Suicidal behavior in a young offender population

Young offenders have numerous problems, including increased psychopathology, housing, and psycho-social stresses and increased rates of substance abuse. The current study investigated the contribution that substance use might make to a particularly vulnerable group of young people. Of the 300 young people approached for the study, 23.7% reported a prior suicide attempt. For this group, the most significant predictors of a prior suicide attempt were negative affect, prior exposure to violence, and housing stress. Life-time substance-use variables were most predictive of the number of suicide attempts a young person might make. Self-reported lethality (the expectation that on the last attempt the young person expected to die) was not strongly predicted by any variable. The research identifies the important role that dynamic risk factors (such as mood, substance use, and psychosocial stressors) play in increasing the risk of self-harm for young offenders, and raises the need to provide for more comprehensive discharge planning and support in order to manage these needs.     

What can we do to help and understand survivors of suicide in Hong Kong?

Survivors of suicide or people bereaved by suicide are underresearched and underserviced. This report contains preliminary data, collected from a psychological autopsy study, which examines the characteristics of suicide survivors in Hong Kong. This paper considers the preliminary data currently available and attempts to suggest a way forward toward understanding and help for this underrecognized group of individuals in Hong Kong.     

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.     

Preventing elderly suicide through primary care by community-based screening for depression in rural Japan

Depression is a major cause of suicide among the elderly. Few previous community-based interventions against depression have reduced the suicide rate. This study aims to evaluate outcomes of a community-based program to prevent suicide among the elderly using a quasi-experimental design with a neighboring reference group. The program, including depression screening with follow-up and health education through primary care and public health nursing, was implemented for 10 years in Matsudai town, a rural area of Japan (population 6,015; suicide rate per 10(5) [65-year-olds] for males 290.6, and for females 361.3). Changes in the suicide risk were estimated by the incidence rate ratio (IRR). The female risk of completing suicide in the intervention area was reduced by 70% (age-adjusted IRR: 0.30; 95% CI: 0.14-0.67), while there was no change in the risk for males in the intervention area nor for males or females in the reference area (Kawanishi town: population 9,425; elderly suicide rate for males 212.2, females 151.9). A ratio of the female IRR in the intervention area to that in its prefecture was also estimated at 0.45 (95% CI: 0.19-0.97), showing that the reduction of suicide risk in the intervention area was greater than the historical trend. A community intervention against suicide using management of depression with nonpsychiatric, primary health care would be effective for elderly females, but not males.     

The lived experience of adults bereaved by suicide: a phenomenological study

In recent years, a plethora of research studies have attempted to delineate the grief experiences associated with suicide from those of other sudden traumatic deaths. The emerging consensus suggests that bereavement through suicide is more similar than different to other bereavements, but is characterized by the reactions of shame, stigma, and self-blame. The causal nature of these reactions has yet to be fully understood. This study reports on the lived experiences of eight adults bereaved by suicides, which were obtained through in-depth interviews. Data were analyzed using interpretative phenomenological analysis. Four main themes dominated the relatives' grief experiences. First, the early months were checkered by attempts to "control the impact of the death." The second theme was the overwhelming need to "make sense of the death" and this was coupled with a third theme, a marked "social uneasiness." Finally, participants had an eventual realization of a sense of "purposefulness" in their lives following the suicide death. Overall, the findings suggest that suicide bereavement is molded and shaped by the bereaved individual's life experiences with the deceased and their perceptions following social interactions after the event. The findings from this study suggest that "meaning making" may be an important variable in furthering our understanding of the nuances in suicide bereavement.     

The Making of a Martyr: Chechen Suicide Terrorism

Beginning in June of 2000 Chechen terrorists have carried out twenty-eight acts of suicide terrorism acts including two mass hostage taking operations combined with suicide terrorism (Beslan and Nord Ost). This paper reports the findings from psychological autopsies (interviews with close family members and friends) of thirty-four (out of 112 total) of these human bombers as well as augmenting them with material from hostage interviews from Beslan and Nord-Ost. The authors analyze the phenomena on the levels of the organization, individual, society and in terms of ideology and compare findings from other arenas also involving suicide terrorism. The main findings are that a lethal mix occurs when individuals in Chechnya are vulnerable to self recruitment into suicide terrorism due to traumatic experiences and feeling a duty to revenge and this vulnerability is combined with exposure to groups that recruit and equip suicide terrorists with both an ideology and the means to explode themselves. The ideology supporting Chechen suicide terrorism is very similar to the global jihadist ideology but remains more nationalist in its goals. It functions for the bombers much like short lived psychological first aid—answering their posttraumatic concerns in a way that shortly leads to their deaths. Unlike the Palestinian case, there is little social support for suicide terrorism in Chechnya.     

Child and adolescent suicide deaths in New Mexico, 1990-1994

The suicide death rate in New Mexico is consistently higher than the national rate. Among adolescents, suicide is the third leading cause of death nationally, but in New Mexico it is the second leading cause of death. This study describes the pattern of adolescent suicide deaths in New Mexico. We conducted a retrospective review of all medical examiner autopsies for adolescent suicides (ages 20 years and younger) in New Mexico from 1990-1994. Records were reviewed for demographics and possible contributing factors such as depression, previous attempts, and alcohol and drug use. We identified 184 suicide deaths among children and adolescents ages 9-20 years for an overall rate of 12.9 per 100,000. Our rates for ages 5-9 years (0.2), 10-14 years (3.8), and 15-19 years (22.3) are over twice the U. S. rates. Suicide deaths resulted primarily from firearms (67%), hanging (16%), poisoning (6%), inhalation (4%), and other methods (7%). Method varied by ethnicity (p = .01) and gender (p = .03); males and non-Hispanic Whites were overrepresented among firearm deaths. Firearm ownership was known in 60 (48%) of the firearm deaths. Of these, 53% of the firearms belonged to a family member, 25% to the decedent, and 22% to a friend. Over one-third of decedents (41%) experienced mental disorders, primarily depressed mood and clinical depression. Previous suicide attempts were noted for 15% of the decedents. Some 50% of the decedents had alcohol or drugs present at the time of death; among American Indians/Alaska Natives, 74% had drugs or alcohol present (p = .003). Targeted interventions are needed to reduce adolescent suicide in New Mexico. We suggest raising awareness about acute and chronic contributing factors to suicide; training physicians to look for behavioral manifestations of depression; and involving physicians, teachers, and youth activity leaders in efforts to limit firearm accessibility, such as advising parents to remove firearms from their households.     

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.     

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.     

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.     

The future of housing systems after the transition – The case of the Czech Republic

The article attempts to answer the question about the future of housing system in the Czech Republic. As other transition countries, the Czech Republic underwent the substantial reform of housing system leading to the change in tenure structure in favour of owner-occupied housing. The authors discuss the basis and implicit aspects of tenure reform. The change in tenure structure was more gradual than in most other transition countries and together with other specific conditions it gave the chance to rental housing becoming a real alternative to homeownership tenure in the future. Using the results from several attitude surveys and unique experiment, the authors tried to find out whether there is any chance of deviating from the path leading towards a housing system unilaterally based on homeownership tenure. The empirical results, however, show that people’s tenure preferences remain strongly skewed in favour of owner-occupation.     

Social housing under the Workers’ Party government: an analysis of the private sector in Brazil

This article examines the patterns of government intervention in social housing in Brazil to analyse the role of the private sector in the elaboration and implementation of social housing policies during the Workers’ Party government. It draws on case study research, and I examine areas which impact on the way social housing has been implemented since 2003 to study the concentration of decision power the private construction sector has on social housing policymaking, which sets the tone of government intervention on social housing. I argue this was part of the Workers’ Party’s approach to neoliberal policies in a more moderated style, a type of intervention repeated on numerous occasions under previous administrations. This article concludes by noting the prominent role of the private sector in social housing developments.     

Unemployment and suicidal behavior in a New Zealand birth cohort: a fixed effects regression analysis

This study examined the association between exposure to unemployment and suicidal behaviors (suicidal ideation and attempted suicide) in a birth cohort of New Zealand young adults using fixed-effects logistic and Poisson regression models. Data were gathered on unemployment and suicidal behaviors at annual periods from ages 16-25 years. At all ages increasing exposure to unemployment was associated with increased risks of suicidal ideation (p < .0001) and number of suicide attempts (p < .0001). Following adjustment for fixed effects and time-dynamic covariates, associations between unemployment and suicidal ideation reduced to marginal significance (p < .10), while the association between unemployment and suicide attempts was not statistically significant (p > .10). After adjustment, those experiencing 6 or more months of unemployment in a given year had odds of suicidal ideation that were 1.43 (95% CI: .96 to 2.16) times higher, and rates of suicide attempts that were 1.72 (95% CI: .89 to 3.32) times higher, than those who were not exposed to unemployment. Although unemployment was associated with moderate increases in risks of suicidal behaviors, much of this association was explained by confounding factors.     

Reaching the Hard to Reach: Drawing Lessons From Research and Practice

Communicating with citizens, stakeholders, or service clients is challenging under normal circumstances. Reaching government audiences who are hard to reach because of language or culture differences, lifestyle unpredictability, mistrust, isolation, or other reasons compounds the difficulty. This article examines who the hard to reach are, addresses reasons why it is important for governments to reach them, explores research and experience, suggests effective approaches for reaching these audiences—drawing upon a social constructionist approach—and proposes lessons and guidelines for public sector communicators. Communication practice and research indicate that more effective strategies include: utilizing knowledge about target audiences; forming partnerships with agencies and individuals that interact with targeted populations; utilizing children to reach parents and older relatives; using ethnic media that effectively reach immigrant and ethnic minority households; and simplifying communication and using feedback techniques.     

U.S. Policy on Terrorism: In Search of an Answer

An analysis of three years of suicide bombing data in Israel reveals an increase in such attacks through March 2002 followed by a steep decline through the end of 2003. The authors propose a terror-stock model that treats the suicide bombing attack rate as a function of the number of terrorists available to plan and execute suicide bombings. The intent of Israeli tactics such as targeted killings and preemptive arrests is to reduce the capacity of terror organizations to commit attacks. When fit to the data, this model suggests that the targeted killing of terror suspects sparks estimated recruitment to the terror stock that increases rather than decreases the rate of suicide bombings. Surprisingly, only the deaths of suspected terrorists, and not Palestinian civilians, are associated with such estimated recruitment. Although Israeli actions have reduced the rate of suicide bombings over time, it is preventive arrests rather than targeted killings that seem more responsible for this outcome.     

People with disabilities working in the disability sector in Timor Leste: a study of ‘lived experience’ using PhotoVoice

Perspectives on disability originating from non-Western cultures are beginning to appear in disability literature, however discussions may become lost in rhetoric unless grounded in experiences of people with disabilities themselves. The purpose of this study was to investigate the lived experience of physical disability in Timor Leste with the assistance of a group of Timorese participants with disabilities who were employed in the disability sector. These participants recounted experiences of disability from their own lives together with their observations of people with disabilities living in remote parts of Timor Leste who often lived with stigma or deprivation. The participants thus described their own lived experiences against a backdrop of a non-Western culture. A picture emerged of a stigmatising culture where acceptance of disability is uncommon yet where significant attempts are being made to change attitudes to disability within the culture of Timor Leste.     

Are Suicide Bombers Suicidal?

Recent work by Ariel Merari argues that, while certain contextual factors increase the probability of suicide attacks, they do not explain why particular individuals become suicide bombers. Merari seeks to demonstrate that suicide bombers are motivated by an unusually high prevalence of depression and suicidal tendencies. This article questions the representativeness of Merari's sample. It raises the possibility that interviewer and contextual effects contaminated his findings. Finally, it presents evidence that challenges Merari's conclusions. This evidence is drawn from interviews with immediate family members and close friends of a 25 percent random sample of Palestinian suicide bombers who conducted attacks between 2000 and 2005. Based on their analysis, the authors question the value of a psychological approach to the study of suicide bombers and assert the importance of focusing on the political and social roots of the phenomenon.     

Evidence-based prevention strategies of suicide behavior in the world: implications for Slovenia

In this review we consider how Slovenia could consider tackling its high rate of suicide (overall 29 per 100,000, 46 in males, 13 in females). First, we consider the evidence for risk factors that may contribute to Slovenia's high rate of suicide. Second, we describe the interventions to try to reduce the impact of these factors and the evidence for such interventions. We categorize interventions in terms of their operation at either the population level or that of high-risk groups. However, it should be borne in mind that settings often assumed to provide access to population groups, such as general practice and schools, do not reach some people who are likely to be at high risk; for example those who have dropped out of school or who have been excluded from a GP's list. We focus particularly on those for high-risk groups, as a number of East-European countries with high suicide rates such as Slovenia, Hungary, and the Baltic republics are currently considering a shift toward more community-based mental health services. The provision of community mental health services in Slovenia would provide an opportunity to study their impact on the suicide rate. However, we conclude that their development should be accompanied by other initiatives operating at population levels. This multilevel approach acknowledges the complexity of the etiology of suicide, the impossibility of reaching all those at risk through services and the lack of strong evidence for any one intervention.     

Suicidal behavior in South Asians in the UK

Rates of deliberate self-harm have been reported to be higher among South Asians, especially women, in the UK. Two studies collected information on inception rates of deliberate self-harm in the UK and reported that rates of attempted suicide are much higher among South Asian women especially those aged 18-24. These rates are associated with high rates of cultural alienation and previous attempts. The implications of cultural conflict are discussed in this context. In addition, a hypothetical model of interrelationship of factors for both adults and adolescents is described.     

Crisis occurrence and resolution in patients with severe and persistent mental illness: the contribution of suicidality

Assertive community treatment appears to have limited impact on the risk of suicide in persons with severe and persistent mental illness (SPMI). This exploratory prospective study attempts to understand this observation by studying the contribution of suicidality to the occurrence of crisis events in patients with SPMI. Specifically, an observer-rated measure of the need for hospitalization, the Crisis Triage Rating Scale, was completed at baseline, crisis occurrence, and resolution to determine how much the level of suicidality contributed to the deemed level of crisis. Second, observer-ratings of suicidal ideation, the Modified Scale for Suicide Ideation, and psychopathology and suicidality, Brief Psychiatric Rating Scale, were measured at baseline, crisis occurrence, and resolution. A self-report measure of distress, the Symptom Distress Scale, was completed at baseline, crisis occurrence, and resolution. Finally, the patients' crisis experiences were recorded qualitatively to compare with quantitative measures of suicidality. Almost 40% of the subjects experienced crisis events and more than a quarter of these events were judged to be severe enough to warrant the need for hospitalization. Our findings suggest that elevation of psychiatric symptoms is a major contributor to the crisis occurrences of individuals with SPMI; although the risk of suicide may have to be conceived as somewhat separate from crisis occurrence.