Reasonable People,Double Jeopardy,and Justice

The equipoise requirement in clinical research demands that, if patients are to be randomly assigned to one of two interventions in a clinical trial, there must be genuine doubt about which is better. This reflects the traditional view that physicians must never knowingly compromise the care of their patients, even for the sake of future patients. Equipoise has proven to be deeply problematic, especially in the Third World. Some recent critics have argued against equipoise on the grounds that clinical research is fundamentally distinct from clinical care, and thus should be governed by different norms. I argue against this “difference position,” and instead take issue with the traditional, exclusively patient-centered account of physicians' obligations that equipoise presupposes. In place of this traditional view, I propose a Kantian test for the reasonable partiality that physicians should show their patients, focusing on its application in clinical research and medical education.     

Double Jeopardy: Child and School Characteristics That Predict Aggressive-Disruptive Behavior in First Grade

High rates of aggressive-disruptive behavior exhibited by children during their initial years of elementary school increase their risk for significant behavioral adjustment problems with teachers and peers. The purpose of the present study was to examine the unique and combined contributions of child vulnerabilities and school context to the development of aggressive-disruptive student behavior during first grade. Parent ratings and child interviews assessed three child characteristics associated with risk for the development of aggressive behavior problems in elementary school (aggressive-disruptive behaviors at home, attention problems, and social cognitions) in a sample of 755 first-grade children in four demographically diverse American communities. Two school characteristics associated with student aggressive-disruptive behavior problems (low-quality classroom context, school poverty levels) were also assessed. Linear and multilevel analyses showed that both child and school characteristics made independent and cumulative contributions to the development of student aggressive-disruptive behavior at school. Although rates of student aggressive-disruptive behavior varied by gender and race, the predictive model generalized across all groups of children in the study.     

Female Suicide Rates in Ghizer,Pakistan

Suicide is an understudied subject in Pakistan. There are many social, legal, and religious sanctions against it. National rates of suicides are not known. We calculated suicide rates of women in the Ghizer District of the remote Northern Areas of Pakistan. During years 2000 to 2004, 49 women committed suicide. Taking average mean population for women for 5 years as 65,783, we calculated annual crude suicide rates for women as 14.89/100,000/year. For women over the age of 15 years, rates were 33.22/100,000/year; age‐specific rates for 15–24 years were 61.07/100,000 per year. These figures are considerably higher than suicide rates in other parts of Pakistan and may be related to high psychiatric morbidity in Pakistani women. This study underscores the need for a standardized system of registration of suicides in Pakistan. There is also urgent need to address high psychological distress in women in Pakistan.     

Suicide Rates in the World: 1950–2004

The cross‐country differences and the trends of suicide rates in 71 countries from 1950 to 2004 are described. The data are from the World Health Organization's Mortality Database. It shows that suicide rates vary greatly across countries, even within the same region or at similar levels of development. Random‐effect models were used to examine the between‐country and within‐country stabilities in suicide rates. The results show that more than 90% of the variance in suicide rates is due to between‐country differences, suggesting suicide rates display a strong temporal stability.     

Sex and Age Differences in Suicide Rates in a Canadian Province:

ABSTRACT: Changes in age and sex suicide rates and methods are shown for a 20-year period. Rate increases from the earliest base have occurred in all age-sex groups. The proportion of poison suicides has increased greatly beginning in 1960 for women, 1965 for men. Adults 30 and over account for most of the increase in ingested poisons; death by carbon monoxide also occurs with increasing frequency among all males, as do violent suicides in males under 30. Accidental poisonings follow a similar pattern. In view of increasing alcohol consumption, risks of concomitant alcohol-drug use are discussed, as are certain protective features for women inherent in their disproportionately high use of medically prescribed drugs.     

A Critical-Mass Theory of National Suicide Rates

Suicide rates in nations of the world from 1970 to 1980 were examined to see whether absolute increases were related to the size of the suicide rates. It was found that nations with higher suicide rates experienced greater increases in their suicide rates. The results are seen as supporting a “critical-mass” theory and are consistent with an explanation in terms of suggestion.     

The Certification of Suicide in Eleven Western States: An Inquiry into the Validity of Reported Suicide Rates

ABSTRACT: From Durkheim's time to the present social researchers interested in the problem of suicide have relied upon officially reported rates of suicide to develop and test their theories. Despite the fact that the validity of any theory rests upon the accuracy of its underlying data, the relative accuracy of reported suicide rates have rarely been questioned or systematically evaluated. This paper investigates the process of death certification as practiced by a sample of 191 coroners in 11 western states. Findings indicate extensive variation in the backgrounds, professional resources, operating procedures, and governing statutes of coroners and coroners' offices and in policies concerning the use of the suicide mode. Since the coroner is generally charged with the official responsibility for certifying the mode of death when unnatural mode is suspect, the extent of variation found here calls into question the validity and comparability of reported suicide rates.     

The Gender Ratio of Chinese Suicide Rates: An Explanation in Confucianism

The gender (male to female) ratio of the Chinese suicide rates is different from those found in the rest of the world. None of the other societies with known suicide data has had female suicide rates higher than those for the males. While we investigate the factors that contribute to the relatively high suicide rates for Chinese women, we also need to ask what makes the relatively low suicide rates for Chinese men. In this study we try to examine some social and cultural variables in rural Chinese youths in order to identify the factors that account for the relatively low rate for men and relatively high rate for women. In rural China, 392 suicides (both men and women) aged 14–35 years consecutively sampled from 16 counties of three provinces were studied with 416 community living controls of the same age range and from the same locations. Case–control psychological autopsy method was used for the data collection. It is found that believing in Confucianism and being married are both protecting the rural young men from suicide, while the two same variables are either risk or non-protecting factors for the Chinese rural young women’s suicide. In rural China, social structure and culture may play an even more important role determining a society’s suicide rates as well as the gender ratios. Thus, suicide prevention may need to include culture specific measures.     

Compounding the Triple Jeopardy:

Over the last 15 years, societal awareness of spouse abuse has resulted in an extensive network of services, legislative reform, and research initiatives focused on increasing the public response to this serious social problem. More recently, battering in intimate lesbian relationships has gained the attention of women's and gay/lesbian organizations that deal with domestic violence issues. Lesbians in violent relationships differ significantly from heterosexual couples where battering occurs due to the powerful effect of societal homophobia that silences them from seeking help. This article will address the unique challenges faced by lesbians of color in violent relationships due to the interface not only between violence and homophobia, but racism as well. Analysis of community response by lesbians of color, and clinical issues presented in therapy by lesbians of color who are battered will also be discussed.     

Suicide and Homicide Rates in Canada and the United States

Suicide and homicide rates by age were analyzed for Canada and the United States, indicating that suicide is higher in Canada and that homicide is higher in the United States. Results indicated a positive association between homicide and suicide rates in the United States but these two rates of death were not significantly associated in Canada. Holinger (1987) had associated the relative size of the cohort to the rates of suicide and homicide in young people in the United States. The more current data in both countries did not support Holinger's results. Using the measure devised by Easterlin (1980) and Ahlburg and Schapiro (1984) –that is, the proportion of youths aged 15–24 relative to adults aged 25–64–the correlation between the size of the youth cohort and the suicide rate of youths aged 15–24 was negative. It is concluded that the two patterns in these two countries may be explained from a historical perspective.     

The Change in Suicide Rates between 2002 and 2011 in China

Chinese suicide rates have been reported in various studies in the past two decades, but few of them were based on national data. The most recent mortality data (2002–2011) provided by the China Ministry of Health and the detailed census data provided by the National Population Census were used in this study. We calculated the age‐, gender‐, and region‐specific suicide rates and their trends in the past 10 years between 2002 and 2011. The overall suicide rates in China decreased during the study period. The rural/urban ratio of the suicide rates has been significantly reduced from the ratio in the 1990s, and male suicide rates have exceeded those of females. Age was positively associated with suicide rates without the two peaks found in the suicide rates over 20 years ago. The Chinese suicide rates have significantly declined in the past decade, with withering of the unique suicide rate patterns previously found in Chinese suicides about 20 years ago.     

Double Jeopardy Upon Resumé Screening: When Achmed Is Less Employable Than Aïsha

Applicants belong to multiple categories (e.g., male, ethnic minority) and a complex set of factors affects category activation and inhibition when making hiring decisions. Two field experiments with recruiters who regularly engage in resumé screening showed that the role of multiple categories (applicants’ ethnicity and sex) in discrimination depended on job type and prejudice. Specifically, in both low‐ and high‐demand (i.e., complex) jobs, Arab women were rated more favorably than Arab men, particularly when considering levels of client contact. Across both studies, recruiters high in explicit ethnic prejudice were discriminatory only when applicants’ job qualifications fit the job position less, lending support for the attributional‐ambiguity effect. Implicit attitudes did not play a strong role. Our study findings point to the complex nature of multiple categorization effects in the hiring process. Implications are considered as to how to avert hiring discrimination during resumé screening.     

The Association Between Gun Ownership and Statewide Overall Suicide Rates

An extensive body of research has demonstrated an association between gun ownership and suicide that extends beyond the effects of a range of covariates. We aimed to expand on extant research by examining the extent to which gun ownership predicts statewide overall suicide rates beyond the effects of demographic, geographic, religious, psychopathological, and suicide‐related variables. By extending the list of covariates utilized, considering those covariates simultaneously, and using more recent data, we sought to present a more stringent test. Gun ownership predicted statewide overall suicide rates, with the full model accounting for more than 92% of the variance in statewide suicide rates. The correlation between firearm suicide rates and the overall suicide rate was significantly stronger than the correlation between nonfirearm suicide rates and the overall suicide rate. These findings support the notion that access to and familiarity with firearms serves as a robust risk factor for suicide. Therefore, means safety efforts aimed at reducing accessibility and increasing safe storage of firearms would likely have a dramatic impact on statewide overall suicide rates.     

The Quality of Life in Modern America and Suicide and Homicide Rates

Abstract

Psychological symptoms of 108 residents in the vicinity of Three Mile Island were assessed following the restart of the nuclear plant in 1985. Findings suggest that psychological symptoms in the community remain chronically elevated since the time of the 1979 accident but may not have been substantially impacted by restart. Twenty-five percent of the variance in global severity of symptoms was predicted by post-restart attitudes. A pattern of psychological reaction in the aftermath of technological disaster is discussed.     

Impact of Firearm Availability and Gun Regulation on State Suicide Rates

Past studies on suicide have investigated the association of firearm ownership and suicide risk in the United States. The aim of the present study was to build on previous work by examining the impact of firearm storage practices and the strictness of firearm regulation on suicide rates at the state level. Data were compiled from primarily three sources. Suicide and firearm ownership information was obtained from the Centers for Disease Control and Prevention. Strictness of handgun regulation was derived from figures available at the Law Center to Prevent Violence, and controls were taken from the US Bureau of the Census. Mixed models were fitted to the data. Household firearm ownership was strongly associated with both suicide by all mechanisms, and firearm suicide. Storage practices had especially elevated consequences on suicide rates. Percent with loaded guns and gun readiness increased suicide rates, and strictness of gun regulation reduced suicide rates. Ready access to firearms can make a difference between life and death. Loaded and unlocked firearms within reach become risk factors for fatal outcomes from suicidal behavior. Future research might want to examine ways of obtaining more recent data on individual firearm ownership. This study proposes several policy recommendations for suicide prevention.     

Do Geographic Regions with Higher Suicide Rates also have Higher Rates of Nonfatal Intentional Self‐Harm?

Fatal and nonfatal intentional self‐harm events in eight U.S. states were compared using emergency department, hospital, and vital statistics data. Nonfatal event rates increased by an estimated 24.20% over 6 years. Case fatality ratios varied widely, but two northeastern states' total event rates (fatal plus nonfatal) were very high (New Hampshire 206.5/100,000 person years; Massachusetts 166.7/100,000). Geographic context did not uniformly impact the likelihood of self‐harm across event types. The state‐level public health burden posed by such acts cannot, therefore, be accurately estimated from either mortality or morbidity data alone.     

The Relationship Between General Population Suicide Rates and Educational Attainment: A Cross‐National Study

Suicides are associated with both high and low levels of intelligence and educational attainment in both individual‐level and aggregate‐level studies. A cross‐national study examining the relationship between general population suicide rates (y) and educational attainment (x) was undertaken with the a priori hypothesis that the relationship would be curvilinear and follow a U‐shaped curve with the quadratic equation Y = A + BX + CX², where A, B, and C are constants. Data on suicide rates and the Education Index (a proxy measure of educational attainment) were ascertained from the World Health Organization and the United Nations Web sites, respectively. The main finding was the predicted curvilinear relationship between general population suicide rates, in both sexes, and the Education Index fit the above quadratic equation. Given the cross‐sectional study design, a causal relationship cannot be assumed. The impact of educational attainment on general population suicide rates may occur through interaction with other factors, mediation of the effects of other factors, or by its effects being mediated by other factors, and require further study.