patients reported the assessment following DSH to have been helpful and the assessor sympathetic. Thirty-three (24%) of the 135 patients assessed were offered treatment by the DSH service but 13 declined or failed to attend. Of the 20 who engaged in treatment, 17 (94%) were satisfied with their care. Open access to the DSH service by telephone was offered to 53 (39%) patients, nine (22%) of whom reported at follow-up that they had used this facility. A specialist DSH service can effectively assess and treat patients following DSH. It is important that the service is accessible and acceptable to patients.     

The role of perfectionism and autobiographical memory in a sample of parasuicide patients: an exploratory study

The main objective of this study was to investigate the relationship between social perfectionism, overgeneral autobiographical memory recall, and psychological distress (hopelessness, depression/anxiety, and suicidal ideation) in a sample of parasuicide patients. Forty patients who had been admitted to a Scottish hospital following an episode of deliberate self-harm participated in the study. The participants completed the autobiographical memory task and a battery of self-report measures (multidimensional perfectionism, hopelessness, depression/anxiety, and suicidal ideation). The results showed that repetitive self-harmers were more overgeneral in their recall of positive autobiographical memories than were first-time self-harmers. Hierarchical regression analyses showed that socially prescribed perfectionism interacted with overgeneral recall of both positive and negative memories to predict suicidal ideation/depression. The findings are discussed in relation to previous research.     

When is a wife not a wife? Some observations on the immigration experiences of South Asian women in West Yorkshire

This article uses black feminist analysis to explore the ways in which the racialized stereotypical image of the passive South Asian woman has informed the categorizing of this group of minority ethnic women within the system of British immigration control. Such stereotypes have led to a very specific category of 'South Asian woman' being regarded as a legitimate immigration applicant: namely that of the traditional South Asian wife dutifully going to live in the country in which her husband is settled. Using interview data from a study of South Asian women's immigration experiences, this article assesses the extent to which South Asian women entering the system of British immigration control actually fit this racialized category of 'wife'. It is also shown that those wives who sponsor a husband to come to the UK, and therefore do not fit the immigration service's assumptions of the South Asian wife, face even more difficulties, due to gender and racial discrimination within the system of British immigration control.     

Sati: a type of nonpsychiatric suicide

Sati as an act of ritual suicide has been reported from the Indian subcontinent, especially among the Hindus, for several centuries. Although legally proscribed, these acts occur even now in modern India. The principle behind such acts has been put forward as the principle of good wife. There is little evidence to suggest that women who commit this act suffer from a formal mental illness. Cultural factors and gender role expectations play a significant role in the act and its consequences. Using recent examples, this paper illustrates the cultural factors, which may be seen as contributing to the act of suicide. Other factors embedded in the act also emphasize that not all suicides have underlying psychiatric disorders and clinicians must take social causation into account while preparing any prevention strategies.     

Suicide rates and mental health services in modern China

Suicide rates in China have in the past been reported to be very low for a variety of historical and political reasons. In recent years, however, the reported suicide rates in China have increased alarmingly among certain age groups. This article reviews reports of the national rural suicide rates in China for 1992, gathered from the Annal of Chinese Public Health, which has previously never been reported publicly. The highest suicide rates occur in the rural areas and among young women and men over 60 years. These data reveal that suicide in China may have some unique characteristic associated with a variety of socio-cultural variables, such as traditional culture, social class, economic status, health care levels, and interpersonal problems. The author shows that lack of mental health services in rural areas in China may be considered one of associated reasons to the high rural suicide rate in China.     

Exploring the Overlap between Victimization and Offending among Women in Sex Work

Abstract

This study examines reported victimization and reported offending of women involved in sex work in the United States in order to identify demographic and behavioral overlap between women who presented to the justice system as victims and offenders, and between women identified as trafficked persons or as prostitutes. Results indicate significant offending and victimization experiences among women in the sex industry. Among women who presented both victimization and offending (victim-offenders)—compared to those who were exclusively victims or exclusively offenders and those without such experiences—substance abuse problems, injuries, and multiple arrests were proportionally higher. Distinctive behavioral differences between trafficked women and prostitutes were not evident. Policy implications for the justice system are discussed.     

Suicidal behavior in black South Africans

In the past suicidal behavior among Black South Africans has been largely underresearched. Earlier studies among the other main ethnic groups in the country showed suicidal behavior in those groups to be a serious problem. This article briefly reviews some of the more recent research on suicidal behavior in Black South Africans. The results indicate an apparent increase in suicidal behavior in this group. Several explanations are offered for the change in suicidal behavior in the reported clinical populations. This includes past difficulties for all South Africans to access health care facilities in the Apartheid (legal racial separation) era, and present difficulties of post-Apartheid transformation the South African society is undergoing, as the people struggle to come to terms with the deleterious effects of the former South African racial policies, related socio-cultural, socio-economic, and other pressures.     

Disparities in Infant Mortality Rates Among Immigrant Caribbean Groups in New York City

SUMMARY

This study examined infant mortality rates (IMR) in New York City (NYC) to identify those groups reporting higher IMR concentrations in recent years and to determine what factors and explanations are associated with this new trend.

Analysis of data from NYC Department of Health (DOH) identified infant mortality patterns throughout the City by both maternal birthplace and NYC Health Districts. In addition, infant mortality rates for those NYC populations with the highest concentrations were compared to the most recently available IMR data from their countries of origin. Focus group sessions were conducted with women in the identified groups in New York City in an effort to obtain their perspectives on causality and other factors associated with the new trend.

Strong patterns emerged from this study pointing to a concentration of the City's highest IMR among groups from the circum-Caribbean region. Results of focus group sessions with women in the identified population groups yielded a list of specific barriers faced by this population in the utilization of perinatal care services. In addition, the study resulted in some clearly delineated program and policy approaches that can help to address the disparities in IMR.

Myriad causative factors contribute to the high rates of IMR among Caribbean immigrant groups. Expanding the availability of both successful program models and promising practices is critical to decreasing infant mortality in immigrant communities. Specific recommendations are for the development of a strategic set of interventions designed to eliminate this most serious challenge to the health of new immigrant groups in NYC.

Any references to comparisons between data from NYC and data from the countries of origin were merely to serve as a reference point as it is not often possible to determine the level of scientific rigor applied to the collection and analysis of data external to the United States (U.S.).

Implications for social work practice with immigrant populations include the need for delivery of culturally competent services in general and for cultural sensitivity to health beliefs surrounding maternal child health issues in particular.     

The effects of family planning effort and development on fertility: An intervening variables framework

To pinpoint the intervening variable that transmit the impacts of development and family planning effort on fertility, a modified proximate determinants model was applied to data from 59 developing countries. The intermediate variable included level of exposure to sexual intercourse (the percentage of women 20-24 years old in a union), deliberate marital fertility control (the percentage of married women of reproductive age who were using contraception), and natural marital fertility (operationalized as average per capita calorie consumption). The regression equations indicated that both social development and family planning effort can influence fertility levels substantially through their association with higher levels of contraceptive use. Interestingly, the direct effects of family planning and social development on the crude birth rate became insignificant when the intermediate variables were included in the same equation. Path analysis revealed that social development has an indirect effect of -0.083 via its influence on marriage patterns and of -0.316 due to its effect on contraceptive usage. Family planning has a lesser indirect impact on fertility (-0.487), and -0.111 of this effect reflects program effort's dependence on the level of social development. Economic development is positively linked to fertility, and future research should assess whether this factor is partially counterbalancing the fertility-reducing impact of social development and family planning programs. Although this analysis confirms that delayed marriage and widespread adoption of contraception are key intervening variables, they cannot influence fertility in societies where there are social or cultural impediments to such changes.     

Monitoring deliberate self-harm presentations to general hospitals

Monitoring of deliberate self-harm (DSH) presentations to hospitals (and in other settings) is receiving increased attention in many countries. This is due to greater recognition of the size of the problem and awareness of its relevance to suicide prevention policy initiatives, because of the strong association between DSH and suicide. A system for monitoring all DSH presentations has been in place in the general hospital in Oxford for 30 years. Based on our experience, in this paper we describe procedures for monitoring, including case definition and identification, linkage of persons and episodes in order to investigate repetition of DSH and other outcomes (including deaths), and data protection and ethical issues. We also provide details of how to carry out monitoring, including different models of data collection, and what data to collect. Finally we consider the potential uses of the data for both clinical and research purposes, including evaluation of national suicide prevention initiatives.     

Participation in Micro-Finance Programmes and Women’s Mental Health in South Asia: A Modified Systematic Review

Micro-finance provides financial services to poor women from developing countries where cultural and social constraints limit their opportunities for economic advancement. Using Forbes’s process of conducting systematic review, 12 quantitative studies from South Asia reporting on the impact of micro-finance on women’s mental health outcomes were analysed. Overall, studies revealed that the duration and depth of involvement in micro-finance activities would make a difference in women’s mental health and not just receiving loans; however, rigorous programme evaluation is needed. Collaborative actions by micro-finance and health care practitioners to recognise women’s mental health needs and to strengthen measures to optimise the beneficial effects of micro-finance must be considered.     

Cognitive-behavioral therapy for deliberate self-harm

Patients who engage in deliberate self-harm (DSH) form a heterogeneous population. There is a need for psychotherapeutic interventions that give therapists the flexibility to tailor the treatment plan to the needs of an individual patient. To detect essential ingredients for treatment, three different cognitive-behavioral theories of DSH will be reviewed: (1) the cognitive-behavioral theory of Linehan (1993a), (2) the cognitive theory of Berk, Henriques, Warman, Brown, and Beck (2004), and (3) the cognitive-behavioral theory of Rudd, Joiner, and Rajab (2001). A review of these theories makes it possible to compare the different approaches to the essential aspects in the treatment of DSH: a trusting patient-therapist relationship, building emotion regulation skills, cognitive restructuring, and behavioral pattern breaking. An overview will be given of therapeutic techniques that can be used to address the cognitive, emotional, behavioral, and interpersonal problems associated with DSH.     

Policy Transfer as a “Contested” Process

Policy transfer studies have commonly assumed that changes to policies borrowed from abroad are either the result of deliberate efforts to adjust/translate them to fit its receiving environment, or an adaptive response to the cultural and institutional circumstances of the latter. In introducing the concept of “contested policy transfer,” this article will argue that differences between the “original model” and the borrowed one might be actually due to the series of conflicts and negotiations which take place among key bureaucratic actors at the “importer” jurisdiction. The article will illustrate the concept by analyzing the transfer of the Chilean “Programa de Mejoramiento de la Gestión” to the Mexican government, a process which took place between 2005 and 2010.     

Suicide,gender, and age variations in India. Are women in indian society protected from suicide?

A new set of data concerning the pattern of suicide in India between 1991-1997 are presented. Suicide rates rose over this period despite a small decline in the Indian suicide rate in 1995 and 1996. It was found that between 1995 and 1997 there was a modest fall in the suicide rates among under 29-year-olds of both sexes, and an increase among those 30 years and older. The pattern of suicides in India is bimodal: the incidence of suicides is highest for those in the 30-44-year-old category of both sexes and tends to decline in higher age categories. Suicide rates were nearly equal for young women and men, a contrast with the pattern of suicide sex ratios in eight developed countries.