Violence, homicide and suicide: strong correlation and wide variation across districts

A Systematic Review of the Effects of Urban Living on Suicidality and Self-Harm in the UK and Ireland

We conducted a systematic review to answer the following: (a) Is there any evidence to support increased prevalence of suicidality and self-harm (i.e. self-harm or suicidality) in urban versus rural environments? (b) What aspects of the urban environment pose risk for suicidality and self-harm? Thirty-five studies met our criteria. Our findings reflect a mixed picture, but with a tendency for urban living to be associated with an increased risk of suicidality and self-harm over rural living, particularly for those living in deprived areas. Further research should focus on the clustering and additive effects of risk and protective factors for suicidality and self-harm in urban environments.

Climate rather than economic variables might have caused increase in US homicide but not suicide rates during the Great Depression

BACKGROUND

It is widely believed that during the Great Depression (1929-1933) there was a rise in suicidal rates which was causally related to the increase in unemployment. There are no studies on the effect the Great Depression had on homicidal rates METHODS: The data concerning suicide, homicide, economic and climatic variables for the years 1900-1940 for the whole of the US were gathered from the US Center for Disease Control, the Maddison Project, the National Bureau of Economic Research and the National Climatic Data Center. Time Series Analysis was performed.

RESULTS

The results are inconclusive on the role of economic factors but preclude any role of climate on suicidal rates during the years 1900-1940 in the US. Suicidal rates might have a 24-years periodicity, however much longer time series are needed to confirm this. On the contrary they strongly suggest an effect of higher temperatures on homicidal rates after 1922.

CONCLUSIONS

The results of the current study suggest a direct and clear effect of climate (higher temperatures) on the increasing homicidal rates in the US after 1922 but failed to establish a causal relationship between suicide rates and economic or climate variables. These should be considered together with increasing concerns on the possible effect of climate change on mental health.

Forensic psychiatry and Covid-19: accelerating transformation in forensic psychiatry

Swift medically led scientifically informed responses to the Covid-19 epidemic nationally have been demonstrably superior to other, non-scientific approaches. In forensic psychiatry and across all psychiatric services, urgent and clinically led responses have underlined redundancies and confusions in the governance of mental health services and a vacuum in policy makers. For the future, a greater emphasis on services for patients with schizophrenia and other severe, enduring mental disorders must aim at reducing standardised mortality ratios, managing risk of violence and improving hard outcomes such as symptomatic remission, functional recovery and forensic recovery of autonomy. This will require more use of information technology at service level and at national level where Scandinavian-style population-based data linkage research must now become legally sanctioned and necessary. A national research and development centre for medical excellence in forensic psychiatry is urgently required and is complimentary to and different from quality management.

Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

BACKGROUND

People with schizophrenia are ten times more likely to commit homicide than a member of the general population. The relationship between symptoms of schizophrenia and acts of violence is unclear. There has also been limited research on what determines the seriousness and form of violence, such as reactive or instrumental violence. Moral cognition may play a paradoxical role in acts of violence for people with schizophrenia. Thoughts which have moral content arising from psychotic symptoms may be a cause of serious violence.

METHOD

We investigated if psychotic symptoms and moral cognitions at the time of a violent act were associated with acts of violence using a cross-sectional national forensic cohort (n = 55). We examined whether moral cognitions were associated with violence when controlling for neurocognition and violence proneness. We explored the association between all psychotic symptoms present at the time of the violent act, psychotic symptoms judged relevant to the violent act and moral cognitions present at that time. Using mediation analysis, we examined whether moral cognitions were the missing link between symptoms and the relevance of symptoms for violence. We also investigated if specific moral cognitions mediated the relationship between specific psychotic symptoms, the seriousness of violence (including homicide), and the form of violence.

RESULTS

Psychotic symptoms generally were not associated with the seriousness or form of violence. However, specific moral cognitions were associated with the seriousness and form of violence even when controlling for neurocognition and violence proneness. Specific moral cognitions were associated with specific psychotic symptoms present and relevant to violence. Moral cognitions mediated the relationship between the presence of specific psychotic symptoms and their relevance for violence, homicide, seriousness of violence, and the form of violence.

CONCLUSIONS

Moral cognitions including the need to reduce suffering, responding to an act of injustice or betrayal, the desire to comply with authority, or the wish to punish impure or disgusting behaviour, may be a key mediator explaining the relationship between psychotic symptoms and acts of violence. Our findings may have important implications for risk assessment, treatment and violence prevention.

Ancestry and different rates of suicide and homicide in European countries: A study with population-level data

INTRODUCTION

There are large differences in suicide rates across Europe. The current study investigated the relationship of suicide and homicide rates in different countries of Europe with ancestry as it is defined with the haplotype frequencies of Y-DNA and mtDNA.

MATERIAL AND METHODS

The mortality data were retrieved from the WHO online database. The genetic data were retrieved from http://www.eupedia.com. The statistical analysis included Forward Stepwise Multiple Linear Regression analysis and Pearson Correlation Coefficient (R).

RESULTS

In males, N and R1a Y-DNA haplotypes were positively related to both homicidal and suicidal behaviors while I1 was negatively related. The Q was positively related to the homicidal rate. Overall, 60-75% of the observed variance was explained. L, J and X mtDNA haplogroups were negatively related with suicide in females alone, with 82-85% of the observed variance described.

DISCUSSION

The current study should not be considered as a study of genetic markers but rather a study of human ancestry. Its results could mean that research on suicidality has a strong biological but locally restricted component and could be limited by the study population; generalizability of the results at an international level might not be possible. Further research with patient-level data are needed to verify whether these haplotypes could serve as biological markers to identify persons at risk to commit suicide or homicide and whether biologically-determined ancestry could serve as an intermediate grouping method or even as an endophenotype in suicide research.

Poverty, social inequality and mental health

The World Health Organization has described poverty as the greatest cause of suffering on earth. This article considers the direct and indirect effects of relative poverty on the development of emotional, behavioural and psychiatric problems, in the context of the growing inequality between rich and poor. The problems of children in particular are reviewed. Targets to reduce inequality have been set both nationally and internationally.

Therapeutic uses of security: mapping forensic mental health services by stratifying risk

The syllabus for higher training in forensic psychiatry requires knowledge of the therapeutic uses of security, although there are no references to this in standard texts. Similarly, the process of mapping a mental health service is an essential first step in planning, audit and needs assessment. All mental health services, not just forensic services, are organised to stratify patients according to the risk they present so that they can be cared for in an environment that is safe but imposes the minimum necessary restrictions and intrusions. Forensic mental health services differ from other mental health services mainly by including subsystems which are at higher levels of security than those necessary in local services. Although they have a general orientation towards risk awareness and risk management, they remain integral parts of the mental health services for the populations they serve.

Predictors of using trains as a suicide method: Findings from Victoria, Australia

This study aimed to investigate the factors associated with the choice of trains over other means of suicide. We performed a case-control study using data on all suicides in Victoria, Australia between 2009 and 2012. Cases were those who died by rail suicide and controls were those who died by suicide by any other means. A logistic regression model was used to estimate the association between the choice of trains and a range of individual-level and neighbourhood-level factors. Individuals who were never married had double odds of using trains compared to individuals who were married. Those from areas with a higher proportion of people who travel to work by train also had greater odds of dying by railway suicide compared to those from areas with a relatively lower proportion of people who travel to work by train. Prevention efforts should consider limiting access to the railways and other evidence-based suicide prevention activities.

Differential correlation of suicide and homicide rates according to geographical areas: A study with population-level data

The current study investigated the relationship of suicide and homicide rates internationally. WHO database mortality data for 82 countries concerning suicide, homicides, and cancer and traffic accidents as controls were used. The analysis included Pearson correlation and multiple linear regression analysis. Worldwide homicidal rates explained 55.42%, 43.86% and 41.7% of male and 22.0%, 22.14% and 13.25% of female suicides for 2000, 2005 and 2010 respectively. In Europe there was a positive correlation between male suicide rates and all homicide rates including homicide rates in both genders, in male victims, and in female victims. In America there is no significant correlation. In Asia there is a significant correlation of male suicidal rates only with homicide rates of female victims. We observed marked and interesting differences in the pattern of association between Europe and the Americas. Overall the current paper suggests that at least in some human populations, suicidality and homicidality share common etiopathogenetic substrates and could be triggered by the same internal or external events or might develop based on common genetic background. Empirically it has been suggested that suicide is related to higher living standards while murder is related to poor quality of life and lower living standards.

Individual and area-level risk factors for suicidal ideation and attempt in people with severe depression

INTRODUCTION

Previous research has identified several risk factors that are strongly associated with suicidal behavior in patients with severe depression. However, the effects of area-level characteristics on suicidal ideation and attempt in this population remain unclear.

METHODS

The Clinical Record Interactive Search (CRIS) database was used to identify 2587 patients with severe depression who received secondary mental health services from the Camden & Islington NHS Foundation Trust. Stepwise multivariable logistic regression models were used to examine associations between socio-demographic characteristics, clinical variables, area-level measures, and suicidal ideation and attempt as separate outcomes.

RESULTS

Both suicidal ideation and attempts were common among this cohort of severely depressed individuals (70.5% and 37.7%, respectively). While several individual socio-demographic and clinical characteristics were associated with both outcomes, particularly past psychiatric admission (suicidal ideation: adjusted OR=2.86, 95% CI: 2.26-3.62; suicide attempt: adjusted OR=4.00, 95% CI: 3.30-4.89), neither social deprivation nor ethnic density (measured at the area-level) was associated with risk for either outcome.

LIMITATIONS

Data were not collected specifically for research purposes and hence information on some potential confounders was not available. Additionally, information was restricted to individuals who accessed secondary mental health services in a defined catchment area and period. The study therefore does not take into account individuals who did not access mental health services.

CONCLUSIONS

The variation in risk for suicidal ideation and attempt among severely depressed individuals is explained by differences in individual socio-demographic and clinical characteristics, most notably past psychiatric admission and substance misuse, and not by area-level measures.

An investigation of neighborhood-level social, economic and physical factors for railway suicide in Victoria, Australia

BACKGROUND

This study investigates the associations between railway suicide and neighborhood social, economic, and physical determinants using postcode-level data. It also examines whether the associations are influenced by having high concentration of high-risk individuals in a neighborhood area.

METHODS

Railway suicide cases from Victoria, Australia for the period of 2001-2012, their age, sex, year of death, usual residential address and suicide location were obtained from the National Coronial Information System. Univariate negative binomial regression models were used to estimate the association between railway suicide and neighborhood-level social, economic and physical factors. Variables which were significant in these univariate models were then assessed in a multivariate model, controlling for age and sex of the deceased and other known confounders.

RESULTS

Findings from the multivariate analysis indicate that an elevated rate of railway suicide was strongly associated with neighborhood exposure of higher number of railway stations (IRR=1.30 95% CI=1.16-1.46). Other significant neighborhood risk factors included patronage volume (IRR=1.06, 95% CI=1.02-1.11) and train frequency (IRR=1.02, 95% CI=1.01-1.04). An increased number of video surveillance systems at railway stations and carparks was significantly associated with a modest reduction in railway suicide risk (IRR=0.93, 95% CI=0.88-0.98). These associations were independent of concentration of high-risk individuals.

LIMITATIONS

Railway suicide may be under-reported in Australia.

CONCLUSIONS

Interventions to prevent railway suicide should target vulnerable individuals residing in areas characterized by high station density, patronage volume and train frequency.

Detecting specialization in interpersonal violence versus suicidal behavior

PURPOSE

Research suggests that interpersonal violence and suicidal behavior often co-occur and share a common set of risk factors. This study examined (1) the extent to which individuals specialize in interpersonal violence or suicidal behavior and (2) the shared and unique covariates of individual specialization.

METHODS

The Project on Human Development in Chicago Neighborhoods is a longitudinal study of youths embedded within neighborhoods in metropolitan Chicago. Interviews with youths (average age, 15 years at baseline) and their primary caregivers were conducted from 1994 to 1997 (baseline) and from 1997 to 2000 (Wave 2). Analysis used an item response theory-based statistical approach on 19,502 interpersonal violence and suicidal behavior item responses from 1,628 youths within 74 neighborhoods to assess the degree to which individuals specialize in either interpersonal violence (ranging from hitting someone to shooting someone) or suicidal behavior (ideation, planning, and attempted suicide). The extent to which variables distinguished interpersonal violence and suicidal behavior was assessed.

RESULTS

Individuals who engaged in high levels of interpersonal violence were unlikely to engage in suicidal behavior. Conversely, individuals who engaged in high levels of suicidal behavior were also likely to engage in interpersonal violence. Several shared (e.g., residential stability, substance use) and distinguishing (e.g., exposure to violent peers, depression) correlates of interpersonal violence and suicidal behavior were detected.

CONCLUSIONS

Interventions that address both self- and outward-directed violence must be evidence based. Addressing violence prevention among youths at risk for suicidal behavior appears warranted, but targeting risk factors for suicide among the most violent youths may not be justified.

Economic correlates of violent death rates in forty countries, 1962-2008: A cross-typological analysis

OBJECTIVES

Our goal was to identify if there might be advantages to combining two major public health concerns, i.e., homicides and suicides, in an analysis with well-established macro-level economic determinants, i.e., unemployment and inequality.

METHODS

Mortality data, unemployment statistics, and inequality measures were obtained for 40 countries for the years 1962-2008. Rates of combined homicide and suicide, ratio of suicide to combined violent death, and ratio between homicide and suicide were graphed and analyzed. A fixed effects regression model was then performed for unemployment rates and Gini coefficients on homicide, suicide, and combined death rates.

RESULTS

For a majority of nation states, suicide comprised a substantial proportion (mean 75.51%; range 0-99%) of the combined rate of homicide and suicide. When combined, a small but significant relationship emerged between logged Gini coefficient and combined death rates (0.0066, p < 0.05), suggesting that the combined rate improves the ability to detect a significant relationship when compared to either rate measurement alone. Results were duplicated by age group, whereby combining death rates into a single measure improved statistical power, provided that the association was strong.

CONCLUSIONS

Violent deaths, when combined, were associated with an increase in unemployment and an increase in Gini coefficient, creating a more robust variable. As the effects of macro-level factors (e.g., social and economic policies) on violent death rates in a population are shown to be more significant than those of micro-level influences (e.g., individual characteristics), these associations may be useful to discover. An expansion of socioeconomic variables and the inclusion of other forms of violence in future research could help elucidate long-term trends.

Understanding why children die in high-income countries

Many factors affect child and adolescent mortality in high-income countries. These factors can be conceptualised within four domains-intrinsic (biological and psychological) factors, the physical environment, the social environment, and service delivery. The most prominent factors are socioeconomic gradients, although the mechanisms through which they exert their effects are complex, affect all four domains, and are often poorly understood. Although some contributing factors are relatively fixed--including a child's sex, age, ethnic origin, and genetics, some parental characteristics, and environmental conditions--others might be amenable to interventions that could lessen risks and help to prevent future child deaths. We give several examples of health service features that could affect child survival, along with interventions, such as changes to the physical or social environment, which could affect upstream (distal) factors.

Interaction of forensic and general psychiatric services in Ireland: learning the lessons or repeating the mistakes?

Objective:General psychiatric bed numbers in Ireland have reduced markedly in recent decades. In other jurisdictions such reductions have been accompanied by increases in the prevalence rates of severe mental illness among prisoners. We examined variations in per capita provision of local psychiatric beds and community residential places in Ireland for associations with forensic psychiatric service utilisation.

Method:All admissions via the courts and prisons to the national forensic psychiatry service during the years 1997-1999 were assigned to the appropriate health board. Forensic admission and bed utilisation rates were compared with measures of general psychiatric service provision.

Results:There were 476 admissions via the criminal justice system during the study period (0.74% of all psychiatric admissions in Ireland). A disproportionate number came from the most urbanised area. There were fivefold differences in overall bed and hostel place allocation between Irish health boards. Combined general psychiatric beds were inversely correlated with forensic bed utilisation (Spearman r = -0.75, p = 0.013). These differences showed a strong inverse correlation with forensic service utilisation.

Conclusions:General psychiatric services are relatively under-resourced in areas of greatest predicted need in Ireland. This is associated with increased use of forensic psychiatric services and may reflect accumulation of the mentally ill in Irish prisons.

The relationship between suicide and violence in schizophrenia: analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset

BACKGROUND

Suicide and violence often co-occur in the general population as well as in mentally ill individuals. Few studies, however, have assessed whether these suicidal behaviors are predictive of violence risk in mental illness.

AIMS

The aim of this study is to investigate whether suicidal behaviors, including suicidal ideation, threats, and attempts, are significantly associated with increased violence risk in individuals with schizophrenia.

METHOD

Data for these analyses were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial, a randomized controlled trial of antipsychotic medication in 1460 adults with schizophrenia. Univariate Cox regression analyses were used to calculate hazard ratios (HRs) for suicidal ideation, threats, and attempts. Multivariate analyses were conducted to adjust for common confounding factors, including: age, alcohol or drug misuse, major depression, antisocial personality disorder, depression, hostility, positive symptom, and poor impulse control scores. Tests of discrimination, calibration, and reclassification assessed the incremental predictive validity of suicidal behaviors for the prediction of violence risk.

RESULTS

Suicidal threats and attempts were significantly associated with violence in both males and females with schizophrenia with little change following adjustment for common confounders. Only suicidal threats, however, were associated with a significant increase in incremental validity beyond age, diagnosis with a comorbid substance use disorder, and recent violent behavior.

CONCLUSIONS

Suicidal threats are independently associated with violence risk in both males and females with schizophrenia, and may improve violence risk prediction.

Patterns of suicide in Brunei Darussalam and comparison with neighbouring countries in South East Asia

A retrospective study of suicides in Brunei Darussalam (Brunei) over a 20 year period from 1991-2010 was conducted by analysing the post-mortem examination and external examination reports and other relevant records. The suicide rate in Brunei is very low (1.9 deaths per 100,000 per year). The majority of the victims were expatriates 82(66%) and hanging was the commonest mode of suicide both in expatriate and local population. The study showed that the suicide rate among the Bruneian Malays was the lowest (0.5 deaths per 100,000 per year) among the different nationalities. The study highlights the demographics and socio-economic background of the victims, methods used in committing suicide, suicide rates in different ethnic groups and predisposing factors. The results of this study would be of use for taking preventive measures to minimize the incidence of suicide.

Elderly suicide rates: the importance of a non-linear relationship with distal risk and protective factors

The elderly population size is increasing worldwide due to prolonged life expectancy and falling birth rates. Traditionally, suicide rates increase with age. For example, a recent cross-national study of 62 developing and developed countries reported an increase in suicide rates with aging in males and females in 25 and 27 countries respectively (Shah, 2007a). Thus, suicides in the elderly are an important public health concern. While much is known about proximal (individual level) risk and protective factors for elderly suicides (e.g. Conwell et al., 1991; Cattell and Jolley, 1995; Harwood et al., 2001), less is known about more distal (societal or population level) risk and protective factors (Rehkopf and Buka, 2006). Moreover, detailed knowledge of these distal factors may have greater public health relevance for the development of comprehensive prevention strategies (Knox et al., 2004).

Suicides by country of birth groupings in England and Wales: age-associated trends and standardised mortality ratios

INTRODUCTION

Suicide rates in England and Wales have declined in recent years. A better understanding of age-associated trends in different ethnic groups may inform strategies to sustain this decline.

MATERIALS AND METHODS

This study examines suicide rates and age-associated trends in England and Wales by country of birth (used as a proxy for ethnicity) using the latest available national mortality data.

RESULTS

The main findings were (a) suicide rates were generally higher in males than females in all age bands in all country of birth groups except the China group, where suicides rates were higher in females than males in the older age bands; (b) male suicide rates increased with ageing in the Indian sub-continent group and female suicide rates increased with ageing in the Africa and China groups; (c) male standardised mortality ratios (SMRs) were generally higher in the younger age bands in the Eastern Europe and Caribbean groups and generally lower in the Australasian, Middle East and Western Europe groups; (d) male SMRs were generally higher in the older age bands in Eastern Europe, Caribbean, Australasian and Western Europe groups and lower in all age bands in the Indian sub-continent group, and (e) female SMRs were generally higher in the older age bands in the China, Africa and Caribbean groups.

CONCLUSION

There is a need for epidemiological data on suicides in BME groups, including age-associated trends, trends over time, risk and protective factors and methods of suicide to inform suicide prevention strategies.

Análise epidemiológica do suicídio no Brasil entre 1980 e 2006

OBJETIVO: O objetivo deste estudo foi realizar uma análise epidemiológica dos índices de suicídio registrados entre 1980 e 2006 nas regiões e capitais estaduais. MÉTODO: Dados referentes à taxa de mortalidade devido ao suicídio foram coletados do Departamento de Informática do Sistema Único de Saúde. RESULTADOS: Entre 1980 e 2006, foi registrado um total de 158.952 casos de suicídio, excluindo-se os casos nos quais os indivíduos tinham menos de 10 anos de idade (n = 68). No período estudado, o índice total de suicídio cresceu de 4,4 para 5,7 mortes por 100.000 habitantes (29,5%). Os índices médios mais altos foram registrados nas regiões Sul (9,3) e Centro-Oeste (6,1). Os homens são os que têm a maior probabilidade de cometer suicídio. Os índices mais altos de suicídio foram registrados na faixa etária de 70 anos ou mais, enquanto que os maiores aumentos aconteceram na faixa etária dos 20 aos 59 anos. As principais características sociodemográficas das pessoas que cometeram suicídio durante o período estudado foram baixo nível educacional e estado civil solteiro. Os métodos mais comuns de suicídio foram por enforcamento, armas de fogo e envenenamento. CONCLUSÃO: Embora o índice brasileiro tenha crescido 29,5% em 26 anos, o índice nacional ainda é considerado baixo se comparado aos índices de suicídio mundiais (média de 4,9 por 100.000 habitantes). Os índices de suicídio nas regiões brasileiras variam muito, ou seja, estão entre 2,7 e 9,3.

A comparative study of elderly suicides in England and Wales, Scotland and Northern Ireland: trends over time and age-associated trends

BACKGROUND

The elderly population size in the U.K. and its constituent countries is increasing. Traditionally, suicide rates increase with aging.

METHODS

Time trends in elderly suicide rates and age-associated trends in suicide rates in the U.K. and its three constituent countries (England and Wales, Scotland and Northern Ireland) were examined and comparisons were made of elderly suicide rates in these three countries using data from the World Health Organization.

RESULTS

Elderly suicide rates in both sexes declined over the 24-year period 1979 to 2002 in the whole of the U.K., England and Wales, and Scotland, but only in females in the age-band 65-74 years in Northern Ireland. Female suicide rates increased with age while male suicide rates peaked in the age-band 25-34 years in England and Wales. In Northern Ireland and Scotland male suicide rates decreased with age and peaked in the age-band 25-34 years, and female suicide rates peaked in the age-bands 25-34, 35-44 and 45-54 years. Elderly suicide rates were lowest in Northern Ireland.

CONCLUSION

The similarities and differences in elderly suicide rates, time trends for elderly suicide rates and age-associated trends in suicide rates between the three constituent countries of the U.K. offer an opportunity to examine the differential characteristics between these countries which may potentially explain these observations.

Elderly suicide rates: cross-national comparisons of trends over a 10-year period

BACKGROUND

Studies examining trends in elderly suicide rates over time reported a decline, an increase and no change. A cross-national study was undertaken to examine the current status of trends over time in elderly suicide rates because previous cross-national studies were well over a decade old.

METHODS

Trends in suicide rates for males and females in the age-bands 65-74 years and 75+ years over a 10-year period were examined using data from the World Health Organization website for all the listed countries.

RESULTS

The main findings were: (1) elderly suicide rates either declined or remained unchanged over the 10-year period in most countries; and, (2) suicide rates in both sexes in both the age-bands, over the 10-year period, declined in several European countries, and remained unchanged in several Central and South American countries, Eastern European countries and countries of the former Soviet Union.

CONCLUSIONS

Potential explanations for regional and cross-national variations in trends over time in elderly suicide rates include cross-national differences in trends over time in the prevalence of mental illness in the elderly, socioeconomic factors, cultural factors, the availability of appropriate healthcare services, and public health initiatives to improve the detection and treatment of mental illness, mental health and suicide prevention.

Inter-regional variations in men's attitudes, suicide rates and sociodemographics in Quebec (Canada)

BACKGROUND

Suicide rates can vary quite considerably and attitudes regarding suicide may explain part of the variation.

METHOD

The present study investigated, across the 17 regions of Quebec (Canada), men's attitudes towards suicide, expressing pain and help seeking, as they are related to suicide rates and sociodemographic variables (unemployment, divorce/separation, income and education).

RESULTS

Most correlations were non-significant. However, in regions with an above-average educational level and with higher divorce/separation rates, men had better attitudes towards expressing pain. Furthermore, in regions where men were more inclined to express pain, suicide rates were lower. Also, significant positive correlations were found between suicide rates and low educational level, but also between an increase in suicide rates and an increase in income level.

CONCLUSIONS

Where the aetiology of suicide is concerned, researchers must examine both sociodemographic factors and the psychological factors associated with them.

The area-based social patterning of injuries among 10 to 19 year olds. Changes over time in the Stockholm County

BACKGROUND

Area-based studies of childhood injuries strongly suggest that neighborhood socio-demographic and economic circumstances impact on various - though not all - types of injuries. The primary aim of this study was to investigate the stability over time of the association between area characteristics and childhood injuries of various causes.

METHODS

Register-based and ecological, the study encompassed Stockholm County's 138 parishes, and considered two time periods (1993-95; 2003-05). Two indices were measured: economic deprivation and social fragmentation, and parishes were allocated to their respective quintile on each index. Data on both unintentional and intentional injuries for children (boys and girls) aged 10-14 and 15-19 respectively were gathered from the County Council's hospital inpatient register. For each period and index, gender, age and cause-specific comparisons were made to assess the rate ratios (with 95% confidence intervals) of being injured using parishes belonging to the best index level as a comparison group. A series of simple and partial Pearson correlations were also calculated to assess the independent contribution of each index.

RESULTS

Regardless of time period, there were rather few significant rate ratios and, when they occurred, there were both under and excess risks. For instance, in each period, boys from both age groups living in parishes with the highest levels of economic deprivation had lower rate of injury as a motor vehicle rider. Most strikingly, intentional injuries were more frequent during the second time period and in considerable excess among girls aged 15-19 from more economically deprived areas. Also, during that last period, none of the injury causes correlated significantly with the index of social fragmentation after adjustment for economic deprivation (partial correlation).

CONCLUSION

Over a ten-year period, differential economic deprivation among parishes has widened more than social fragmentation in Stockholm County. The correlation between those indices is high in both periods of time whilst the association between the levels of each index and injury rates varies depending on group of injuries or time period considered. It is of concern that intentional injuries have increased numerically and are significantly and positively correlated with economic deprivation (net of social fragmentation), in particular among girls.

A cross-national study of the relationship between elderly suicide rates and life expectancy and markers of socioeconomic status and health care

BACKGROUND

Socioeconomic status may influence cross-national variations in elderly suicide rates.

METHODS

The relationship between suicide rates in both sexes in the age-bands 65-74 years and 75+ years and (i) life expectancy, (ii) measures of socioeconomic status (per capita gross national domestic product (GDP) and the Gini coeffcient), and (iii) measures of the quality and quantity of available healthcare services (the proportion of GDP spent on health, per capita expenditure on health and child mortality rates) was examined using data from the World Health Organization and the United Nations.

RESULTS

The main findings were: (i) a significant negative correlation between the Gini coefficient and suicide rates for both sexes in both age-bands; (ii) a significant positive correlation between per capita expenditure on health and suicide rates for both sexes in both age-bands; (iii) the significant positive correlation between the proportion of GDP spent on health and suicide rates was only evident in males in both age-bands; (iv) a significant negative correlation between child mortality rates and suicide rates for both sexes in both age-bands; and, (v) the significant positive correlation between life expectancy and suicide rates was evident in females in both age-bands.

CONCLUSIONS

A potentially testable model with five sequential stages was proposed to explain these findings.

The relationship between suicide rates and age: an analysis of multinational data from the World Health Organization

BACKGROUND

Suicide rates generally increase with age. With the emergence of studies from several countries without an increase in suicides rates with aging, a cross-national study examining the relationship between suicide rates and age was undertaken.

METHODS

The relationship between suicide rates and age was examined by ascertaining suicide rates in both sexes in seven age-bands 16-24 years, 25-34 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years and 75+ years, from the World Health Organization website for all the listed countries (N = 62).

RESULTS

The main findings were: (i) there was a significant increase in suicide rates with increasing age in males and females in 25 and 27 countries respectively; (ii) there was no significant increase in suicide rates with increasing age in males and females in 31 and 29 countries respectively; (iii) suicide rates were the highest in the younger age-bands in countries without a significant increase in male suicides rates with increasing age; (iv) countries without a significant increase in the suicide rate with increasing age in both sexes, females only and males only demonstrated regional clustering; and, (v) in a small number of countries suicide rates declined with increasing age.

CONCLUSIONS

Potential explanations for regional and cross-national variations in the relationship between suicide rates and age require further study.

Do hot spots of deprivation predict the rates of suicide within London boroughs?

INTRODUCTION

The ecological associations between suicide rates and different indices of deprivation within London have been investigated at least for half a century. In the present study, the association between rates of suicide with newly developed hot spots of deprivation index within London boroughs have been studied taking into account the results of the spatial dependency between suicide rates in nearby boroughs.

METHODS

Suicide data were provided by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. The hot spots index of deprivation and the population counts were provided by the Department of the Environment, Transport and the Region (DETR) and Office for the National Statistics (ONS), respectively.

RESULTS

The results show that there is no strong spatial dependency between suicide rates in the London boroughs, the 'hot spots' index of deprivation predicts the rates of suicide in males 30-49, better than other age and sex groups. The rate of suicide decreases with decreasing deprivation as indicated by the 'hot spots' index.

CONCLUSION

These findings suggest that at the London boroughs the 'hot spots' index of deprivation (together with other socio-economic and social fragmentation indices) should be considered as a potential explanatory variable to explain the effects of age on rates of suicide in men and women.

Living circumstances of suicide mortality in a South African city: an ecological study of differences across race groups and sexes

In this study the importance of living area circumstances for suicide mortality was explored. Suicide mortality was assessed across race and sex groups in a South African city and the influence of area-based compositional and sociophysical characteristics on suicide risk was considered. Suicide mortality rates are highest among Whites, in particular White males. Main--and independent--dimensions of the living circumstances of residential areas (i.e., socioeconomic circumstances, economic need, and matrimony) influence age-adjusted suicide rates for both sexes but minimally so for race groups. Less favorable clusters of circumstances have a protective effect.

The ecological association between suicide rates and indices of deprivation in English local authorities

INTRODUCTION

There are several published studies that have been focused on the ecological association between suicide rates in different areas with indices of deprivation or fragmentation. Most of these studies, however, have used census-based indices of deprivation or fragmentation. In the present study the newly developed Indices of Deprivation have been used, taking into account the results of the spatial autocorrelation tests.

METHODS

Data on all deaths for which suicide or an open verdict was returned during 1996-1998 in England were subjects of this study. These data were provided by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. The indices of deprivation and the population counts were provided by the Department of the Environment, Transport and the Region (DETR) and Office for National Statistics (ONS), respectively.

RESULTS

The results show that, in England as a whole, the rates of suicide in young and middle-aged males were strongly associated with the indices of deprivation. However, the rates of suicide in females and in older age groups were less influenced by the indices of deprivation. In the present study all the indices of deprivation tended to show a similar pattern in which a better socio-economic status of local authorities was associated with a lower rate of suicide.

CONCLUSION

These findings suggest that at the local authority level, the "hot spots" index of deprivation may represent the same level of magnitude in predicting the rates of suicide as the number of unemployed or income-deprived people. However, more studies using multilevel modelling are needed to shed more light on the ecological associations between suicide rates and socio-economic and social cohesion status.

Deprivation: different implications for forensic psychiatric need in urban and rural areas

BACKGROUND

Ecological relationships between deprivation and forensic psychiatric admission rates may differ in urban and rural areas.

AIMS

The aim of the study was to compare the relationship between material deprivation and forensic admission rates in rural and urban areas for a whole-national service in Ireland over a 3-year period.

METHOD

All Irish forensic admissions from 1997 to 1999 were allocated to the appropriate small area. Material deprivation scores were calculated from census data. Mean annual admission rates and Bayesian standardised forensic admission ratios for small areas were aggregated by material deprivation score and population density.

RESULTS

At small area level, there were significant non-linear increases in forensic admissions with increasing deprivation. The increases in urban areas (population density >10/hectare) were absent in less densely populated areas.

CONCLUSIONS

Deprivation alone may not be the key factor in predicting forensic service utilisation. Factors associated with specifically urban deprived areas may be of greater relevance in planning services.

The Psychology and Neurobiology of Suicidal Behavior

Suicide is a leading cause of death, but it is not well understood or well researched. Our purpose in this review is to summarize extant knowledge on neurobiological and psychological factors involved in suicide, with specific goals of identifying areas particularly in need of future research and of articulating an initial agenda that may guide future research. We conclude that from both neurobiological and psychological perspectives, extant research findings converge on the view that two general categories of risk for suicide can be identified: (a) dysregulated impulse control; and (b) propensity to intense psychological pain (e.g., social isolation, hopelessness), often in the context of mental disorders, especially mood disorders. Each of these categories of risk is underlain at least to some degree by specific genetic and neurobiological factors; these factors in general are not well characterized, though there is emerging consensus that most if not all reside in or affect the serotonergic system. We encourage future theorizing that is conceptually precise, as well as epistemically broad, about the specific preconditions of serious suicidal behavior, explaining the daunting array of suicide-related facts from the molecular to the cultural level.

Mortality of children in the Transkei region of South Africa

This study attempted to unfold, perhaps for the first time, the problem of childhood mortality resulting from trauma in the Eastern Cape Province of South Africa. This study was carried out in the Umtata and Ngqeleni magisterial districts, which have a combined population of about 400,000. Most people there have very few resources and have historically relied on money repatriated by migrant workers. In the Transkei region, unemployment is at a very high level: 48.5%. Assault on children is very common in this region, and this may result in death. The aim of this study was to establish the state of deaths resulting from pediatric trauma, and to formulate recommendations that could probably help prevent or reduce these deaths. The objective was to gather epidemiologic information on the victims of pediatric trauma. The study was designed as a descriptive study, using reviews of traumatic deaths in pediatric age groups during the period January 1993 to December 1999. This study was carried out on cases that were brought to the medicolegal laboratory at Umtata General Hospital, Umtata, in the Transkei region of the Eastern Cape Province, South Africa. There were 6181 autopsies conducted from 1993 to 1999. All the medicolegal autopsies were divided into two groups: pediatric (15 years of age or younger) and adult (older than 15 years). Of the autopsies, 89.4% (n = 5587) were in the adult group, and 10.6% (n = 594) were in the pediatric group. Of the pediatric deaths, 64% (n = 383) were related to trauma. The highest numbers were in the 11- to 15-year (n = 146, 38%) and the 6- to 10-year (n = 135, 34%) age groups. Of the children who died of trauma, 112 (28%) were aged 0 to 5 years. Unintentional injuries from motor vehicle accidents were the leading cause of death (59%), whereas intentional injuries (41%) were associated with murder. Nearly a quarter (22%) of pediatric traumatic deaths were due to penetrating injuries: stab (12%) and gunshot (10%) wounds. Most of the pediatric deaths occurred during the festive months of December, January, and April; the death toll during these months was three to four times higher than in the rest of the year. It was concluded that 64% of pediatric deaths in the Transkei region were the result of trauma. This represents 1 pediatric trauma death for every 10 adult trauma deaths. Forty-one percent of the child trauma deaths were due to intentional injuries, usually murder. It is recommended that the government set targets and put into place strategies for the reduction of pediatric deaths due to trauma. The different deaths so called "rule of reversal" could be considered as an indicator of social health.

[Regional variations in homicide mortality in Jalisco, Mexico]

The present study describes regional variations in homicide rates in Jalisco State, Mexico, in 1989-1991, 1994-1996, and 1999-2000, analyzing the trends by gender and socioeconomic stratum. Using mortality data generated by the National Institute for Statistics, Geography, and Information Technology, homicide rates adjusted by age and gender were calculated, along with rate/female rate ratios; rate ratios by socioeconomic stratum and 95% confidence intervals were also calculated. According to the results, the homicide rate showed: a downward trend in the 1990s; a regional homicide mortality pattern, with the highest rates in peripheral regions, considered among the poorest areas in the State; municipalities with the lowest socioeconomic conditions also presenting a statistically significant excess homicide mortality; and an evident over-mortality from homicide among males. The results point to tasks and challenges for public health and law enforcement institutions, including the need to implement different inter-institutional policies that take into consideration the characteristics of homicide and violent crime in Jalisco.

Medium secure forensic psychiatry services: comparison of seven English health regions

BACKGROUND

Regional medium secure developments have proceeded unevenly, with wide variations in resources to deliver services.

AIMS

To compare patients admitted to seven (pre-reorganisation) regional services and styles of service delivery.

METHOD

A record survey of a complete sample of 2608 patients admitted on 3403 occasions between 1 January 1988 and 31 December 1994.

RESULTS

Services differed according to location of patients before admission, their legal basis for detention, criminal and antisocial behaviour, diagnosis, security needs and length of stay. Regions with more resources and lower demand provided a wider range of services. Thames services were relatively under-provided during the study period, with North East Thames substantially reliant on admissions to private hospitals.

CONCLUSIONS

Uncoordinated development led to under-provision despite high demand. Certain regions prioritised offender patients and did not support local psychiatric services. New standards are required for service specification and resource allocation to redress inequality. Traditional performance measures were of limited usefulness in comparing services.