Toward an understanding of suicide in First-Nation Canadians

Despite having a suicide rate that is consistently higher than the national Canadian average, our understanding of suicide within First-Nation Canadians is limited. Furthermore, our historical research endeavors in this area have tended to focus on clarifying characteristic symptoms, symptom clusters, and risk factors; establishing causal links; and identifying clinical phenomena associated with the presence of increased risk and have tended to use quantitative methods. The "voice" of the suicidal First-Nation person is largely "silent" within this literature and, as a result, any understanding we have of this issue is unbalanced and incomplete. Accordingly, this paper makes the case for adding a complementary (or shifting the existing) research emphasis for studying suicide within First-Nation Canadian communities. It suggests a complimentary strategic research activity that is more concerned with qualitative methods: A model that augments the current understanding of the "developmental-existential" model of suicide by accessing and articulating the "voices" of the First-Nation people themselves.     

Similarities and Differences in Victimization Risk Factors for Nonoffending and Offending Substance Users

In this cross-sectional study of substance users in Norway, the authors describe the patterns of victimization and investigate the factors associated with victimization, for nonoffenders and offenders separately. Recent victimization was reported by 59%, and the victimization rate was higher among offenders compared with nonoffenders (69% and 43%, p < .001). Women, regardless of offender status, experienced more victimization. Unstable housing was associated with victimization among nonoffenders, whereas markers for more severe substance use and indicators for poor mental health were associated with victimization in both groups. Addressing these factors may be important in reducing victimization and its negative outcomes among substance users.     

Remarks by Mary McAleese, President of Ireland made at the International Association of Suicide Prevention XXIV Biennial Conference, August 31, 2007, Irish National Events Centre, Killarney, Co. Kerry, Ireland

Reducing suicide rates requires a collective, concerted effort from all groups in society: health, social services, other professionals, communities and community leaders, voluntary and statutory agencies and organizations, parents, friends, neighbors, and individuals. It also requires the careful nurturing of a culture in which people in psychological distress don't hesitate to seek help from family, friends, health professionals and community leaders, a culture that recognizes the signs and signals of distress and is willing to help, and that focuses early in life on developing good coping skills and avoiding harmful practices; in short, a sensitive culture that cherishes human courtesy and takes responsibility for our own mental health and the mental health of others. Suicide occurs in many diverse contexts but there are recurring patterns and elements that research is revealing to us. The more we are learning, the better we are able to devise strategies and take action. We already know, for example, that alcohol abuse plays a very significant role in suicide and features prominently in youth suicide. Research has also established that cannabis increases the risk of depression and psychosis and that it reduces normal inhibitions against suicide. Since marijuana is the illegal drug most used by those under25 years of age, a critical factor in suicide prevention must be to inform young people as to its danger and counter the erroneous impression that it is a benign substance. We know that bullying sometimes features in the story of suicide. Our young people need to know just how damaging, just how unacceptable, bullying is. Education and access to support structures - whether at work, school, or home - are an essential part of protecting the victim of bullying not just from the bully but from their own downward spiral into suicidal thoughts. A less discussed but nonetheless important issue worth raising is the issue of dealing with sexual identity. Although Ireland is making considerable progress in developing a culture of genuine equality, recognition, and acceptance of gay men and women, there is still an undercurrent of both bias and hostility which young gay people must find deeply hurtful and inhibiting. For them, homosexuality is a discovery, not a decision, and for many it is a discovery which is made against a backdrop where, within their immediate circle of family and friends as well as the wider society, they have long encountered antigay attitudes which will do little to help them deal openly and healthily with their own sexuality.     

Outcome of suicidal ideation and behavior in a young, help-seeking population over a 2-year period

Suicidal behavior is associated with negative outcomes, including completed suicide. This study examined the prevalence of suicidal behavior in a sample of referrals to a youth psychiatric service and investigated the stability of suicidality over 2 years. Of the 140 people (mean age 17.8) who were referred to a youth psychiatric service, 82 who were accepted for treatment (RA group) and 58 who were not accepted (RNA group) were assessed; 57% reported considering suicide and 39% reported attempting suicide in the 12 months prior to referral. Participants who reported suicidal ideation were significantly more likely than nonsuicidal participants to have multiple Axis I diagnoses and lower levels of functioning. At the 2-year follow-up there was a significant reduction in suicidality in the RA group, but not in the RNA group. In conclusion, suicidality is prevalent among young people referred to psychiatric services. Even brief contact with services results in a reduction in suicidality over 2 years.     

The privilege and responsibility of suicide prevention

Each year about a million people worldwide take their lives, and a further unknown number, but probably no less than 20 million, attempt suicide. In addition, for every person who engages in suicidal behavior, another five or six will be associated with them in some way, making a conservative total of 100 million people worldwide who are affected each year--and to whom we have some degree of responsibility. There is no one approach to suicide prevention, and probably more so than for any other human condition, we are privileged to be able to collaborate with many different disciplines in our endeavors. However, there is a considerable responsibility to ensure that whatever our own area of expertise and interest may be, we should apply universal principals of objective analysis to these diverse contributions. This is addressed by examining research from four broad areas. First, there are studies that irrevocably bring together the sociological and biological approaches to suicide. Second, there are reports that support the notion of the universality of suicide. Third, despite considerable attention paid to the media, its influence on suicide is very limited. And finally, although there have been pessimistic reviews, there are persuasive data from innovative research designs that have documented that we can prevent suicide.     

Adverse Childhood Experiences and Subsequent Substance Abuse in a Sample of Sexual Offenders: Implications for Treatment and Prevention

The purpose of this study was to explore the prevalence of substance abuse indicators in a sample of male sexual offenders (N = 679) and to examine the influence of adverse childhood experiences (ACE) on the likelihood of substance abuse outcomes. Half of these sex offenders reported a history of drug or alcohol abuse, and nearly one in five reported a substance-related arrest. Higher ACE scores were associated with endorsement of a greater number of substance-abuse-related problems, suggesting that accumulation of early trauma may increase the likelihood for substance misuse. By enhancing our understanding of the frequency and antecedents of dynamic risk factors such as substance abuse, we can better devise clinical interventions that respond to the comprehensive needs of sexually abusive individuals and reduce risk for sexual reoffense. As well, early interventions for at-risk families and maltreated youth may interrupt their trajectory toward adulthood substance abuse and criminal behavior, including sex offending.     

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.     

Gender and cultural patterns of suicidal behavior: young Hindustani immigrant women in the Netherlands

Patterns of suicidal behavior vary among cultures and along gender. Young Hindustani immigrant women attempt suicide four times more often than young Dutch women. This article explores multi-disciplinary explanations for suicidal behavior in this group. The interconnection of Durkheimian concepts of social integration and regulation with ecological insights into family relations and psychological and psychiatric theories on individual distress are relevant. It is suggested that young Hindustani women who display suicidal behavior possess certain personality and cognitive constellations that are interlocked with specific parenting styles in stressful family environments. These families are embedded in a context of moral transformations resulting from migration to a Western culture and may be facing difficulties accompanying the transitional processes encountered in the West, particularly those regarding gender roles. Durkheimian fatalistic and anomic suicides elucidate this. The Hindustani women who appear most at risk are those facing contradictory norms and overregulation, which prevent them from developing autonomy.     

The death of offenders in England and Wales

The death of offenders in the community has received considerably less attention than the death of prisoners, although limited research suggests that community offenders may be even more vulnerable to death than prisoners. This study compared the nature and extent of death among prisoners (n = 236) and offenders serving community sentences or ex-prisoners receiving postcustodial supervision by the Probation Service (n = 1,267) in England and Wales in 1996 and 1997. Information contained in death certificates was used to code for mode of death. Prisoners and community offenders were found to be reasonably similar in vulnerability to suicide/self-inflicted death; however, the risk of accidental death and homicide was greater for community offenders, and drugs and alcohol played a bigger part in their deaths. The policy implications of the findings are discussed.     

A Mixed Methods Exploratory Examination of Victim Injury and Death: Effect of Weapon Type and Victim Resistance During Sexual Assaults by Strangers

Extending prior research regarding victim injury during sexual assault, the current study employed mixed-methods sequential explanatory research design to identify predictors of victim injury and victim death in 361 attempted and completed sexual assaults committed by 72 repeat sex offenders who assaulted strangers. Results from multinomial path analysis indicated that being female and offender coercion increased the likelihood of victim resistance, which in turn elevated the likelihood of victim injury. Divergent from the predictors of victim injury, the risk of victim death increased with victim age, offender alcohol use, and offender weapon possession. Exploratory analyses suggest that certain weapons resulted in higher probability of victim injury or victim death within the context of victim resistance. Exploratory analysis of qualitative data indicated that crime event order was not uniform—in some cases victim resistance preceded victim injury and in some assaults victim injury occurred prior to or was unrelated to victim resistance. The study findings highlight the need for further investigation of victim survival strategies when offenders possess different types of weapons.     

One-hundred cases of suicide in Budapest: a case-controlled psychological autopsy study

The authors performed a case-controlled psychological autopsy study of 100 successive suicides in Budapest, examining the presence of major depression, alcohol, and drug and/or medicament dependency/ abuse according to DSM-IV. The presence of somatic diseases, psychosocial stress, oppressive experiences, and interpersonal relationship disorders within the period of 1 month previous to death was also examined. The control group of 100 people who died of natural causes was identical with the suicide group in respect of number, sex, and age. RESULTS: Among those committing suicide, psychosocial stress, oppressive experiences, and interpersonal relationship disorders were much more frequent and behavioral changes occurred more often in the weeks preceding death compared to the control group. A single suicide attempt during one's life span did not prove to be predictive for a later fatal action, but multiple attempts did. Major depression was diagnosed in 36% of the cases in the suicide group and 17% in the control group. Half of major-depressed suicides (18 persons) and almost all in the control group (16 persons) suffered from reactive (secondary) major depression as a result of somatic disease. Severe alcoholism was found in 33% of the suicide cases and in 44% of the control group. Drug and/or medicament consumption (misuse and/or abuse) occurred in 14% and 8% of the cases, respectively. The data emphasize again that alcoholism seems to be one of the most serious problems in Hungary both in psychological and somatic illnesses.     

Suicide in developing countries (2): risk factors

The majority of studies on risk factors for suicide have been conducted in developed countries, and less work has been done to systematically profile risk factors in developing countries. The current paper presents a selective review of sociodemographic, clinical, and environmental/situational risk factors in developing countries. Taken together, the evidence suggests that the profiles of risk factors in developing countries demonstrate some differences from those in developed countries. In some developing countries, at least, being female, living in a rural area, and holding religious beliefs that sanction suicide may be of more relevance to suicide risk than these factors are in developed countries. Conversely, being single or having a history of mental illness may be of less relevance. Risk factors that appear to be universal include youth or old age, low socioeconomic standing, substance use, and previous suicide attempts. Recent stressful life events play a role in both developing and developed countries, although their nature may differ (e.g., social change may have more of an influence in the former). Likewise, access to means heightens risk in both, but the specific means may vary (e.g., access to pesticides is of more relevance in developing countries). These findings have clear implications for suicide prevention, suggesting that preventive efforts that have shown promise in developed countries may need to be tailored differently to address the risk factor profile of developing countries.     

Provider Perspectives on Sex Trafficking: Victim Pathways,Service Needs, & Blurred Boundaries

This study examines service providers’ perspectives on survivors of trafficking using a purposeful sample of professionals specializing in intimate partner violence, sexual assault, and child maltreatment. Entry points into trafficking included recruitment by Romeo pimps, survival sex, kidnapping, and deceptive offers of employment. Service needs of survivors were described as more extreme and enduring than those of other types of victims served, with particular needs in long-term housing, health and mental health, substance use treatment, legal aid, and employment assistance. An overarching issue involved survivors’ dual identities as both victims and offenders, including self-identification and understanding/treatment by human service providers and law enforcement officers.     

Suicidal ideation and suicide attempts among Australian adults

Too little is known about suicidal thoughts and behaviors at a population level to recommend appropriate preventive strategies. Using data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), this study examined rates of, and risk factors for, suicidal ideation and suicide attempts. For 10,641 respondents, the 12-month and lifetime cumulative incidence rates of suicidal ideation were 3.4% and 16.0%, respectively; the 12-month and lifetime cumulative incidence rates of suicide attempts were 0.4% and 3.6%, respectively. 12-month ideation was associated with anxiety disorders (relative risk ratio [RRR] = 3.51; population attributable risk percent [PAR%] = 19.6%), affective disorders (RRR = 11.94; PAR% = 38.8%) and substance abuse disorders (RRR = 1.85; PAR% = 6.1%). Attempts in the past 12 months were also associated with anxiety disorders (RRR = 7.06; PAR% = 37.0%), affective disorders (RRR = 12.24; PAR% = 39.5%), and substance abuse disorders (RRR = 2.09; PAR% = 7.7%). Age, marital status, and disability were associated with ideation; marital status and employment status with attempts. Approximately 12% of ideators in the sample progressed to making an attempt; employment status was the only significant predictor. Reducing suicidal ideation and attempts requires a multi-faceted approach that targets those with mental illness but also adopts population-based strategies that address other factors, such as unemployment.     

Explaining Young People’s Involvement in Online Piracy: An Empirical Assessment Using the Offending Crime and Justice Survey in England and Wales

Abstract

The Internet has been widely acknowledged as facilitating many forms of youth offending. Existing research has identified important drivers of young people’s involvement in online crime, yet this has overwhelmingly relied on school or college samples. As such, it tells us little about those young people that have left the formal education system—a group who are more likely perpetrators of juvenile crime more generally. Focusing on young people’s involvement in online piracy offenses, our analysis draws on data from a nationally representative survey of England and Wales to better understand the dynamics of involvement in online crime across the population. We assess the potential overlaps between online and offline offending, the role of differential association and deviancy neutralization techniques in shaping offending behavior, as well as the protective effect of strong family support networks in reducing involvement in piracy. We find that illegal downloaders tend to be young, male, and have a higher number of delinquent friends. We also find that many of these offenders do not confine their offending to online spaces, with involvement in offline property offenses also high among this group.     

Some problems of research on the association between blood types and suicide mortality: comment on Lester (2004)

This is a comment on the ecological finding of a negative association of national suicide rate and national proportion of people with Type O blood (Lester, 2004). Current knowledge on this topic is reviewed and several problems, limitations, and discrepancies within this research line are noted. Specifically, it is suggested that (1) this association appears to have been subject to attenuation recently; (2) available ecological evidence on this association is contradictory to both individual-level findings on the same topic and similar ecological-level findings pertaining to personality-related risk factors and antecedents of suicide; (3) a negative association of one of the four ABO phenotypes with suicide mortality does not help single out phenotypes with possibly increased suicide risk; and (4) genetic suicide risk factors may well be associated with other ABO phenotypes than Type O and may further coincide with other blood polymorphisms than the ABO system.     

The main factors of repetition: review of some results of the Pecs Center in the WHO/EURO Multicentre Study on Suicidal Behaviour

The authors obtained more information about the characteristics of suicide attempters in order to examine the most important differences between those who attempted suicide for the first time (first-evers) and those who had a previous attempt (repeaters). Within the framework of the WHO/EURO Multicentre Study on Suicidal Behaviour in Pecs Center, 1158 cases of parasuicide were collected over 4 years (July 1, 1997-June 30, 2001). In the monitoring sample, 728 (62.9%) parasuicide acts were committed by women and 430 (37.1%) by men, and more than half of the attempters had made a previous attempt In the logistic regression model a higher risk of repetition was found to be related to being divorced (OR 1.84), unemployed or economically inactive (OR 1.45), and without higher education (OR 2.54). In the sample, mental disorders were the most significant risk factor for repeated attempts. The odds ratio was highest (OR 5) for personality disorders. The results may reflect (besides some factors of social destabilization) a higher importance of major mental health problems among repeaters. For this reason, more effective recognition and treatment of the underlying psychiatric and social conditions of suicide attempters has special importance to prevent future suicidal behaviour.     

Trends in US emergency department visits for suicide attempts, 1992-2001

This article describes trends in suicide attempt visits to emergency departments in the United States (US). Data were obtained from the National Hospital Ambulatory Medical Care Survey using mental-health-related ICD-9-CM, E and V codes, and mental-health reasons for visit. From 1992 to 2001, mental-health-related visits increased 27.5% from 17.1 to 23.6 per 1000 (p < .001). Emergency Department (ED) visits for suicide attempt and self injury increased by 47%, from 0.8 to 1.5 visits per 1000 US population (p(trend) = .04). Suicide-attempt-related visits increased significantly among males over the decade and among females from 1992/1993 to 1998/1999. Suicide attempt visits increased in non-Hispanic whites, patients under 15 years or those between 50-69 years of age, and the privately insured. Hospitalization rates for suicide attempt-related ED visits declined from 49% to 32% between 1992 and 2001 (p = .04). Suicide attempt-related visits increased significantly in urban areas, but in rural areas suicide attempt visits stayed relatively constant, despite significant rural decreases in mental-health related visits overall. Ten-year regional increases in suicide attempt-related visits were significant for the West and Northeast only. US emergency departments have witnessed increasing rates of ED visits for suicide attempts during a decade of significant reciprocal decreases in postattempt hospitalization. Emergency departments are increasingly important sites for identifying, assessing and treating individuals with suicidal behavior.     

Risk of suicide ideation associated with problem-solving ability and attitudes toward suicidal behavior in university students

The present paper investigates the risk of lifetime suicide ideation associated with problem-solving ability and attitudes toward suicidal behavior in a sample of 328 university students (41% male, 59% female). The response rate was 77% based on the total number of students registered for the relevant courses. A series of questions assessed lifetime suicide ideation, while problem solving and attitudes toward suicide were measured using the Self-Rating Problem Solving scale and four subscales of the Suicide Opinion Questionnaire, respectively (McLeavey, 1986; Domino et al., 1989). Almost one-third of the students surveyed had lifetime suicide ideation. Both genders were similar in terms of their suicide ideation history, problem solving, and attitudes toward suicidal behavior with the exception that male students were more in agreement with the attitude that suicidal behavior lacks real intent. Compared with 2% of nonideators and ideators, one in four planners reported that they would more than likely attempt suicide at some point in their life. Greater agreement with the attitude that suicidal behavior is normal was associated with significantly increased risk of being an ideator, as was poor problem solving and less agreement with the attitude that suicidal behavior is associated with mental illness.