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.     

The prevention of suicide in India and the developing world: the need for population-based strategies

Very high rates of suicide have been reported from India and the developing world. However, much of the debate on suicide prevention focuses on individuals, methods, site-specific solutions, or particular suicide prevention strategies. This article argues for population based approaches that focus on improving the general health of populations (e.g., macroeconomic policies that aim for social justice, schemes to meet basic human needs, organizing local support groups within vulnerable sections of society, developing and implementing an essential pesticide list, addressing gender issues, and increasing public awareness through the mass media) rather than medical, psychiatric, and other strategies that target individuals (e.g., treatment of mental illness, counseling, etc.) in order to reduce high suicide rates in India and developing countries. Individual approaches will help people in distress and prevent individuals from committing suicide, but will not reduce population suicide rates.     

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.     

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.     

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.     

Newspaper reporting of suicide cases in Hong Kong

This study addresses the concerns over newspapers' reporting of suicide cases in Hong Kong, SAR (Special Administrative Region), using the WHO guidelines on the reporting of suicide news as a reference for comparison. We compared the official suicide information extracted from the Coroner's Court for the year 2000 with newspaper reports on suicides taken from five major Chinese local newspapers, which accounted for about 80% of the total circulation in Hong Kong. The type of newspaper reporting on suicides was also examined. Newspapers tended to report on those suicide victims who suffered relationship problems, whereas those who had family problems were significantly underreported. Among the suicides reported in the newspapers, 6.2% were found on the front page and the majority of the reports were presented pictorially. The reporting of suicides was selective and the coverage was incomplete, with student suicides reported excessively. The method of reporting for Hong Kong newspapers was not in line with the recommendations of the WHO or international best practices on presenting suicide news. For this reason we recommend a partnership approach with active participation from the media on suicide prevention so that communication professionals can proactively participate in suicide prevention work more effectively.     

The media and suicide: a cautionary view

There is now unequivocal statistical evidence of an association between some media portrayals of suicide and further subsequent suicide. However, it is a weak association, and it is probably of far less importance than our need to address basic principles of good mental health management. Rather than prescribe to the media how to report suicide, its potentially positive effects should be addressed.     

Suicide to harass others: clues from mythology to understanding suicide bombing attacks

Suicide by revenge, the Samsonic suicide, and the suicide by devotio, all described in classical mythology and also reported in the ethnographic literature, belong to the same class of suicidal behaviors as kamikaze suicide and the suicide bombing attack: suicide to harass and burden others or suicide with a hostile intent. The lack of a social dimension to share in a positive manner may lead an individual to integrate him/herself in another social structure, e.g., a military organization, which allows the individual to express his/her desires and personal identity only by destroying others and themselves. The dynamics of these forms of suicide are also likely to work in other displays of life-threatening behavior, such as family annihilation, mass murder, and spree killing. A more thorough investigation of the dynamics operating in suicide bombing attacks could, therefore, contribute to preventative strategies against violence at large.     

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.     

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.     

Placing School Victimization in a Global Context

ABSTRACT

Although often considered to be safe havens, schoolhouses have a darker side: they are places where students are victimized. Research in the United States shows that students are victimized by various forms of misconduct, ranging from property-related crime (e.g., theft, destruction) to violent behavior (e.g., assault, homicide) in schools. Notably, international studies reveal that school victimization is a serious concern across the globe. In this context, the present study provides an overview of the extent and nature of school victimization from international perspective. Special attention is given to bullying, a form of victimization found across the globe. Important school-based prevention efforts developed outside the United States are discussed. Finally, this study raises awareness to another type of serious victimization—terrorist attacks—that are on the rise, particularly among nations located in the Middle East, Southeast Asia, and Africa.     

An exercise in improving suicide reporting in print media

This study was conducted to support the publication of guidelines for media reporting on suicide. First, quantitative and qualitative aspects of suicide reporting in Swiss print media were surveyed over a time span of 8 months. The results were presented at a national press conference, and written guidelines for suicide reporting were sent out to all newspaper editors. The results of the survey and the guidelines were discussed in a personal meeting with the Editor-in-Chief of the main tabloid. After the publication of the guidelines a second, identical survey was conducted. The main variables regarding frequency, form, and content of the newspaper reports before and after the press conference were compared. The number of articles, on the one hand, increased over the 3 years between the first and second survey, but the quality of reporting clearly improved on the other. The personal contact with the editor of the tabloid was probably the most effective means of intervention.     

I.A.S.P. guidelines for suicide prevention. I.A.S.P. Executive Committee

There are a number of ways in which suicide can be prevented. Broad social issues can be influenced by firm advocacy for change in appropriate areas in different countries, such as by restricting access to specific means of suicide and by enhancing health and social services in general. At the individual level, after the establishment of rapport, there should be screening for the presence of specific mental disorders, which, if present, should be treated vigorously. If medication is indicated, the safest drug should be prescribed, although it is emphasized that even if drugs are utilized, nondrug treatment is important for every suicidal person. The focus of supportive therapy, which can be provided by both the helping professions and volunteer organizations, should be the provision of hope for the future, the enhancement of independence, and the learning of different ways of coping with the inevitable stressors of everyday life. If these guidelines are followed, there is every reason to believe that an impact can be made upon the worldwide problem of suicidal behavior.     

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.     

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.     

Team Characteristics and Team Member Knowledge,Skills, and Ability Relationships to the Effectiveness of Cross‐Functional Teams in the Public Sector

Abstract

This study examines members of cross‐functional teams in the public sector for the necessary knowledge, skills, and ability (KSA) to be effective team members. It was determined that members of cross‐functional teams in the public sector possess the necessary KSA to perform effectively. The following characteristics are statistically significant factors: (1) years of professional work experience; (2) frequency of team participation; (3) the type of team training, i.e., collaboration and performance management; and (4) situational entry to team assignments (volunteered, assigned, requested), specifically volunteer and requested. The findings are significant in that managers within the government have some guidelines on team formation. They now know who should be team members, team members should be volunteers, and management should ensure that the team members have specific training in the areas of team collaboration and performance management. The findings are significant for employees as well. To acquire experience, employees should be interested in participating in a team environment (i.e., volunteering for the assignment). They should participate on numerous teams, so that they can become more effective as team members. Employees should acquire training in specific team skills (i.e., collaboration and performance management) to help them better understand how to work within the team and the team members and get results.     

Party,State, and Socialism in Guinea-Bissau

Suicide is generally regarded as an anti-social behavior. It is, perhaps, for this reason that sociologists and psychologists, among other experts, have been interested in studying the incidence of suicide in many societies. Most modern theories on suicide, however, do not emphasize the idea of “heroic suicide.” Epitomizing this “genre” of suicide are the high profile, politically motivated suicides in early colonial Ibadan examined here. This article suggests that the key to understanding these suicide cases is to be found not only in these people’s multilayered pasts — the general Yoruba past and Ibadan’s nineteenth-century military heritage — but also in their conception of honor and in their social norms. The ideals of honor thus carried over into the twentieth century were so strong that they survived the first three decades of colonial rule despite the intrigue-laced nature of Ibadan chieftaincy politics and the official interference of the colonial authorities. This article concludes that politically motivated suicide, though self destructive was actually meant to serve an honorable purpose such that those involved became heroes even in death. There is therefore the need for suicide theorists to highlight exceptions like these.     

Radical Beliefs and Violent Actions Are Not Synonymous: How to Place the Key Disjuncture Between Attitudes and Behaviors at the Heart of Our Research into Political Violence

This article develops and elaborates on three core points. First, as with research into other social science themes, it is argued that it is necessary to apply the logic of correlation and causality to the study of political violence. Second, it highlights the critical disjuncture between attitudes and behaviors. Many or most individuals who support the use of political violence remain on the sidelines, including those who sympathize with insurgents in Afghanistan (reportedly 29 percent in 2011), and those supportive of “suicide attacks” in the Palestinian Territories (reportedly reaching 66 percent in 2005). Conversely, those responsible for such behaviors are not necessarily supportive of the ostensible political aims. Third, it is argued that the motives that drive these attitudes and behaviors are often (or, some would argue, always) distinct. While the former are motivated by collective grievances, there is substantial case study evidence that the latter are commonly driven by economic (e.g., payments for the emplacement of improvised explosive devices), security-based (i.e., coercion) and sociopsychological (e.g., adventure, status, and vengeance) incentives. Thus, it is necessary for the research community to treat attitudes and behaviors as two separate, albeit interrelated, lines of inquiry.