Anabolic steroids and violent crime--an epidemiological study at a jail in Stockholm, Sweden

Violent crime has been associated with the abuse of anabolic-androgenic steroids (AAS) in several reports. Speculations concerning such associations have been raised with regard to several recent crimes committed in Sweden. To test this hypothetical relationship, individuals in a Stockholm jail who had been arrested for violent crimes were screened for AAS in the urine. No AAS were detected in the urine samples of 50 prisoners who had volunteered for the study. However, 16 prisoners refused to participate. AAS abuse was admitted by two of the participating subjects. Although there is a great need for epidemiological studies to objectively confirm the association of AAS abuse and violence, it seems that such studies will be impossible to conduct as long as they, for legal reasons, depend on voluntary participation.

Ethical aspects of psychological autopsy

Survivors of suicide victims are usually vulnerable to new traumatic experiences. Researchers who have used the method of psychological autopsy, including interviews with survivors, have paid little attention to ethical questions. The purpose of this article is to discuss such issues based on empirical data. Data and experiences from 3 studies of suicide among men (n = 271), women (n = 104) and youth (n = 58) are presented; the last 2 also include telephone follow-up by an independent researcher who measured the reactions of the interviewees to the main interviews. The ethical problems for 3 groups of agents (informants and other relatives, including the deceased; the researcher; and the research) are discussed according to 3 basic ethical principles (nonmaleficence, beneficence and respect for autonomy). Many of the interviewees still had signs of crisis reactions and thus constituted a vulnerable group. Nevertheless, drop-out was infrequent. Nor did we find any interviewee who was hurt by the interview, even if the possibility cannot be excluded in a few cases (less than 4%). Many of the interviewees seem to benefit from the interview. The interviews ought to be done by researchers prepared to meet people in crisis situations. The informants had different opinions on whether letter or telephone was the best method for first contact. Tape-recording was generally accepted. It seems to be possible and advisable to further change the design to better meet the needs of the interviewees, without violating the requirements of the researcher and the research.

Interviews with survivors of suicides: procedures and follow-up of interview subjects

In a series of 104 suicides in women, 91 primary informants were interviewed face-to-face. Sixty-two informants participated in a follow-up interview by phone, conducted by an independent investigator in order to determine their attitudes toward the initial interview. One third thought that the initial interview shed new light on the suicide, and two thirds considered the interview emotionally beneficial. In all, the initial interview was a positive or neutral experience for 54 informants and negative for 6. All but one of these were recognized as problematic interview subjects at the initial interview. The remaining two subjects could not be judged at the follow-up. In order to avoid negative consequences of the interviews, the investigator should adjust the procedures and provide support in the crisis reaction.

A psychiatric study of suicide among urban Swedish women

A total of 104 suicides among women were investigated by means of a modified psychological autopsy, including interviews with survivors and a review of somatic and psychiatric records. Diagnosis according to Research Diagnostic Criteria (RDC) showed that 35% were suffering from a major depressive disorder during their final month and another 24% were also depressed; 12% were substance abusers and 14% had adjustment disorders. Two thirds had attempted suicide and another 23% had communicated suicidality in other ways. Slightly more than half of the women had been psychiatric inpatients and another 19% had at some time been outpatients. Fifty-seven percent had been psychiatric inpatients or outpatients during the final year of life. An increasing number of life events occurred during the final 6 months. In most cases the depressed women had been treated ineffectively with antidepressant drugs.

Psychological autopsies: methods and ethics

Essential knowledge on suicide is derived from studies that include interviews with survivors. In this paper, we discuss methodological and ethical issues pertaining to the interview method known as "psychological autopsy"; the discussion is based on our application of the method to three studies of suicides in Sweden and on a review of other investigations. Interviewing a survivor is a delicate matter, and the integrity of the deceased, the integrity and health of the informant, and the psychological strain on the interviewer must all be taken into consideration. The interviewer should have clinical experience in order to be prepared to deal with interviewees in grief. Contact by telephone, followed by an introductory letter, provides an opportunity to meet survivors in an empathic manner and has a low rejection rate. A 2- to 6-month interval between suicide and interview is recommended. The survivor's reactions to the interview should be evaluated in order to expand the empirical base for ethical considerations. Studies on the validity and reliability of the method are necessary.

Birth cohort analysis of changing suicide risk by sex and age in Sweden 1952 to 1981

The study aims at exploring the sex and age shift in suicide in Sweden. Data from the Causes of Death Register comprising suicides occurring in 1952 to 1981 among persons born in 1877 to 1966 were included. Analysis of linear regression of cumulative suicide incidence in successive birth cohorts yielded a shift toward younger ages and a general increase in female suicide risk. The statistical suicide risk in the 20 to 24 male age group has increased 3.6 times. The male to female suicide risk sex ratio has decreased for those older than 45, while it has increased among young adults. There is an urgent need of explanatory studies.