Suicide in developing countries (3): prevention efforts

Until now, suicide prevention efforts have been limited in developing countries, although there are pockets of excellent achievement. Various universal, selective, and indicated interventions have been implemented, many of which target a different pattern of risk factors to those in developed countries. In the absence of sufficient mental health services, developing countries rely heavily on nongovernment organizations (NGOs) to provide crisis interventions for suicidal individuals, as well as proactive interventions aimed at raising community awareness and building resilience. Often these NGOs work within a social and public health framework, collaborating with others to provide nested suicide prevention programs that are responsive to local community needs. There is a clear need to develop appropriate, relevant and effective national suicide prevention plans in developing countries, since, to date, only Sri Lanka has done so. These plans should focus on a range of priority areas, specify the actions necessary to achieve positive change in these priority areas, consider the range of collaborators required to implement these actions, and structure their efforts at national, regional, and local levels. The plans should also promote the collection of accurate data on completed and attempted suicide, and should foster evaluation efforts.     

Suicide prevention: a pragmatic review of recent studies

Because of the almost complete absence of randomized controlled trials demonstrating the effectiveness of specific treatments, there is sometimes a degree of pessimism about our ability to prevent suicidal behaviors. However, the methodological challenges to produce such research are formidable and may never be overcome. Therefore, a pragmatic review of evidence-based methods of suicide prevention is required. This review of recent studies using a variety of research strategies, both nonpharmacological and pharmacological, particularly at the community level, provides persuasive data that suicide prevention is possible. This is achievable by the application of broad community and professional education programs, as well as by the optimum management of mental disorders.     

日本少年犯罪的现状和预防对策

日本的少年犯罪现状以及预防对策是众多中国学者关心的领域;本文就2003年度的日本少年犯罪、近几年少年犯罪的变化特征以及代表性形式作了详细的论述;对其原因以及前兆作了独特的探讨;另外说明了少年犯罪前在家庭、学校、社区的“暗示”性表现,最后提出地区性的少年犯罪预防对策和21世纪日本整个国家应然的预防少年犯罪的对策。     

Migrations in Kazakhstan: past and present

This article traces the history of migration flows from Russia to Kazakhstan before 1917 to the present. The present problems in the republic stem from the complicated character of migration. Russian migration of Cossacks and peasants began after Russian annexation in 1731. Migration was intense during the Revolution of 1905-07 and the strongest during 1917-91. Records reveal 1.1 million migrants and 5 million total population in 1900. 6.2 million migrated during 1917-91. During 1917-91, migrants in the early years were victims of collectivization (est. 250,000), followed by WWI refugees and migrants from northern provinces fleeing civil war (100,000 persons). During the 1930s, industrial workers were recruited (1.3 million). "Unreliables" were deported during WWII (1.3 million). Forced evacuees from occupied territories settled during 1941-45 (1.45 million). Spontaneous flows occurred during the 1970s (1 million). There were secret military settlements (250,000), labor migrants (200,000), and war and ethnic refugees fleeing national conflicts (50,000) post-WWII. 42% of Kazakhs died from hunger and epidemics, and 33% fled abroad during the early decades of the century. In 1937, population amounted to 2.8 million. Today, about 100 nationalities live in Kazakhstan, although the largest groups are Kazakhs (43.2%) and Russians (36.4%). In 1993, 75.8% of the total work force were non-Kazakh workers. Kazakhs are 60% of rural population, but many are migrating to cities that are dominated by Russians. Growing unemployment fostered tensions with the Chechens and may lead to conflicts with Russians.     

Suicide in the Ukraine

The suicide rates of the 24 provinces (oblasts) of the Ukraine were found to be strongly associated with indices of social disintegration (such as divorce and illegitimacy rates), with the Western provinces incorporated in the USSR later than other Ukrainian territories having lower suicide rates and lower levels of social disintegration.     

Suicide reporting content analysis: abstract development and reliability

Despite substantial research on media influences and the development of media guidelines on suicide reporting, research on the specifics of media stories that facilitate suicide contagion has been limited. The goal of the present study was to develop a content analytic strategy to code features in media suicide reports presumed to be influential in suicide contagion and determine the interrater reliability of the qualitative characteristics abstracted from newspaper stories. A random subset of 151 articles from a database of 1851 newspaper suicide stories published during 1988 through 1996, which were collected as part of a national study in the United States to identify factors associated with the initiation of youth suicide clusters, were evaluated. Using a well-defined content-analysis procedure, the agreement between raters in scoring key concepts of suicide reports from the headline, the pictorial presentation, and the text were evaluated. The results show that while the majority of variables in the content analysis were very reliable, assessed using the kappa statistic, and obtained excellent percentages of agreement, the reliability of complicated constructs, such as sensationalizing, glorifying, or romanticizing the suicide, was comparatively low. The data emphasize that before effective guidelines and responsible suicide reporting can ensue, further explication of suicide story constructs is necessary to ensure the implementation and compliance of responsible reporting on behalf of the media.     

Pathological Teasing and Bullying Turned Deadly: Shooters and Suicide

Bullying, a form of interpersonal violence, has emerged in the 21st century as an important public health issue. Bullying during childhood and adolescence is a common problem and occurs almost universally. It may be viewed on a continuum as a relationship problem in which power and aggression are inflicted on a vulnerable person to cause distress. However, teasing and bullying can turn deadly. A deeply troubled youth, after years of chronic bullying, may decide he has no alternative but suicide. The Daniel Scruggs case is one such example. Alternatively, the troubled youth may be attracted to the violent hero presented in the media that demonstrates his power via weapons as in the cases of school shootings.

Why does bullying continue? Some of the problem is the belief that bullying is simply a part of growing up; adults who believe this are often unwilling to intervene. Bullies are not always easy to identify, as they are adept at concealing bullying behavior. Anti-bullying school programs have shown promise in reducing unacceptable behaviors. The next step is to educate teachers, law enforcement, and mental health staff members to identify the red flags of teasing and bullying that indicate an at-risk youth for either suicide or homicide.     

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 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 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.     

Suicide and the media. Part III: Theoretical issues

The body of evidence suggests that there is a causal association between nonfictional media reporting of suicide (in newspapers, on television, and in books) and actual suicide, and that there may be one between fictional media portrayal (in film and television, in music, and in plays) and actual suicide. This finding has been explained by social learning theory. The majority of studies upon which this finding is based fall into the media "effects tradition," which has been criticized for its positivist-like approach that fails to take into account of media content or the capacity of audiences to make meaning out of messages. A cultural studies approach that relies on discourse and frame analyses to explore meanings, and that qualitatively examines the multiple meanings that audiences give to media messages, could complement the effects tradition. Together, these approaches have the potential to clarify the notion of what constitutes responsible reporting of suicide, and to broaden the framework for evaluating media performance.