Sudden Infant Deaths: models of health and illness

ABSTRACT The assumptions underlying the traditional biomedical model of health and illness and criticisms of it are described. An examination of the historical development of ideas concerning cot (crib) deaths shows how early explanations, which were congruent with this model, came to be discredited. Because subsequent explanations have also been considered unsatisfactory, cot deaths have come to be regarded as medically problematic. The relationship of models of health and illness to cot deaths has therefore been exposed to an unusual degree of scrutiny. Two possible contending models, social epidemiological and socio-economic are identified, and their status vis-à-vis the biomedical model is considered. The choice as to which of these models is applied to cot deaths is shown to be not only of theoretical interest but also to have ethical implications for health care policy and medical practice.     

Contribution of imitative suicide to the suicide rate in prisons

Suicide rates in prisons are high. Our aim was to investigate the contribution of imitative suicide to the prison suicide rate. We used Knox tests for space-time clustering in a case register of natural and self-inflicted deaths in prisons in England and Wales and model simulations to estimate the effect size. We found significant space-time clustering among 657 self-inflicted deaths in 90 prisons over 10 years but no space-time clustering among 430 deaths from natural causes in 87 prisons over this period. Model simulations with an imitation rate of 5.8% (CI 1%-11%) reproduced the observed space-time clustering.     

Bicycle fatalities: Trends in crashes with and without motor vehicles in The Netherlands

Boufous and Olivier (2015) recently found an increasing trend of police-reported cyclist deaths in single-vehicle crashes while a decreasing trend was found for fatal bicycle-motor vehicle crashes. This study sets out to conduct the same trend analyses for the Netherlands using causes of death statistics. The results show that for 1996–2014, the number of cyclist deaths in motor vehicle collisions per km cycled (i.e. the risk) has declined by 3.8% per annum (95% CI: −4.6%, −3.0%) while the risk of cyclist deaths in crashes without motor vehicles increased by 7.0% per annum (95% CI: 5.5%, 8.7%). The large majority of cyclist deaths at the beginning of the study period were due to bicycle-motor vehicle crashes. By 2014, however, the share with motor vehicles was only slightly higher than the share without motor vehicles. We also conducted trend analyses controlling for age by stratifying into nine age groups. After controlling for age, the average annual decrease of cyclist deaths in crashes with motor vehicles was 5.4% (95% CI: −6.0% to − 4.7%). The average annual increase of deaths in crashes without motor vehicles was 4.4% (95% CI: 3.1–5.7%). These trends are more favourable than those without controlling for age which can be explained by more cycling among the elderly who have an elevated risk. We conclude that, similar to Australia, cyclist deaths following motor vehicle crashes in the Netherlands have decreased while deaths without motor vehicles have increased.     

When a 12.86% mortality is more dangerous than 24.14%: implications for risk communication

Participants assessed the riskiness of 11 well-known causes of death. Each participant was presented with an estimation of the number of deaths in the population due to that particular cause. The estimates were obtained from a previous study of naive participants' intuitive estimations. For instance, based on the result of the previous study, the number of deaths due to cancer was presented as: ‘2,414 out of 10,000’, ‘1,286 out of 10,000’, ‘24.14 out of 100’ and ‘12.86 out of 100’. The estimates of deaths were presented in analogous ways for the remaining ten causes of death. It was hypothesized that the judged degree of riskiness is affected by the number of deaths, irrespective of the total possible number (such as 10,000 or 100). Results from Experiment 1 were consistent with this prediction. Participants rated cancer as riskier when it was described as ‘kills 1,286 out of 10,000 people’ than as ‘kills 24.14 out of 100 people’, and similar results were observed regarding the remaining 10 causes of death. Experiment 2 replicated this trend. Implications for risk communications are discussed. © 1997 John Wiley & Sons, Ltd.     

The Representation of Mortality Statistics and the Perceived Importance of Causes of Death

This study investigated how different methods of presenting mortality statistics may influence subjective impressions of the importance of a given cause of death. Subjects were 214 students from the fifth year of a comprehensive school (average age 15). Each subject rated one of six causes of death on a scale labeled "extremely minor–extremely major cause of death" before and after receiving accurate information concerning the number of deaths per annum in the United Kingdom resulting from the cause in question. This information was presented in one of five forms: (a) a statement of what proportion of all deaths resulted from the specified cause; (b) a statement of what percentage of all deaths were so caused; (c) a pie chart representing the proportion pictorially; (d) a bar chart representing the proportion pictorially; and (e) a statement of absolute number of deaths from the specified cause without information on total number of deaths from all causes combined. Analysis showed that subjects discriminated between the different causes both before and after presentation of the information but their ratings were imperfectly calibrated with actual frequencies. Also, the changes in ratings following the information depended significantly on the mode of presentation. Except when subjects were told the absolute frequency, the changes were in the direction of decrease in perceived importance. This decrease was most marked in the bar chart and pie chart conditions. The data are interpreted in relation to the literature on statistical inference processes and on judgmental contrast.     

ST. THOMAS AQUINAS ON DEATH AND THE SEPARATED SOUL

Since St. Thomas Aquinas holds that death is a substantial change, a popular current interpretation of his anthropology must be mistaken. According to that interpretation – the ‘survivalist’ view – St. Thomas holds that we human beings survive our deaths, constituted solely by our souls in the interim between death and resurrection. This paper argues that St. Thomas must have held the ‘corruptionist’ view: the view that human beings cease to exist at their deaths. Certain objections to the corruptionist view are also met.     

Adolescents' Perceptions of Lightning and Tornado Risks1

Four hundred and fifty-five adolescents estimated the subjective probability risk for lightning and tornado deaths. Based on observations by Slovic, Fischhoff, and Lichtenstein (1982), we predicted that teenagers would underestimate the risks for lightning fatalities relative to tornado deaths. This prediction was confirmed for the sample as a whole. However, personal experience with both lightning and tornado events contributed to more realistic risk perceptions. Attention to news reports, thrill seeking, and gender did not contribute to perception. The findings are discussed in the context of the availability heuristic.     

Language and Civilian Deaths: Denying Responsibility for Casualties in the Gaza Conflict 2014

The United Nations High Commissioner for Refugees (UNHCR) estimated that 1,462 civilians were killed in Gaza, and six civilians were killed in Israel during the conflict of 2104. This article uses discursive psychology to examine how Israeli spokespeople described the conflict, and Israel's actions, in ways that denied responsibility for civilian deaths. They did this using a number of discursive strategies. These included: (1) using passive and noun constructions which minimized reference to civilian deaths and erased Israeli involvement in those deaths; (2) repeatedly naming and providing details of Hamas weapons and attacks while avoiding reference to Israeli weapons and violence; (3) presenting Israel as only trying to avoid civilian deaths; and (4) describing Hamas as responsible for all deaths. These types of linguistic constructions allow governments and potential supporters to avoid acknowledging the consequences of their military actions and is one way that the virtuous nature of the ingroup is reinforced in political discourse.     

Sex differences in completed suicide by schizophrenic patients: a meta-analysis

A meta-analysis was conducted on all studies of suicide mortality in follow-up studies of schizophrenic patients that presented data for male and female patients separately. The percentage of deaths from suicide was significantly greater for the male schizophrenic patients than for the female schizophrenic patients in studies where both sexes were included. Regression equations devised to predict the percentage of deaths from suicide after all of the sample had died estimated that 0.50% of male schizophrenic patients would die from suicide as compared to 0.20% of female schizophrenic patients. Suggestions are made for future research.     

Dyadic Death: A Typology

In dyadic deaths, a second victim acts in consort with, is associated with, or is killed by a person who, contemporaneous with the first death, then suicides. Dyadic deaths thus include both homicide–suicides and suicide pacts. This paper describes, suggests organizing dynamics of, and illustrates distinct types of dyadic deaths. The proposed typology varies by levels of dominance, dependence–enmeshment, and the presence or absence of hostility in and between partners.     

A Comparison of Suicide and Undetermined Deaths in Psychiatric Patients

ABSTRACT: Those people who had previously been patients of the Department of Mental Health of Missouri who died in the three year period 1972 through 1974 and whose deaths were designated as suicide or “undetermined whether purposely or accidentally inflicted,” were identified by matching statewide death tapes against the DMH data base. The demographic characteristics of the two groups are compared to ascertain if the members of the undetermined group are essentially similar to the suicides, as has frequently been hypothesized. It is found that, in general, the similarities are in areas which would not have had a direct influence on the medical examiner/coroner's verdict, whereas, the differences do highlight areas which could cause an indecisive verdict. The significance of the undetermined deaths is discussed.     

Environmental factors in suicide in long-term care facilities.

One major purpose of this study was to identify environmental factors related to suicide in long-term care facilities. Questionnaires were mailed to a random sample of administrators at 1,080 facilities. Information was collected on facility characteristics, overt suicide, and intentional life-threatening behavior. Chi-square analyses revealed 4 environmental characteristics related to suicidal behavior and deaths from suicide: staff turnover, size, auspices, and per diem cost. More suicides occurred in larger facilities and facilities with higher staff turnover. Religious or "other" facilities experienced more suicidal deaths than public or private facilities; facilities charging less experienced more deaths.     

Suicides and Other Deaths in Police Custody

This article presents data from a study on 59 deaths in Dutch police stations in the period 1983–1993. Twenty deaths were caused by suicide, 19 by intoxications, 8 by natural causes, and 12 by other or unknown causes. The mortality rate, suicide rate, and poisoning rate in police stations were higher than in penitentiary institutions and in the general population. The morality rate was lower in large police stations than in small police stations. Identification of deviant detainees seemed less problematic than handling these deviant detainees. It is argued that exceptional detainees without serious charges should be transferred to Health Care services. Other structural preventive measures are also discussed.     

Suicide surveillance in the U.S. Military--reporting and classification biases in rate calculations

The military has a well-defined population with suicide prevention programs that have been recognized as possible models for civilian suicide prevention efforts. Monitoring prevention programs requires accurate reporting. In civilian settings, several studies have confirmed problems in the reporting and classification of suicides. This analysis evaluated whether suicides were underreported or misclassified under accident or undetermined manner of death in the military system. We reviewed all 1998 and 1999 military deaths using official death reports and compared these data with additional sources, most importantly the DoD Medical Mortality Registry. We assessed for evidence of expressed suicidal intent and past psychiatric history among deaths classified as undetermined and accidents due to gunshot, overdose, drowning, falls, or asphyxia. Using sources other than official records, we found 17% more suicides than were reported, and an additional 4% of deaths that were suspicious for suicide. This study suggests that reporting and classification errors may account for 21% additional suicides in the military. These findings are comparable to rates seen in civilian studies and add to the literature regarding the problems inherent in using administrative death classification data for medical surveillance purposes.     

Deaths of Despair: Conceptual and Clinical Implications

Since the late 1990s, mortality rates for middle-aged (45-55), White non-Hispanic (WNH) Americans began to rise while rates declined for all other demographic and age groups. Coinciding with the rise in mortality, rates of death due to suicide, drug- and alcohol-related overdoses, and alcohol-related liver diseases increased as well for this demographic. Research suggests these causes of death (i.e., suicide, poisoning, alcohol-related liver disease) are driving the overall mortality rate for middle-aged WNHs and have been described as “deaths of despair” in the literature. In the current paper, we describe the social and clinical features of “deaths of despair,” explore theoretical models of psychopathology (e.g., depression, posttraumatic stress disorder) that may inform our understanding of mechanisms of risk for negative mental health outcomes, and propose an initial conceptual model of “deaths of despair” to identify intervention targets. We then review an applied case example demonstrating how this model could be used for clinical application. We conclude our paper by describing how current cognitive-behavioral interventions may address these mechanisms of “despair.”     

An Examination of Potential Misclassification of Army Suicides: Results from the Army Study to Assess Risk and Resilience in Servicemembers

Debate continues about the accuracy of military suicide reporting due to concerns that some suicides may be classified as accidents to minimize stigma and ensure survivor benefits. We systematically reviewed records for 998 active duty Army deaths (510 suicides; 488 accident, homicide, and undetermined deaths; 2005‐2009) and, using research criteria, reclassified 8.2% of the nonsuicide cases to definite suicide (1), suicide probable (4), or suicide possible (35). The reclassification rate to definite suicide was only 0.2% (1/488). This low rate suggests that flagrant misclassification of Army deaths is uncommon and surveillance reports likely reflect the “true” population of Army suicides.     

Thematic review of family therapy journals in 2005

In this paper the principal English‐language family therapy journals published in 2005 are reviewed under the following headings: research in family therapy, couples, families and wider systems, parental alimentation syndrome, diversity, training, and deaths.     

Assessing Legal Strains and Risk of Suicide Using Archived Court Data

Relatively little is known about legal entanglements and suicide risk. This matched case–control study estimated the risk of suicide associated with legal strains using online court archives, a novel source of exposure data. Court records linked to suicide deaths (N = 315), controls (N = 630), and unintentional injury and poisoning deaths (N = 630) for an urban county from 2000 to 2005 revealed that nearly a third of suicide victims had recent court involvement, twice the proportion among controls. Misdemeanors, car accidents, and foreclosures were each associated with a threefold risk of suicide. Implications for suicide prevention and research are discussed.     

Some notes on conducting a psychological autopsy.

This paper outlines procedures for conducting interviews with relatives of suicide victims or survivors of equivocal deaths, by means of the "psychological autopsy." A number of methodological recommendations are made which deal with training interviewers, contacting survivors and using experimental controls.