Prevention of suicide.

We reviewed the epidemiologic features of suicide in Canada and evaluated suicide prevention programs. Three groups were found to be at increased risk for suicide: men aged 70 years or more, women aged 65 to 69 and men aged 20 to 24. The other groups, in decreasing order of risk, were the mentally ill, people who have attempted suicide, those with a life-threatening illness, native people, people with a family history of suicide and prisoners. Studies that evaluated suicide prevention programs showed that none significantly reduced the incidence of suicide; however, the studies were found to be methodologically inadequate or used noncomparable systems of data collection. On the basis of our findings we recommend that primary care physicians routinely evaluate suicide risk among patients in high-risk groups and that intervention include counselling, follow-up and, if necessary, referral to a psychiatrist. Close follow-up is recommended for newly discharged psychiatric patients and those who recently attempted suicide.     

Suicide and attempted suicide among South Asians in England: who is at risk?

Evidence from both large-scale and small-scale studies suggests differences and similarities in patterns of suicide and attempted suicide between South Asians and the total population in England. Among South Asians, the excess of females among both suicides and attempted suicides is even more marked; the traditional view of a strong family structure among Asians is confirmed, although cultural conflict between generations is apparent. The technique of suicide by burning among Asians appears to be waning. Asians who attempt or complete suicide are more likely to be suffering from stress, but less likely to have been diagnosed as mentally ill. Their psychological problems appear to have been frequently overlooked by general practitioners, or not presented to them. Differences in religion, with Hindus producing higher rates than Muslims, and demographic, geographical, financial and cultural differences, contribute to the need for disaggregation and up-to-date research.     

Suicide rates in young men in England and Wales in the 21st century: time trend study

Objectives To explore trends in suicide in young people to investigate the recent observation that after year on year rises in the 1970s, 1980s, and early 1990s, rates in young men are now declining.Design Time trend analysis.Setting England and Wales, 1968-2005.Population Men and women aged 15-34 years.Results Since the 1990s, rates of suicide in young men have declined steadily and by 2005 they were at their lowest level for almost 30 years. This decline is partly because of a reduction in poisoning with car exhaust gas as an increased number of cars have catalytic converters; but there have been declines in suicides from all common methods, including hanging, suggesting a more pervasive effect. Other risk factors for suicide, such as unemployment and divorce, have also decreased. Possible recent reductions in alcohol use among young men and increases in prescribing of antidepressants do not seem to be temporally related to the decline in suicide.Conclusions Suicide rates in young men have declined markedly in the past 10 years in England and Wales. Reductions in key risk factors for suicide, such as unemployment, might be contributing to lower rates.     

Attempted Suicide in Bipolar Disorder: Risk Factors in a Cohort of 6086 Patients

Objective

Bipolar disorder is associated with high risk of self-harm and suicide. We wanted to investigate risk factors for attempted suicide in bipolar patients.

Method

This was a cohort study of 6086 bipolar patients (60% women) registered in the Swedish National Quality Register for Bipolar Disorder 2004–2011 and followed-up annually 2005–2012. Logistic regression was used to calculate adjusted odds ratios for fatal or non-fatal attempted suicide during follow-up.

Results

Recent affective episodes predicted attempted suicide during follow-up (men: odds ratio = 3.63, 95% CI = 1.76–7.51; women: odds ratio = 2.81, 95% CI = 1.78–4.44), as did previous suicide attempts (men: odds ratio = 3.93, 95% CI = 2.48–6.24; women: odds ratio = 4.24, 95% CI = 3.06–5.88) and recent psychiatric inpatient care (men: odds ratio = 3.57, 95% CI = 1.59–8,01; women: odds ratio = 2.68, 95% CI = 1.60–4.50). Further, those with many lifetime depressive episodes were more likely to attempt suicide. Comorbid substance use disorder was a predictor in men; many lifetime mixed episodes, early onset of mental disorder, personality disorder, and social problems related to the primary group were predictors in women.

Conclusion

The principal clinical implication of the present study is to pay attention to the risk of suicidal behaviour in bipolar patients with depressive features and more severe or unstable forms of the disorder.     

Gendered Endings: Narratives of Male and Female Suicides in the South African Lowveld

Durkheim's classical theory of suicide rates being a negative index of social solidarity downplays the salience of gendered concerns in suicide. But gendered inequalities have had a negative impact: worldwide significantly more men than women perpetrate fatal suicides. Drawing on narratives of 52 fatal suicides in Bushbuckridge, South Africa, this article suggests that Bourdieu's concepts of 'symbolic violence' and 'masculine domination' provide a more appropriate framework for understanding this paradox. I show that the thwarting of investments in dominant masculine positions have been the major precursor to suicides by men. Men tended to take their own lives as a means of escape. By contrast, women perpetrated suicide to protest against the miserable consequences of being dominated by men. However, contra the assumption of Bourdieu's concept of 'habitus', the narrators of suicide stories did reflect critically upon gender constructs.     

Gender, Suicide, and the Sociocultural Context of Deliberate Self-Harm in an Urban General Hospital in Mumbai, India

Recognizing the complementary effects of social contexts and psychiatric disorders, this study clarifies the role of gender in suicidal behavior in urban Mumbai by considering psychiatric diagnoses and patient-identified sociocultural features. The cultural epidemiological approach suggests the critical impact of situational sociocultural factors that complement the customary psychopathological accounts for those who harm or kill themselves. The cultural epidemiology of deliberate self-harm (DSH), it is argued, is critical to planning for suicide prevention, community mental health and psychiatric practice. This study, based on a cultural epidemiological framework, compares male and female admissions for DSH, evaluating conditions with SCID-I and EMIC interviews. We assessed features and narratives of suicidal behavior, patient-identified underlying problems, their perceived causes and triggers. The study included 92 women and 104 men. A diagnosis of depressive disorder was made for 48.9 percent of women and 39.4 percent of men. Many patients (50.0 percent of women and 41.3 percent of men) did not fulfill the criteria for any diagnosis, or did so only for an adjustment disorder or a V-code. Men typically explained DSH with reference to work problems, financial problems and problem drinking. Women typically discussed domestic problems, in-law relations and victimization. Problem drinking affected women living with men who drank. Social and situational factors appear to play a relatively greater role than psychiatric illness in self-harm and suicide in Mumbai, as in other Asian studies, compared with Europe and North America.     

Trends in deliberate self poisoning and self injury in Oxford, 1976-90.

OBJECTIVE--To review trends in deliberate self poisoning and self injury (attempted suicide) over 15 years (1976-90) on the basis of general hospital referrals. DESIGN--Prospective data collection by computerised monitoring system. SETTING--Teaching general hospital. SUBJECTS--All patients aged 15 and over (n = 9605) referred to the hospital after episodes (n = 13,340) of deliberate self poisoning or self injury. MAIN OUTCOME MEASURES--Rates based on population of Oxford city; changes in substances used for self poisoning; history and repetition of attempts; and rates of admission to the hospital and of referral to the psychiatric service. RESULTS--Attempted suicide rates for women declined during the late 1970s and early 1980s but increased again during the late 1980s. Those for men remained relatively steady throughout the period. Highest mean annual rates occurred in women aged 15-19 (711/100,000) and in 20-34 year old men (334/100,000). The proportion of overdoses with paracetamol increased from 14.3% (125/873) in 1976 to 42% (365/869) in 1990 (chi 2 for trend = 481, p less than 0.01). Throughout the period the proportions of referred patients admitted to hospital and of those attempting suicide for the first time (over two thirds) did not decrease. Annual rates of repetition of attempts by women declined from 15.1% (257/1700) in 1976-8 to 11.9% (161/1356) in 1987-9 (chi 2 for trend = 7.8, p less than 0.01). Lower repetition rates occurred in women admitted to hospital and referred to the psychiatric service (431/4585, 9.4%) than in those not referred (42/235, 17.9%; chi 2 = 17.2, p less than 0.0001). CONCLUSIONS--Rates of attempted suicide declined in the 1970s and early 1980s, in women, but there are probably at least 100,000 hospital referrals a year in England and Wales because of this problem. Prevention of paracetamol self poisoning requires urgent attention, and psychosocial assessment should be conducted with as many of those who attempt suicide as possible.     

Suicide among Arab-Americans

Background

Arab-American (AA) populations in the US are exposed to discrimination and acculturative stress—two factors that have been associated with higher suicide risk. However, prior work suggests that socially oriented norms and behaviors, which characterize recent immigrant ethnic groups, may be protective against suicide risk. Here we explored suicide rates and their determinants among AAs in Michigan, the state with the largest proportion of AAs in the US.

Methodology/Principal Findings

ICD-9/10 underlying cause of death codes were used to identify suicide deaths from among all deaths in Michigan between 1990 and 2007. Data from the 2000 U.S. Census were collected for population denominators. Age-adjusted suicide rates among AAs and non-ethnic whites were calculated by gender using the direct method of standardization. We also stratified by residence inside or outside of Wayne County (WC), the county with the largest AA population in the state. Suicide rates were 25.10 per 100,000 per year among men and 6.40 per 100,000 per year among women in Michigan from 1990 to 2007. AA men had a 51% lower suicide rate and AA women had a 33% lower rate than non-ethnic white men and women, respectively. The suicide rate among AA men in WC was 29% lower than in all other counties, while the rate among AA women in WC was 20% lower than in all other counties. Among non-ethnic whites, the suicide rate in WC was higher compared to all other counties among both men (12%) and women (16%).

Conclusions/Significance

Suicide rates were higher among non-ethnic white men and women compared to AA men and women in both contexts. Arab ethnicity may protect against suicide in both sexes, but more so among men. Additionally, ethnic density may protect against suicide among Arab-Americans.     

Ethnicity- and Sex-Based Discrimination and the Maintenance of Self-Esteem

The psychological underpinnings of labor market discrimination were investigated by having participants from Israel, the West Bank and Germany (N = 205) act as employers in a stylized employment task in which they ranked, set wages, and imposed a minimum effort level on applicants. State self-esteem was measured before and after the employment task, in which applicant ethnicity and sex were salient. The applicants were real people and all behavior was monetarily incentivized. Supporting the full self-esteem hypothesis of the social identity approach, low self-esteem in women was associated with assigning higher wages to women than to men, and such behavior was related to the maintenance of self-esteem. The narrower hypothesis that successful intergroup discrimination serves to protect self-esteem received broader support. Across all participants, both ethnicity- and sex-based discrimination of out-groups were associated with the maintenance of self-esteem, with the former showing a stronger association than the latter.     

Are there differences in serum cholesterol and cortisol concentrations between violent and non-violent schizophrenic male suicide attempters?

Previous studies have shown an association between low concentration of serum cholesterol, as well as high concentration of serum cortisol, in suicide behavior. The aim of this study was to evaluate whether men after a violent suicide attempts have different serum cholesterol and cortisol concentrations than those who attempted suicide by non-violent methods. Venous blood samples were collected within 24 hours of admission, to study concentrations of serum cholesterol and cortisol. The sample consisted of 31 male subjects suffering from schizophrenia, admitted in a general hospital after suicide attempt, and was compared with 15 schizophrenic nonsuicidal male controls. Patients with a violent suicidal attempt were found to have significantly lower cholesterol levels and significantly higher cortisol level than patients with non-violent attempts and the control subjects. Our findings suggest that suicide attempts should not be considered a homogenous group. The hypothesis of an association of violent suicidal attempts and peripheral biological markers (cholesterol and cortisol) was supported by our findings.     

Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths

South Asia accounts for the majority of the world’s suicide deaths, but typical psychiatric or surveillance-based research approaches are limited due to incomplete vital surveillance. Despite rich anthropological scholarship in the region, such work has not been used to address public health gaps in surveillance and nor inform prevention programs designed based on surveillance data. Our goal was to leverage useful strategies from both public health and anthropological approaches to provide rich narrative reconstructions of suicide events, told by family members or loved ones of the deceased, to further contextualize the circumstances of suicide. Specifically, we sought to untangle socio-cultural and structural patterns in suicide cases to better inform systems-level surveillance strategies and salient community-level suicide prevention opportunities. Using a mixed-methods psychological autopsy approach for cross-cultural research (MPAC) in both urban and rural Nepal, 39 suicide deaths were examined. MPAC was used to document antecedent events, characteristics of persons completing suicide, and perceived drivers of each suicide. Patterns across suicide cases include (1) lack of education (72% of cases); (2) life stressors such as poverty (54%), violence (61.1%), migrant labor (33% of men), and family disputes often resulting in isolation or shame (56.4%); (3) family histories of suicidal behavior (62%), with the majority involving an immediate family member; (4) gender differences: female suicides were attributed to hopeless situations, such as spousal abuse, with high degrees of social stigma. In contrast, male suicides were most commonly associated with drinking and resulted from internalized stigma, such as financial failure or an inability to provide for their family; (5) justifications for suicide were attributions to ‘fate’ and personality characteristics such as ‘stubbornness’ and ‘egoism’; (5) power dynamics and available agency precluded some families from disputing the death as a suicide and also had implications for the condemnation or justification of particular suicides. Importantly, only 1 out of 3 men and 1 out of 6 women had any communication to family members about suicidal ideation prior to completion. Findings illustrate the importance of MPAC methods for capturing cultural narratives evoked after completed suicides, recognizing culturally salient warning signs, and identifying potential barriers to disclosure and justice seeking by families. These findings elucidate how suicide narratives are structured by family members and reveal public health opportunities for creating or supplementing mortality surveillance, intervening in higher risk populations such as survivors of suicide, and encouraging disclosure.     

Trends in suicide in Scotland 1974-84: an increasing problem.

A detailed investigation of trends in suicide rates in Scotland from 1974 to 1984 showed a complex pattern. Overall rates for men increased by 40% with the greatest increases in those aged 45-64. In contrast, rates for women showed a small decline, which was most noticeable in those aged 15-24. The well recognised decline in poisoning by domestic gas was seen over this period, and suicide by this method virtually stopped. Both sexes showed a decline in suicide by poisoning with drugs, although the decrease was larger among women. The fall in suicide rates among young women was almost all due to the decrease in this method. The rise in rates for men was largely due to increases in hanging and poisoning with vehicle exhaust gases, although all methods except drugs and domestic gas showed some increase. These findings indicate that suicide is an increasing problem with causes that are far from understood, so that prevention may be difficult.     

Dispossession and empowerment in the ethnography of Palestinians in the occupied territories

This article is a review of two recent ethnographies on Palestinians in the West Bank: Resistance, Repression, and Gender Politics in Occupied Palestine and Jordan, by Frances Hasso (2005), and Law, Violence and Sovereignty Among West Bank Palestinian by Tobias Kelly (2006). Hasso examines the significant and unique role of women in organizing the Democratic Front for the Liberation of Palestine in the Occupied Territories, as compared to Jordan, while Kelly examines the jurisdictional and practical problems of labor disputes for male workers in a West Bank village. The two books exemplify how ethnographies of Palestinians in the Occupied Territories oscillate between documenting dispossession and empowerment.     

Des « terres noires » médiévales urbaines de France aux buttes anthropiques tropicales : l'archéologue en action

Thanks to its general objective, Archaeology depends on Natural Sciences as well as on Anthropology and on the varied scientific domains it understates. Consequently, it has to allocate the definitions of its objects to Nature or Culture or to an unmeasurable mixing of both. The analysis of two different occurrences of joint natural sciences and archaeology work, shows that in fact, the Nature/Culture separation does not intervene while defining the objects but is imposed afterwards in the official publication where, more or less cleaned off from its multiple links, the object appears with a name or termed within a sentence limiting the natural and cultural shares which gathered for this designation.This dichotomy from modern Constitution entails the general issue of choice (realized or difficult) between the natural, cultural or divine origin of these world beings. This choice is philosophical, i.e. political, and if it is legitimately, but insufficiently debated in the West, it raises well beyond, the question of the reasons and justifications of the extension and domination of the so-called Constitution to other societies and soon, to the entire world.     

Evolution,Sex, and Jealousy: Investigation With a Sample From Sweden

When asked to choose which would be most upsetting, a mate’s sexual or emotional infidelity, past research has demonstrated that men are more likely than women to choose sexual infidelity, whereas women are more likely than men to choose emotional infidelity. Explanation of this sex difference has been controversial. In the current study we attempted to replicate previous research by examining a sample of college students in Sweden. In doing so, we also investigated the “double-shot” explanation. In the current study, the majority of men chose the sexual infidelity scenario as most upsetting, whereas the majority of women chose the emotional infidelity scenario as most upsetting. Contrary to the double-shot explanation, choice of scenario was unrelated to attitudes regarding whether the other sex was capable of satisfying sexual relations outside of a love relationship.     

Biomechanical analysis of women weightlifters during the snatch

The majority of the research to date on weightlifting has focused on men competitors. This study attempted to bridge the sex-based gap evident in the scientific literature. The performances of 10 women weightlifters competing in the 1999 United States national championships were analyzed. The performance of the athletes competing in the 69-kg class was recorded and analyzed using a Peak5 2D Motion Analysis system. The purpose of this study was 3-fold: (a) analyze the horizontal bar displacement of women weightlifters, (b) analyze key kinematic variables related to performance, and (c) compare the power outputs of the first, second, and total pulls in the snatch. Less than half (<50%) of the snatch attempts demonstrated by the women weightlifters in this study displayed the optimal toward-away-toward horizontal bar trajectory reported elsewhere. The women in this study demonstrated greater drop displacement and drop under times than those previously reported for men weightlifters. They also demonstrated lesser maximal vertically velocities of the barbell than those reported for world class women weightlifters. These women weightlifters demonstrated statistically significant differences (p < 0.05) during each phase of the snatch, and total power output values were comparable to values previously reported. The results of this study suggest that women demonstrate performance characteristics that differ subtly from those reported in men weightlifters. Knowledge of performance measures during the snatch may help coaches and athletes more fully refine the training leading to competition.     

Suicide attempts in the Epidemiologic Catchment Area Study

This study examines risk factors for attempted suicide in the general community. Data from the five-site NIMH Epidemiologic Catchment Area (ECA) Study were used to estimate lifetime prevalence and identify risk factors for suicide attempts. Occurrence of suicide attempts and lifetime diagnosis of psychiatric disorder were ascertained, using the NIMH Diagnostic Interview Schedule (DIS). Of 18,571 adult respondents aged 18 and over, 2.9 percent reported that they had attempted suicide at some time in their lives. A weighted logistic regression model was constructed to ascertain significant (p less than .0028 with Bonferroni correction) risk factors for attempted suicide. Persons who had a lifetime diagnosis of a psychiatric disorder had the highest risk of attempted suicide (odds ratio [OR] = 8.4). Females (OR = 3.3), separated or divorced persons (OR = 2.5), Whites (OR = 1.7), persons in the two lowest socioeconomic quartiles (ORs = 2.2, 2.3), and respondents from the Los Angeles ECA (OR = 1.8) were also more likely to have attempted suicide. These findings contribute to an understanding of suicide and suicidal behavior in general populations, outside the clinical setting.     

宫颈癌研究新进展

宫颈癌是威胁女性健康的最常见的主要恶性肿瘤之一,据统计全世界每年新发现有数万女性患有宫颈癌这种癌症,越来越多的妇女死于宫颈癌。宫颈癌也是一种预防的肿瘤,其致病因素多种多样,包括初次性生活的年龄、吸烟、HPV、HSV、HCMV、EBV等因素。目前的检测方法有巴氏涂片法、薄层液基细胞学涂片法、宫颈组织活检及宫颈管刮术、HPV-DNA检测、计算机辅助细胞学检测系统等方法可以诊断宫颈癌。早期诊断、早期检查对宫颈癌的预防和治疗具有积极作用,同时降低宫颈癌的死亡率。     

Evidence of traditional knowledge loss among a contemporary indigenous society

As biological and linguistic diversity, the world’s cultural diversity is on decline. However, to date there are no estimates of the rate at which the specific cultural traits of a group disappear, mainly because we lack empirical data to assess how the cultural traits of a given population change over time. Here we estimate changes in cultural traits associated to the traditional knowledge of wild plant uses among an Amazonian indigenous society. We collected data among 1151 Tsimane’ Amerindians at two periods of time. Results show that between 2000 and 2009, Tsimane’ adults experienced a net decrease in the report of plant uses ranging from 9% (for the female subsample) to 26% (for the subsample of people living close to towns), equivalent to 1% to 3% per year. Results from a Monte Carlo simulation show that the observed changes were not the result of randomness. Changes were more acute for men than for women and for informants living in villages close to market towns than for informants settled in remote villages. The Tsimane’ could be abandoning their traditional knowledge as they perceive that this form of knowledge does not equip them well to deal with the new socio-economic and cultural conditions they face nowadays.     

Suicide and public health

Suicide as a public health problem is generally underestimated. Deaths from suicide annually outnumber those from cancer of the respiratory system or of other common sites; more than twice as many die by suicide as from most communicable diseases combined. Most suicides are motivated by concern over ill health or domestic difficulties.A program tried in Yolo County to follow up persons who have attempted suicide indicates that a more systematic and widespread effort in this direction might be of value to the public health. It is recommended that attempts at suicide be considered a reportable disease for a one-year period and that a statewide program for following the patients be put into effect to provide rehabilitation as well as symptomatic treatment. Efforts by local health departments and private physicians are also worth while in reducing attempts at suicide.