Suicide risk in patients with somatization disorder

The aim of the study was to assess suicide risk in psychiatric outpatients with and without somatization disorder. A total sample of 120 psychiatric outpatients was used in the study, 29 of whom met diagnostic criteria for somatization disorder. The results indicated that somatization disorder was significantly associated with suicide attempts even when the effects of both a comorbid major depressive disorder and a comorbid personality disorder were statistically controlled for. The results suggest that, although a patient meets the criteria for a principal diagnosis of major depressive disorder and/or a personality disorder, it is still of significant importance to decide whether or not the patient also meets the criteria for a somatization disorder in order to more optimally assess suicide risk. The findings highlight the fact that the potential for suicide in patients with somatization disorder should not be overlooked when a diagnosable depressive disorder or personality disorder is not present.     

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.     

Assessing suicide risk in cluster C personality disorders

The aim of the study was to assess suicide risk in psychiatric outpatients with specific cluster C personality disorders (avoidant, dependent, and obsessive-compulsive). A sample of 142 psychiatric outpatients was used for the study. The sample was composed of 87 outpatients meeting diagnostic criteria for a personality disorder and 53 psychiatric outpatients meeting criteria for an axis I disorder only. The results showed that dependent, but not avoidant or obsessive-compulsive, personality disorders, as well as the clusters A and B personality disorders, were significantly associated with suicide attempts. This association remained significant after controlling for both a lifetime depressive disorder and severity of depression for the cluster A and the cluster B personality disorders, but not for dependent personality disorder. The results underline the importance of assessing suicide risk in patients with cluster A and cluster B personality disorders, while the assessment of suicide risk in patients with cluster C personality disorders seems to be irrelevant as long as assessment of a comorbid depressive disorder is appropriately conducted.     

Suicide and changing values and beliefs in Ireland

This paper addresses some of the generalized theories explaining rising suicide rates in Ireland. The conclusion here is that linking suicide patterns to changing beliefs and values is problematic. Church attendance as well as adherence to traditional values remain high in this country compared to European levels, and variations in beliefs and values, especially rural/urban differences, do not fit with general explanations. Moreover, attitudes to value areas fluctuate in that justification for suicide--which showed an upward trend in the 1980s--was reversed in the 1990s, and this may have resulted from increased public focus and debate. Generalized explanations are unlikely to decipher complex phenomena such as suicidal behavior. Religious belief, if protective in relation to suicide, is unlikely to act alone. Social transformations have a differential impact depending on one's socio-economic positioning, which translates ideas of a general male vulnerability to suicide into focused areas of male distress.     

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.     

Suicide in Japan: present condition and prevention measures

This article introduces the reader to present conditions and suicide prevention measures in Japan. The suicide rate has increased gradually since the early 1990s, reaching a postwar peak in 1998. The number of suicides has remained at about 30,000 every year since 1998. Middle-aged (55-59 years) and elderly men have especially high suicide rates. In 2002, The Council of Learned People on Measures Against Suicides (organized by the Japanese Ministry of Health, Labor, and Welfare) released its report on national suicide prevention strategies. Although national suicide prevention strategies have just begun to be established, some prefectures or regions have undertaken unique suicide prevention measures.     

Suicidal behavior in patients with adjustment disorders

This retrospective study characterizes the suicidal behavior in 119 patients with Axis I adjustment disorders as assessed by psychiatrists at the University of Virginia Hospital. Results indicated that 72 patients (60.5%) had documented suicide attempts in the past, 96% had been suicidal during their admission to the hospital, and 50% had attempted suicide before their hospitalization. The most commonly used method of suicide attempts was overdosing. Of the sample group with suicide attempts in the past, 67% had Axis II diagnoses of borderline personality disorder and antisocial personality disorder. Adjustment disorder diagnosis in patients with the suicide attempts was associated with a high level of suicidality at admission, involuntary hospitalization and substance-abuse disorders. Axis II diagnoses in patients with adjustment disorders constituted risk factors for further suicidal behavior. Additional future prospective studies with reliability checks on diagnosis of adjustment disorders and suicidal behavior are needed.     

Bombers and Bystanders in Suicide Attacks in Israel, 2000 to 2003

This article analyses the results of interaction between suicide operatives and bystanders in the course of 103 suicide attacks in Israel over a recent 3-year period. It shows that bystanders' intervention tended to reduce the casualties arising by numbers that were both statistically and practically significant. When bystanders intervened, however, this was often at the cost of their own lives. The value of a challenge was particularly large for suicide missions associated with Hamas, but Hamas operations were also less likely to meet a challenge in the first place. These findings, although preliminary, may have implications for counterterrorism. More systematic collection of statistical data relating to suicide incidents would be of benefit.     

Suicide and the media. Part II: Portrayal in fictional media

The association between the portrayal of suicide in fictional media and actual suicide has been debated since 1774, when it was asserted that Goethe's The Sorrows of Young Werther had led people to take their own lives. Since that time, a plethora of studies considering the association has been conducted. This review considered 34 studies examining the impact of fictional portrayal of suicide (in film and television, music, and plays) on actual suicidal behavior. It asked the question: "Is there any association, and if so, can it be considered causal?" Using strict criteria to establish causality, we found that the evidence was more equivocal than was the case for nonfictional reporting.     

Suicide and the media. Part I: Reportage in nonfictional media

Numerous studies have considered the association between media reporting and portrayal of suicide and actual suicidal behavior or ideation. This review considered 42 studies that have examined the nonfiction media (newspapers, television, and books). Consideration was given to the extent to which inferences could be made about the relationship between portrayal of suicide in the given media and actual suicidal behavior in terms of: the strength of its association; and the extent to which it could be considered causal. The review demonstrated that there is an association between nonfictional media portrayal of suicide and actual suicide. The association satisfies sufficient of the criteria of consistency, strength, temporality, specificity and coherence for it to be deemed causal.     

Palestinian Suicide Terrorism in the Second Intifada: Motivations and Organizational Aspects

Suicide terrorism has developed into a widely used tactic, and arguably one of the major strategic threats facing some countries. This article explores various issues related to Palestinian suicide terrorism by presenting a two-phase model to explain the processes and factors underlying the development of Palestinian suicide bombers, and the execution of suicide bombing attacks. The model is applied to the case of suicide attacks that have occurred in the course of the first 21 months of the Second Intifada, from September 2000 to June 2002. The assumptions of the model are tested by taking an in-depth look into the various motives leading individual Palestinians to volunteer for suicide missions, and by discussing the activities and major functions of the organizations that have employed this modus operandi in the specified time frame. It will be concluded that while a counter-terrorism strategy aimed at targeting terrorist organizations may offer short-term gains, in the long run Israel will need to identify ways of removing or reducing the incentives that lead some Palestinians to volunteer for suicide missions.     

Suicide in the Greek penal system and the problem of various limitations in relevant studies

Suicides in prison are not merely self-destructive acts or a "cry for help." They reflect the inherent need for freedom and the repercussions of imprisonment. SPACE statistics on suicides in prison reveal a rate above 10 per 10,000 in 10 European countries, 4 of which have a rate above 20. Greek data do not appear in all SPACE statistics. This fact has stimulated the present paper. Unpublished data obtained from the Greek Ministry of Justice reveal that Greece belongs to the group of countries with a rate below 10 in 1995 (the year of SPACE statistics). However, the suicide rates fluctuated widely in Greece from a low rate of 3.2 per 10,000 prisoners (convicted, on remand, or hospitalized) in 1982 to the incredibly high rate of nearly 40 in the year 1979 (11 suicides, 10 of which occurred in prison hospitals). A review of the literature indicates that various limitations mentioned in relevant studies lie in the unreliability of data (doubts about the validity of official statistics, missing data in archives, missing files on the victims, suicide in juvenile institutions not always recorded separately, etc.). The research emphasizes the importance of improving suicide statistics (recording, clearing up the incidents of deaths that are recorded without specification of cause, etc.) in order to plan and enforce suicide prevention and intervention strategies that seem to "work" in a particular milieu and are not debatable (e.g., the use of "suicide proof" cells).     

Suicide and other external-cause mortality statistics in Ireland: a comparison of registration and occurrence data

There are two sets of annual mortality statistics released by the Central Statistics Office (CSO) in Ireland, one based on deaths registered in the particular year and the other based on the deaths that occurred in that year. We compared the registration and occurrence figures for suicide and for other deaths by an external cause for the years 1987-2003. The occurrence figures were, on average, 6% higher than the registration figures. There was evidence that the extent of the discrepancy increased over the study period, reaching almost 20% in recent years. The findings suggest that caution needs to be taken in the media reporting of registration figures for suicide and other external causes of death in Ireland and in the interpretation of these figures by health professionals.     

Suicide Terrorism in Iraq: A Preliminary Assessment of the Quantitative Data and Documentary Evidence

This preliminary assessment of suicide terrorism in Iraq sheds light on why some groups in the insurgency employ suicide attacks although others do not. The unequal utilization of suicide bombings corresponds to divergent strategies in the insurgency. Some groups fight to achieve system reintegration, whereas others send suicide bombers to collapse the emerging political order. Quantitative data and documentary evidence substantiate the finding that suicide terrorism is carried out by groups that cannot compete in any future political and institutional alignments in Iraq's new coalition politics. Suicide terrorism is intended to produce system collapse, sectarian warfare, and a failed state.     

Deliberate self-harm patients with alcohol disorders: characteristics, treatment, and outcome

Deliberate self-harm (DSH) patients with alcohol problems present a considerable challenge for clinical services. In a study of a sample of 150 DSH patients who were representative of all such patients seen at a general hospital during the study period, 40 patients with an ICD-10 diagnosis of alcohol dependence or harmful use of alcohol were compared with the remainder of the sample. The treatment of the patients with alcohol disorders before and after the episode of DSH and the outcome 12-20 months later were also investigated. Compared with other DSH patients, those with an alcohol diagnosis were older and more often male, living alone, unemployed, sick, disabled, or with a past history of DSH. They also had higher scores on measures of anger, aggression, and impulsivity. Comorbid psychiatric disorder was present in 37 (92.5%) patients, this being depression in three-quarters of those cases. Fourteen (35.0%) patients were receiving treatment from the psychiatric services prior to DSH, and 33 (82.5%) were subsequently offered treatment. Of the patients who were followed up, 37.9% remained in contact with psychiatric services, 55.2% showed poor compliance with treatment and 44.8% reported a further episode of DSH. All patients presenting after DSH need to be carefully screened for alcohol disorders and for comorbid psychiatric diagnoses. Treatment of DSH patients with alcohol disorders should include the treatment of any comorbid depressive illness.     

The rise of risk assessment and risk management in the United Kingdom

This article examines the reform of the health care system in England in terms of the risk assessment and risk management. Three major health policies are examined, the Health of the Nation strategy, community care and the Patient's Charter. The article demonstrates that effective risk assessment and risk management is an important component of each initiative. The Health of the Nation strategy is based on epidemiological evidence on the nature of health risks and is linked to specific targets for the reduction of harm that require effective management of risks. Community care is a well established policy designed to provide long term and continuing support for vulnerable individuals in the community. With high profile incidents in the 1980s, there has been a greater emphasis on effective risk assessment and risk management, especially to protect the public. The Patient's Charter is designed to empower users of service.

Central to this strategy is informed consent. Effective empowerment depends of the provision of adequate information, especially on the risks of treatment. Although competent adults may formally be autonomous risk-taking decision-makers, their ability to assess risk and make decisions depends on having adequate information.