Adolescent self-poisoning: a cohort study of subsequent suicide and premature deaths

Previous self-harm has been identified as a risk factor for subsequent suicide by adolescents. The objective of the study was to identify further risk factors for subsequent premature death and suicide in a population of adolescents presenting with self-poisoning. A longitudinal cohort design using data-linkage of consecutive adolescent patients presenting to the Hunter Area Toxicology Service, a regional toxicology service for Newcastle, Australia, with the National Death Index of the Australian Institute of Health and Welfare was used. A total of 441 adolescents aged 10 to 19 years presented with self-poisoning over 5 years from January 1991 to December 1995, with follow-up to March 2001. There were 14 deaths total, eight of which were likely suicides. There was a 22-fold increase in suicide rate for males and a 14-fold increase for females compared with age-normalized population rates. Adjusted hazard ratios (95% CI) forpremature death were male gender 3.77 (1.11-12.78), nonaffective psychotic disorders 16.3 (3.83-69.34) and the mental illnesses of childhood 6.12 (1.68-22.23). There was a similar pattern for suicide: Male gender, nonaffective psychotic disorders, and the mental illnesses of childhood confer greater risk for subsequent suicide or premature death in this population.     

A German Cornucopia

Books reviewed in this article:
Marcel Kaufmann, Europäische Integration und Demokratieprinzip
Norbert Reich, Europäisches Verbraucherrecht
Jürgen Schwarze (ed), Das Verwaltungsrecht unter Europäischem Einfluß/e1>     

Contraceptive behavior in adolescence: A decision-making perspective

The contraceptive behavior of adolescent girls was viewed from a decision-making perspective. A semistructured interview protocol was used in interviewing 120 girls aged 12–19 in three clinics (Teen Family Planning, Prenatal, Pediatric Acute Care) at Michael Reese Hospital and Medical Center on (1) demographic in formation; (2) sexual and obstetric history; (3) contraceptive and sexual knowledge, attitudes, and practices; (4) environmental pressures; (5) personality factors; and (6) decision-making style. We found that the girls were generally poor contraceptors. They viewed the costs of contraception (in terms of safety) to be high; and they positively valued physical intimacy, opportunities for which come up unexpectedly and sporadically. These factors, along with their ambivalent views toward pregnancy and childbearing seemed to encourage their risk-taking behavior. Once pregnancy occurred, it was carried to term because of the strong internal and external pressures they felt to have and keep the baby. The peer-led intervention program that we are developing based on the survey findings will focus on (1) the teenagers' lack of accurate and complete knowledge about birth control and conception, (2) their limited sense of options concerning birth control and pregnancy outcomes, and (3) their poor understanding of and lack of insight into what motivates their behavior.This study is part of the investigation being conducted by the YADMAC (Young Adult and Adolescent Decision Making About Contraception) Project at Michael Reese Hospital and Medical Center, 2959 South Cottage Grove, Chicago, Illinois 60616. The authors are all members of the YADMAC research team.Received Ph.D. from the University of Chicago. Current interests are human sexuality and reproductive behavior. Currently at Department of Psychology, St. Xavier College.Received M.D. from the University of Michigan. Current interests are liaison child psychiatry and adolescent sexuality.Received Ph.D. from the University of Chicago. Current interests are early adolescent development issues.Current interests are puberty and sex differences.B. A. candidate in social work, Roosevelt University. Current interests are adolescent sexuality and contraceptive behavior.     

Toxicology and Circumstances of Completed Suicide by Means Other than Overdose*

Abstract: To determine the prevalence and circumstances of psychoactive substances amongst nonoverdose completed suicide, 1436 consecutive cases autopsied at the NSW Department of Forensic Medicine over the period 1/1/1997–12/31/2006 were analyzed. Substances were detected in 67.2% of cases, and illicit drugs in 20.1%. Alcohol was present in 40.6% of cases. Males were more likely to be positive for alcohol, cannabis, and psychostimulants, and females for pharmaceuticals. Illicits were associated with younger age. Alcohol was most prominent amongst toxicity cases, as were opioids, psychostimulants amongst gunshot cases, and pharmaceuticals amongst drownings. Cases in which drug and alcohol histories were noted were more likely to have a substance detected. Alcohol was more common where a suicide note was left and where relationship problems were involved. Pharmaceuticals were more common where a previous attempt was noted. Licit and illicit substances are strongly associated with suicide, even when the method does not involve drug overdose.     

Assessing policy capacity in Canada's public services: Perspectives of deputy and assistant deputy ministers

Abstract: The state of policy capacity within Canada's various levels of government has for some time been the subject of discussion both within the public services themselves and among the academic research community. Drawing on the results of a 2006 survey of deputy and assistant deputy ministers working in Canada's federal, ten provincial and three territorial governments, this article presents assessments made by the most senior leadership. The survey results show that ninety per cent of deputy ministers and assistant deputy ministers agree that policy capacity has changed but that the change is not uni‐directional. Both improvements and decline in policy capacity were observed, although assessments of decline were somewhat more pronounced. Moreover, improvements in policy capacity were found to be associated with a reduced focus on direct service delivery, a greater concern with long‐term planning, and the presence of a political leadership interested in innovation. Conversely, declining policy capacity was found to be linked to centralization of power, the loss of institutional memory, and “churning” within the ranks of the executive leadership. Additionally, level of government was also observed to be linked with change in policy capacity, with provincial deputies reflecting more negatively on policy capacity decline in their government than deputies at other levels.     

Examining Factors Co-Existing with Interpersonal Violence in Lesbian Relationships

Interpersonal violence within lesbian relationships is a significant yet understudied problem. Women attending a gay pride festival in Atlanta, GA, were asked to complete a survey concerning same-sex interpersonal violence. Women who reported being in a current or previous same-sex partner relationship were included in the analyses (N = 226). Factors that occurred in the context of interpersonal violence were investigated: substance use, HIV/STI risk behaviors, barriers to reporting abuse, and attitudes inhibiting seeking of social support. In addition, the survey assessed relationship-related power dynamics. Results of multivariate analyses support the hypotheses that power imbalance and inequality when making sex-related decisions within women’s same-sex relationships are associated with interpersonal violence. Further findings suggested that a combination of factors must be considered when dealing with and reducing the risk for violence in same-sex relationships.