Restrictions in means for suicide: an effective tool in preventing suicide: the Danish experience

Restriction of means for suicide is an important part of suicide preventive strategies in different countries. The effect on method-specific suicide rate and overall suicide rate of restrictions on availability of carbon monoxide, barbiturates, and dextropropoxyphene was examined. From 1970 to 2000, overall suicide mortality and method-specific suicide mortality in Denmark were compared with official information about availability of barbiturates and analgesics and carbon monoxide in vehicle exhaust and household gas. Restrictions on availability of household gas with carbon monoxide content and barbiturates was associated with a decline in the number of suicides and suicides by self-poisoning with these compounds after controlling for the effect of calender year. Restricted access occurred concomittantly with a 55 percent decrease in suicide rate.     

Deliberate Self-Poisoning,Unemployment, and Public Health

The purpose of the present investigation was to explore further the known relationship between deliberate self-poisoning and social deprivation. Each individual who attended one of Cork city's three casualty departments following an act of deliberate self-poisoning in 1988 was examined. The place of residence (ward) of each city resident patient was established. The social status of the city's 34 wards was estimated using a number of indices obtained from the 1981 and 1986 census reports and social service records. A comparison was made between the 1988 self-poisoning rate for each ward and the rate found in a 1982 study of the city. Correlations between self-poisoning rate and seven social deprivation indices were found to be significant. Multiple regression, factor, and partial correlation analyses were carried out to examine more closely the interrelationships between the social deprivation indices. With respect to explaining the variation in the self-poisoning rate, unemployment alone performed almost as well as all of the indices together and as well as the factors derived using factor analysis. The correlation between unemployment and self-poisoning rate remained highly significant when the other related variables were controlled for. However, at fixed levels of unemployment, these variables were found to be independent of the self-poisoning rate. It is suggested that whereas clinical intervention may benefit the individual, deliberate self-poisoning as an issue requires a public health approach for its resolution.     

Interpersonal problem-solving deficits in self-poisoning patients

Self-poisoning patients (n = 40) were compared with psychiatric patients (n = 40) and nonpatient controls (n = 20) on measures of interpersonal problem-solving skills and locus of control in an effort to determine the importance of these cognitive and personality variables in self-poisoning behavior. The psychiatric and self-poisoning groups showed deficits on measures assessing interpersonal problem solving when compared with nonpatient controls. The self-poisoning group performed below the level of the psychiatric patients on all except one test, on which they performed at the level of the psychiatric group. Locus of control did not differentiate self-poisoning patients from nonpatient controls, and it was concluded that this variable is not an important factor in self-poisoning behavior.     

The Hospital Management of Fatal Self‐Poisoning in Industrialized Countries: An Opportunity for Suicide Prevention?

Suicide by self-poisoning is a prevalent cause of death worldwide. A substantial proportion of individuals who poison themselves come into contact with medical services before they die. Our focus in the current study was the medical management of drug self-poisoning in industrialized countries and its possible contribution to suicide prevention. We reviewed the literature to determine the proportion of self-poisoning suicides who reach hospital alive, the sociodemographic and clinical characteristics of in-hospital overdose deaths, the in-hospital management this group of patients receives, and whether there are specific aspects of pre-hospital care and in-hospital management that have the potential to improve survival. Between 11% and 28% of individuals who died following deliberate ingestion of drugs reached hospital alive. The substances which were most frequently implicated in death were paracetamol (acetaminophen) and paracetamol compounds, tricyclic antidepressants, and benzodiazepines. Most patients received fairly intensive treatment, yet death may have been preventable in a small proportion of cases. Only one intervention (the administration of acetylcysteine) was shown to reduce mortality and this was in a highly selected group of patients (those who had ingested paracetamol and developed fulminant hepatic failure). It is possible that other interventions such as better airway management, the prompt administration of activated charcoal, and improved pre-hospital care may improve outcomes but their potential contribution to suicide prevention needs to be investigated in future studies.     

Interpersonal Problem-Solving Skills Training in the Treatment of Self-Poisoning Patients

The present study evaluated the effectiveness of interpersonal problem-solving skills training (IPSST) for the treatment of self-poisoning patients. Thirty-nine self-poisoning patients were assigned randomly either to IPSST or to a control treatment condition (a brief problem-oriented approach). Both conditions were equally effective in reducing the number of presenting problems and in reducing hopelessness levels. However, the IPSST condition was significantly more effective than the control condition as determined by other outcome measures (measures of interpersonal cognitive problem solving, self-rated personal problem-solving ability, perceived ability to cope with ongoing problems, and self-perception). Follow-up studies showed maintenance of IPSST treatment gains at 6 months and a greater reduction of repetition of self-poisoning in the IPSST group at 1 year posttreatment.     

Normativity,Guardianship, and the Elderly

The concept of guardianship, its associated principles, distinctions, and articulation of the legal needs of the elderly are introduced via a review of well-canvassed criticisms of Canadian guardianship legislation. Claims that the reformed legislation of Alberta, Quebec, and British Columbia represent models of adequate adult guardianship compared with traditional (archaic lunacy) law are examined. This paper argues that these renovated models exhibit a dubious normative advance over traditional legislation. Specifically, the normative presuppositions of the reformed legislation, such as, restriction to an autonomy-paternalism framework, and the norms of the liberal individual and state, obscure important issues in at least two key areas which challenge the models' assumptions; namely, assessment and legal competence and assessment and need. The development of guardianship laws and of social arrangements that are more responsive to the life experiences of the elderly requires critical re-articulation of the nature of individuals and their communities.     

Firearm legislation and statewide suicide rates: The moderating role of household firearm ownership levels

Firearm legislation is associated with statewide suicide rates; however, prior research has often relied upon older data and categorical legislative grades while also failing to consider the nuanced role of firearm ownership. Therefore, the robust literature base on legislation and suicide has not directly examined regarding the extent to which the value of legislation hinges upon the rate of firearm ownership in a given state. The current study examined 2015 US statewide firearm legislation strength scores from Giffords Law Center to Prevent Gun Violence and 2016 statewide suicide rates from the Centers for Disease Control and Prevention. Firearm legislation strength was inversely associated with statewide overall and firearm suicide rates, but not with non‐firearm suicide rates. Firearm ownership rates moderated the association between firearm legislation strength and statewide overall suicide rates. Specifically, firearm legislation strength was inversely associated with statewide overall suicide rates at mean and high levels of firearm ownership. Findings support the potential utility of firearm legislation as part of a national effort to decrease US suicide deaths, particularly in areas with higher firearm ownership rates.     

Self-Poisoning with Follow-Up Considerations

ABSTRACT: One hundred patients who in 1963 had attempted self-poisoning and were subsequently admitted to the intoxication ward of a psychiatric hospital were studied twice: immediately after the attempted self-poisoning and 8 years after the attempt. It was found that within the follow-up period a total of nine patients had died, four of whom had committed suicide. The risk of suicide per years is .5%. According to the literature the range of the annual suicide risk is .9% to 2.5%.     

Mortality and Causes of Death in a 10-Year Follow-Up of Patients Treated for Self-Poisonings in Oslo

The present 10-year follow-up study includes all patients (N = 926; 50% females) treated in the medical departments in Oslo for self-poisonings during one year (1980). Seventeen percent were considered suicidal attempts upon admission, 25% among the non-substance abusers and 8% among the abusers. At follow-up, 207 patients (22%) were dead (62% males). The mortality rate was highest among the abusers. The most common causes of death were suicide (21%), heart disease (17%), opiate abuse (15%), and accidents/wounds (13%). Forty-one percent of the suicides occurred during the first two years of the follow-up period. The suicides were by poisoning (57%), hanging (20%), and other methods (23%). The female mortality rate decreased in the second half of the follow-up period whereas the male rate did not change. The risk of death within 10 years after discharge increased with age and was higher in men and in abusers, whereas social group and motive for suicide were not predictive factors. The females had an excess suicide rate of 182 (36–327, 95% CI) in the first year after the self-poisoning and 61 (36–87, 95% CI) in the total period. The corresponding figures for males were 70 (19–122) and 21 (12–30). The only factor associated with an increased suicide rate was a suicidal motive upon the admission for self-poisoning with a 3.1 (1.7–5.8, 95% CI) times increased risk of suicide in the 10-year follow-up period.     

Low income, unemployment, and suicide mortality rates for middle-age persons in Japan

The relationships between age-specific suicide mortality rates and social life factors for all 47 Japanese prefectures in 1980, 1985, and 1990 were assessed by multiple regression analysis after factor analysis on 20 social life indicators. During this period, Japan experienced a secondary oil crisis in 1980-1983 and a bubble economy in 1986-1990. It was concluded that (1) low income was the major determinant which positively affected suicide mortality rate in middle-aged men during a previous 20-yr. period (1970-1990), (2) urbanization was negatively associated with male suicide mortality rates in most of the age classes in the 1980s, (3) unemployment was one of the major determinants of increased suicide mortality rate in middle-age men in the 1980s, and (4) unemployment was the major factor which was inversely associated with suicide mortality rate for elderly women from 1980 to 1990 in Japan.     

镇静与镇痛在ICU机械通气患者中的应用变化

探讨ICU内机械通气患者应用镇痛剂、镇静剂及肌松剂的情况及其对机械通气和预后的影响。回顾性分析我院中心ICU2006年、2007年收治的244例行有创机械通气治疗超过48h患者的临床资料,并将患者分为2006年组和2007年纽,用统计软件分析患者在年龄、性别、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、基础疾病,气管插管时间、机械通气时间、ICU住院天数、镇痛与镇静剂应用的时间、机械通气时是否使用肌松剂、Ramsay评分及病死率方面是否存在差别。统计分析显示2006年组和2007年组在年龄、性剐、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、是否使用肌松剂及基础疾病方面无差别;与2006年组相比2007年组患者气管插管时间、机械通气时间及ICU住院天数均缩短,镇痛与镇静剂应用时间均缩短,Ramsay评分降低,病死率下降。提示对机械通气的危重症患者应合理使用镇痛剂与镇静剂。     

Minority religions,litigation, and the prevention of harm

Religious anti-discrimination legislation institutionalises non-violent ways of living with radical difference associated with religious diversity. The need to govern the growing number of conflicts generated by increasingly pluralistic societies is a major reason governments have introduced a range of new laws relating to religion. These laws are important not only because they protect human rights, which they do, but also because they shape social processes that generate extreme harms such as mass murder and the sexual abuse of minors. A detailed examination of three case studies of minority religions illustrates this argument. The histories of the Fundamentalist Latter Day Saints and The Family demonstrate that the socio-cultural processes that result in sexual abuse in minority religions are similar to the processes that result in extreme violence and that litigation plays a key role in preventing the escalation of these processes, although it is of a post hoc nature. The case of the Ordo Templi Orientis demonstrates that religious anti-discrimination legislation proactively disrupts the socio-cultural processes that lead to the escalation of tension that results in serious forms of harm.     

Pink triangles: antecedents and consequences of perceived workplace discrimination against gay and lesbian employees.

A model of perceived sexual orientation discrimination was tested in a national sample of 534 gay and lesbian employees. The effects of legislation, organizational policies and practices, and work group composition on perceived sexual orientation discrimination were examined, as well as the attitudinal and organizational outcomes associated with discrimination. Gay employees were more likely to report discrimination when employed in groups that were primarily heterosexual and in organizations that lacked supportive policies and were not covered by protective legislation. Disclosure of sexual orientation at work was related to discrimination and antecedent variables. Perceived discrimination was associated with negative work attitudes and fewer promotions. Organizational policies and practices had the strongest impact on perceived discrimination and were directly related to outcomes.     

Sex differences in pain indices, exercise, and use of analgesics

To understand better reported sex differences in sensitivity to pain, this study examined daily pain frequency and intensity, use of analgesics, physical activity, and both subjective and physiological response to acute pain in 18 men and 24 women, healthy people who provided information about their daily pain symptoms and physical activity before completing a cold pressor task. Compared to men, women reported more frequent and intense pain symptoms, as well as more frequent use of analgesics and lower physical activity. Women evinced higher physiological arousal during the cold pressor task but similar subjective pain. The findings highlight the different ways men and women cope with pain and the effect on their responses to acute pain.     

Modifiable risk factors for attempted suicide in Australian clinical and community samples

Modifiable risk factors for suicide attempt require identification in clinical and community samples. The aim of this study was to determine if similar social and psychiatric factors are associated with suicide attempts in community and clinical settings and whether the magnitude of effect is greater in clinical populations. Two case-control studies were used: nationwide community-based lifetime attempted suicide (ComAS) cases compared to nationwide community controls; and clinical deliberate self-poisoning (ClinDSP) cases that had hospital treatment compared to normative controls of similar demographic composition. The pattern of risk factors in ComAS and ClinDSP cases was similar, the magnitude of risk usually greater in clinical cases. Greatest attributable fractions were: ComAS current unemployment (39.8% male, 15.5% female) and anxiety disorders (14.0% males, 22.6% females); and ClinDSP current unemployment (69.6% male, 55.5% female) and affective disorders (45.4% male, 39.1% female). Practical intervention targets were unemployment, anxiety and substance use disorders, affective disorders (clinical only), and personality disorder (females only).     

Educational inequalities in quantity, duration and type of tobacco consumption among lung cancer patients in Asturias: epidemiological analyses

Socioeconomic inequalities cause different tobacco consumption patterns. The purpose of this study was to examine the relationship between educational level and smoking behaviour, including type of tobacco consumption, in lung cancer patients. To this end, epidemiological analyses of 801 lung cancer patients recruited for a case-control study in four public hospitals in Asturias, Spain, between October 2000 and April 2006 were carried out. Smoking behaviour and educational level data were obtained through personal interview. Analyses indicated that the probability of heavy smoking among low educational-level patients was approximately twice as high as for high educational-level patients (RRR>31.2 packs/years=2.04; CI 95%=1.15-3.62; RRR>52packs/years=2.14; CI 95%=0.98-4.64). Low-educated patients were more than three times as likely to be long-time smokers (RRR>40 years=3.30; CI 95%=1.43-7.62). The probability of smoking exclusively black tobacco was almost four times greater in low educational-level patients (RRRblack only=3.72; CI 95%=1.23-11.19). The results show that there are broad educational inequalities with regard to the quantity, duration and type of tobacco consumption among lung cancer patients in Northern Spain.     

Extreme Social Isolation, Use of Community-Based Senior Support Services, and Mortality Among African American Elderly Women

The effect of extreme social isolation and use of community-based senior services on longevity was examined in a national sample of African American elderly women (ages 55–96). Consistent with previous research on the social integration/mortality link, African American elderly women who were extremely socially isolated were hypothesized to have a higher 5-year mortality rate. It was also hypothesized that use of community senior services would be negatively associated with 5-year mortality. Results of logistic regression analysis controlling for age, education, income, and health status found that extremely socially isolated African American elderly women were three times more likely than the nonisolated women to die within the 5-year period from the initial survey. Use of community senior services did not have a relationship on mortality. Results are discussed in terms of directions for future research and intervention.     

The treatment of neuropathic pain

Neuropathic pain is responsible for a significant amount of the morbidity associated with generalized and focal peripheral neuropathies. It is a consequence of alterations in neuronal function, chemistry, and structure that occur secondary to nerve injury. These manifestations of neuronal plasticity occur in the peripheral nerve, spinal cord, and brain. A variety of agents from diverse pharmacologic classes, the so-called adjuvant analgesics, have been used to treat neuropathic pain. These include antidepressants, first- and second-generation anticonvulsants, antiarrhythmic agents, topical agents, N-methyl-D-aspartate receptor antagonists, and opioid analgesics. The use of these adjuvant analgesics, either alone or in combination, should result in the alleviation of neuropathic pain in most patients. Recent advances in the understanding of pain mechanisms at multiple central nervous system levels should pave the way toward more effective treatment modalities.     

The life and death of creativity: The effects of mortality salience on self versus social-directed creative expression

Research in terror management theory suggests that our connections to others function, in part, to provide protection from the anxiety associated with the awareness of inevitable death. The individuating nature of creative expression can potentially undermine these connections, making creativity particularly problematic when one is dealing with mortality concerns. Consistent with this, a number of findings have elucidated emotional consequences associated with creativity when mortality concerns are active. However, to date, research has not focused on how mortality awareness may impact levels of creativity. The present study assessed the hypothesis that mortality concerns will inhibit creative behavior that threatens social connections but will not undermine and may even facilitate creative behavior that bolsters social connections. The results showed that amplified concerns about mortality decreased creativity when the act was self-directed but not when it was community-directed. Theoretical implications and future directions are discussed.