Deaths from violence in North Carolina, 2004: how deaths differ in females and males

Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis

BACKGROUND

Existing evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally.

METHODS

Databases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940.

FINDINGS

A total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4-17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2-139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9-1·7) with again a broad range amongst studies (RR 0·2-18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9-4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7-36·6). There was very substantial heterogeneity (I²  > 98%) between studies for all pooled estimates.

INTERPRETATION

The homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations.

FUNDING

No specific funding was provided to conduct this research. DK is funded by Wellcome Trust and Elizabeth Blackwell Institute Bristol. Matthew Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. Rebecca Musgrove is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).

Efforts and Opportunities to Understand Women's Mortality Due to Suicide and Homicide Using the National Violent Death Reporting System

Women's mortality due to violent deaths is a public health issue that has received national attention. Many data systems only collect death certificate data, which provide very limited information about the circumstances surrounding a violent death. The Centers for Disease Control and Prevention's (CDC's) National Violent Death Reporting System (NVDRS) is the first and only surveillance system to capture data from death certificates, coroner/medical examiner reports, and law enforcement reports allowing for a more comprehensive picture and targeted prevention efforts. The system currently operates in 40 states, the District of Columbia, and Puerto Rico; however, with additional funding from the Consolidated Appropriations Act of 2018, this surveillance system will fully expand to cover all 50 states. A number of analyses have been conducted using NVDRS data to compare suicide and homicide among women with men; however, only a handful of studies have been conducted among subgroups of women. The present study provides an overview of NVDRS while highlighting a few key analytic studies with implications for suicide and homicide prevention/intervention among women. Data from the 2014 NVDRS Surveillance Summary are also presented to emphasize the unique opportunity to use NVDRS data to study the characteristics of suicide and homicide among women. The summary includes data from 18 states that were collected statewide. This information can provide state and local public health experts with essential data on female suicide and homicide, not provided in other surveillance systems, to help shape prevention and intervention efforts.

Increased Risk of Mortality Due to Interpersonal Violence in Foreign-Born Women of Reproductive Age: A Swedish Register-Based Study

Violence against women is an increasing public health concern, with assault leading to death as the most extreme outcome. Previous findings indicate that foreign-born women living in Sweden are more exposed to interpersonal violence than Swedish-born women. The current study investigates mortality due to interpersonal violence in comparison with other external causes of death among women of reproductive age in Sweden, with focus on country of birth. Foreign-born women and especially those from countries with low and very low gender equity levels had increased risk of mortality due to interpersonal violence, thus implicating lack of empowerment as a contributing factor.

Gender Differences in Intimate Partner Homicides Among Ethnic Sub-Groups of Asians

This study explored differences in intimate partner homicides (IPHs) among Asian Americans. Data from newspapers and femicide reports by different state coalitions on 125 intimate partner killings occurring between 2000 and 2005 were analyzed. Men were the perpetrators in nearly 9 out of 10 cases of Asian IPHs. Gender differences were found in ages of victims and perpetrators, types of relationship between partners, and methods of killing. Most homicides occurred among South-east Asians, and East Asians had the highest within-group proportion of suicides. The findings call for culturally competent risk assessment and intervention strategies to prevent IPHs among at-risk Asian Americans.

Gender differences in the presence of drugs in violent deaths

AIMS

To investigate differences in the presence of drugs, by gender, when considering deaths attributable to homicides and suicides.

DESIGN

Logistic regression analysis of mortality data collected by the Colorado Violent Death Reporting System.

PARTICIPANTS AND SETTING

A total of 5791 Colorado decedents who died of violent causes from 2004 to 2009.

MEASUREMENT

Forensic pathologist autopsy data on drug presence at time of death, coded as present, not present or missing.

FINDINGS

Postmortem presence of drugs is associated strongly with the specific cause of violent death. Compared with suicide decedents, homicide decedents are significantly more likely to test positive for amphetamines [odds ratio (OR): 1.79; confidence interval (CI): 1.34, 2.39], marijuana (OR: 2.03; CI: 1.60, 2.58) and cocaine (OR: 2.60; CI: 2.04, 3.31), and are less likely to test positive for opiates (OR: 0.27; CI: 0.18, 0.39) and antidepressants (OR: 0.17; CI: 0.10, 0.28). When other drugs are controlled for the influence of alcohol is abated dramatically. The patterns of drug prevalence associated with homicide (particularly marijuana) are stronger among males; the patterns of drug prevalence associated with suicide are stronger among females.

CONCLUSIONS

Suicide and homicide decedents are characterized by varying patterns of licit and illicit drug use that differ by gender. Drugs associated with homicide (marijuana, cocaine and amphetamines) are stronger among males, while drugs associated with suicide are stronger among females (antidepressants and opiates). Taking these differences into consideration may allow for targeted interventions to reduce violent deaths.

Depressed mood and cause-specific mortality: a 40-year general community assessment

PURPOSE

The current study describes how the excess mortality risk associated with depression translates into specific causes of death occurring during a 40-year follow-up period, with focus on deaths related to injuries, cardiovascular diseases, and cancer.

METHODS

Data come from a cross-sectional survey (Community Mental Health Epidemiology Study) conducted in the early 1970s in Washington County, Maryland. Random sampling for the survey resulted in 2762 interviews. For the current analyses, baseline depressed mood was linked to current participant vital status through the use of death certificates.

RESULTS

The relative subdistribution hazards for cardiovascular deaths (3.08 [1.74-5.45]) and fatal injuries (4.63 [1.76-12.18]) were significant during the entire 40-year period for young adults (18-39 years old at baseline). The relative subdistribution hazard for cardiovascular deaths during the first 15 years of follow-up was pronounced in elderly (≥ 65 years) males (2.99 [1.67-5.37]) subjects. There were no significant associations between depressed mood and cancer deaths.

CONCLUSIONS

Individuals in the general community with depressed mood may be at increased risk of deaths as the result of cardiovascular disease and injury, even several decades after exposure assessment. Young adults with depressed mood appear to be particularly vulnerable to these associations.

Integrating medical examiner and police report data: can this improve our knowledge of the social circumstances surrounding suicide?

BACKGROUND

Recently, suicide in the United States has begun to be viewed as a preventable public health issue. This has led to the creation of a National Violent Death Reporting System that collects and integrates data on the social circumstances surrounding suicides.

AIMS

The study examines data on social circumstances surrounding suicides as collected by the medical examiner report (ME) and police report (PR) and subsequently integrated into the state of Maryland's violent death reporting system.

METHODS

Reported data on social circumstances surrounding suicides occurring in the years 2003-2006 in Maryland (n = 1,476) were analyzed by examining their prevalence in the ME and PR, strength of association, and integration.

RESULTS

With the exception of three circumstances, there was variation among reported circumstances in the ME and PR. Furthermore, there was only a moderately strong relationship between the ME and PR for most circumstances, while a significant increase occurred in the prevalence of these circumstances when ME and PR were integrated.

CONCLUSIONS

The integration of ME and PR has the potential to increase our knowledge of the circumstances surrounding suicide and to better inform prevention efforts. However, before this potential can be reached, there are still issues that must be considered.

Area disadvantage and intimate partner homicide: an ecological analysis of North Carolina counties, 2004-2006

Using data from the North Carolina Violent Death Reporting System and other sources, we examined ecologic relationships between county (n = 100) disadvantage and intimate partner homicide (IPH), variability by victim gender and county urbanicity, and potential mediators. County disadvantage was related to female-victim homicide only in metropolitan counties (incidence rate ratio [IRR] 1.25); however, disadvantage was associated with male-victim IPH regardless of county urbanicity (IRR 1.17). None of the potential intervening variables examined (shelter availability, intimate partner violence services' funding) was supported as a mediator. Results suggest disparities across North Carolina counties in IPH according to county disadvantage. Future research should explore other potential mediators (i.e., service accessibility and law enforcement responses), as well as test the robustness of findings using additional years of data.

Divergence in contributing factors for suicide among men and women in Kentucky: recommendations to raise public awareness

OBJECTIVES

The primary purpose of this study was to compile demographic information from 1999 to 2005 on suicides and examine specifically toxicology differences between men and women dying by suicide and differences in what type of intimate partner problems (IPPs) were cited as a precipitating circumstance.

METHODS

In addition to death certificate data, coroner investigation reports were available for more than three-quarters of cases in 2005 detailing precipitating factors leading up to suicide. We linked toxicology results to death certificates and coroner investigation reports in the Kentucky Violent Death Reporting System database for statewide analysis.

RESULTS

In 2005, IPP was documented as a contributing factor in 128 (29%) of all suicide cases where the circumstances were known. In 54 (42%) of the 128 cases, the coroner noted that the decedent's intimate was in the process of leaving, breaking up, had recently left, had recently separated, had recently filed for divorce, was awaiting divorce, or had a divorce recently finalized. Of those 54 cases involving IPPs, most (87%) of the suicide victims were men and were significantly different from the women.

CONCLUSIONS

As a result of this study, we have two recommendations: (1) partnering with the media and community-based programs and services to systematically disseminate information on issues such as male IPPs and suicide, and (2) continuing and expanding the use of violent death surveillance to improve risk factor identification. With improved data gathering, targeted interventions can better address the various dynamics influencing the decision to take one's own life.

Comparison of the National Violent Death Reporting System and Supplementary Homicide Report: Potential Benefits of Integration

This paper introduces researchers and practitioners to a new data source called the National Violent Death Reporting System (NVDRS), which has the potential to be linked to the Supplementary Homicide Report (SHR). Using data from Maryland, we examine limitations of the SHR cited by past research and how integration of the SHR with the NVDRS can simultaneously enhance both the SHR and NVDRS. Although some limitations remain, it appears that the integration of the SHR with the NVDRS has potential benefits that can more accurately inform both homicide research and local policy.

Addressing intimate partner violence with male patients: a review and introduction of pilot guidelines

Intimate partner violence (IPV) is a common and devastating problem affecting the health of women, men, and children. Most health-care research focuses on the effects of IPV on women and children and addressing IPV with women in the health-care setting. Less is known about addressing IPV with men in the health-care setting. This article reviews the challenges in interpreting research on IPV in men, its prevalence and health effects in men, and the arguments for addressing IPV with men in the health-care setting. It introduces pilot guidelines that are based on the existing literature and expert opinion.

Female homicidal strangulation in urban South Africa

BACKGROUND

Female strangulation in South Africa occurs in a context of pervasive and often extreme violence perpetrated against women, and therefore represents a major public health, social and human rights concern. South African studies that provide accurate descriptions of the occurrence of strangulation incidents among female homicide victims are limited. The current study describes the extent, distribution and patterns of homicidal strangulation of women in the four largest South African metropolitan centres, Tshwane/Pretoria, Johannesburg, Cape Town and Ethekwini/Durban.

METHODS

The study is a register-based cross sectional investigation of female homicidal strangulation, as reported in the National Injury Mortality Surveillance System for the four cities, for the period 2001 to 2005. Crude, unadjusted female strangulation rates for age and population group, and proportions of strangulation across specific circumstances of occurrence were compiled for each year and aggregated in some cases.

RESULTS

This study reports that female homicidal strangulation in urban South Africa ranges from 1.71/100 000 to 0.70/100 000. Rates have generally declined in all the cities, except Cape Town. The highest rates were reported in the over 60 and the 20 to 39 year old populations, and amongst women of mixed descent. Most strangulations occurred from the early morning hours and across typical working hours in Johannesburg and Durban, and to a lesser extent in Cape Town. Occurrences across Johannesburg, Durban and Pretoria were distributed across the days of the week; an exception was Cape Town, which reported the highest rates over the weekend. Cape Town also reported distinctly high blood alcohol content levels of strangulation victims. The seasonal variation in strangulation deaths suggested a pattern of occurrence generally spanning the period from end-winter to summer. Across cities, the predominant crime scene was linked to the domestic context, suggesting that perpetration was by an intimate partner or acquaintance.

CONCLUSION

The study contributes to an emerging gendered homicide risk profile for a country with one of the highest homicide rates in the world. The results support the call for the development of evidence-based and gender-specific initiatives to especially address the forms of violence that instigate fatalities.

The US National Violent Death Reporting System: domestic and international lessons for violence injury surveillance

OBJECTIVES

This article reviews and comments on the development, strengths and limitations of the US National Violent Death Reporting System (NVDRS) from a variety of domestic and international perspectives.

METHODS

The authors were provided preliminary copies of the manuscripts in this special edition and examined them to understand and put in context the elements and uses of the NVDRS so far. Their comments are based on their reading and interpretation of these papers plus their own combined experience in injury and public health surveillance from four different countries: the US, Colombia, Australia, and South Africa.

RESULTS

The NVDRS is bigger than the sum of its parts because it links existing data from multiple sources. Its adoption of modern relational database technologies offers advantages over traditional injury surveillance databases and creates new opportunities for understanding, collaboration, and partnerships. Challenges include overcoming resource limitations so that it can become a truly national system, measuring and improving its sensitivity and comparability, and the need to examine mortality in context with serious non-fatal violent events.

CONCLUSIONS

The NVDRS is an important work in progress for the US. Each country should examine its own needs, traditions, resources, and existing infrastructure when deciding what kind of violence surveillance system to develop. However, collaboration in developing common definitions and classifications provides an important foundation for international comparisons.