The power of (Mis)perception: Rethinking suicide contagion in youth friendship networks

Highlights

• Youth tend to overestimate friends' attempted suicide.
• Misperception of friends' attempted suicide occurs primarily among at-risk youth.
• Overestimating friends' attempted suicide amplifies the risk of attempted suicide.

Suicide is a leading cause of death among youth. In the wake of peer suicide, youth are vulnerable to suicide contagion. But, questions remain about the mechanisms through which suicide spreads and the accuracy of youths' estimates of friends' suicidal behaviors. 

This study addresses these questions within school-aged youths' friendship networks. Social network data were drawn from two schools in the National Longitudinal Study of Adolescent to Adult Health, from which 2180 youth in grades 7-12 nominated up to ten friends. A measure of "perceived" friends' attempted suicide was constructed based on respondents' reports of their friends' attempted suicide. This measure was broader than a "true" measure of friends' attempted suicide, constructed from self-reports of nominated friends who attended respondents' schools. Sociograms graphically represented the accuracy with which suicide attempters estimated friends' suicide attempts. 

Results from cross-tabulation with Chi-square analysis indicated that approximately 4% of youth (88/2180) attempted suicide, and these youth disproportionately misperceived (predominantly overestimated) friends' suicidal behaviors, compared to non-suicide-attempters. Penalized logistic regression models indicated that friends' self-reported attempted suicide was unrelated to respondent attempted suicide. But, the odds of respondent attempted suicide were 2.54 times higher (95% CI, 1.06-6.10) among youth who accurately perceived friends' attempted suicide, and 5.40 times higher (95% CI, 3.34-8.77) among youth who overestimated friends' attempted suicide. 

The results suggest that at-risk youth overestimate their friends' suicidal behaviors, which exacerbates their own risk of suicidal behavior. Methodologically, this suggests that a continued collaboration among network scientists, suicide researchers, and medical providers is necessary to further examine the mechanisms surrounding this phenomenon. 

Practically, it is important to screen at-risk youth for exposure to peer suicide and to use the social environment created by adolescent friendship networks to empower and support youth who are susceptible to suicidal thoughts and behaviors.

Purchase full article at:   http://goo.gl/xEtr2L

By:  Zimmerman GM1, Rees C2, Posick C3, Zimmerman LA4.

• Electronic address: g.zimmerman@neu.edu.
• 2Brigham Young University, Department of Sociology, 2019 Joseph F. Smith Building, Provo, UT 84602, USA. Electronic address: carter_rees@byu.edu.
• 3Georgia Southern University, Department of Criminal Justice & Criminology, PO BOX 8105, 1332 Southern Drive, Statesboro, GA 30458, USA. Electronic address: cposick@geogiasouthern.edu.
• 4Department of Gastroenterology/Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: lori.zimmerman@childrens.harvard.edu.
• Soc Sci Med. 2016 Apr 1;157:31-38. doi: 10.1016/j.socscimed.2016.03.046.  

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Nature & Determinants of Suicidal Ideation among U.S. Veterans: Results from the National Health & Resilience in Veterans Study

BACKGROUND:

Suicidal thoughts and behaviors among U.S. military veterans are a major public health concern. To date, however, scarce data are available regarding the nature and correlates of suicidal ideation (SI) among U.S. veterans. This study evaluated the prevalence and correlates of suicidal ideation in a contemporary, nationally representative, 2-year prospective cohort study.

METHOD:

Data were analysed from a total of 2157 U.S. veterans who participated in the National Health and Resilience Veterans Study (NHRVS; Wave 1 conducted in 2011; Wave 2 in 2013). Veterans completed measures assessing SI, sociodemographic characteristics, and potential risk and protective correlates.

RESULTS:

The majority of veterans (86.3%) denied SI at either time point, 5.0% had SI onset (no SI at Wave 1, SI at Wave 2), 4.9% chronic SI (SI at Waves 1 and 2), and 3.8% had remitted SI (SI at Wave 1, no SI Wave 2). 

Greater Wave 1 psychiatric distress was associated with increased likelihood of chronic SI (relative risk ratio [RRR]=3.72), remitted SI (RRR=3.38), SI onset (RRR=1.48); greater Wave 1 physical health difficulties were additionally associated with chronic SI (RRR=1.64) and SI onset (RRR=1.47); and Wave 1 substance abuse history was associated with chronic SI (RRR 1.57). 

Greater protective psychosocial characteristics (e.g., resilience, gratitude) at Wave 1 were negatively related to SI onset (RRR=0.57); and greater social connectedness at Wave 1, specifically perceived social support and secure attachment style, was negatively associated with SI onset (RRR=0.75) and remitted SI (RRR=0.44), respectively.

LIMITATIONS:

Suicidal ideation was assessed using a past two-week timeframe, and the limited duration of follow-up precludes conclusions regarding more dynamic changes in SI over time.

CONCLUSIONS:

These results indicate that a significant minority (13.7%) of U.S. veterans has chronic, onset, or remitted SI. Prevention and treatment efforts designed to mitigate psychiatric and physical health difficulties, and bolster social connectedness and protective psychosocial characteristics may help mitigate risk for SI.

Purchase full article at:   http://goo.gl/u4D8Z6

By:  Smith NB1, Mota N2, Tsai J3, Monteith L4, Harpaz-Rotem I5, Southwick SM2, Pietrzak RH2.

• 1U.S. Department of Veterans Affairs National Center for PTSD , VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA. Electronic address: Noelle.smith2@va.gov.
• 2U.S. Department of Veterans Affairs National Center for PTSD , VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
• 3Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; New England Mental Illness, Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA.
• 4Denver VA Medical Center, Rocky Mountain MIRECC, Denver, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
• 5U.S. Department of Veterans Affairs National Center for PTSD , VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Northeast Program Evaluation Center, West Haven, CT, USA. 
• J Affect Disord. 2016 Mar 2;197:66-73. doi: 10.1016/j.jad.2016.02.069.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Self-Harm & Overcrowding among Prisoners in Geneva, Switzerland

Purpose
Prison institutional conditions affect risk for self-harm among detainees. In particular, prison overcrowding may increase the likelihood of self-harm by creating competition for resources, space, and enhancing a "deprivation state." The purpose of this paper is to examine the association between overcrowding and prisoner acts of self-harm. 

Design/methodology/approach
This cross-sectional study took place at Geneva's pre-trial prison (capacity:376) between 2006 and 2014. Outcomes were acts of self-harm that required medical attention, and self-strangulation/hanging events (combined into one group, as these are difficult to differentiate). Dichotomous predictors were overcrowding index- annual mean daily population divided by capacity ( > 200 percent vs < 200 percent), and year group (2006-2009 vs 2011-2014). 

Findings
Self-harm and self-strangulations/hangings increased in 2011-2014 compared to 2006-2010 (p < 0.001). Overcrowding in excess of 200 percent was associated with self-strangulation/hangings (p < 0.001) but not with all self-harm events. In terms of pertinent demographics that would affect self-harm, there was no prison change in gender, area of origin, foreign residency, religion, or psychiatric treatment. 

Research limitations/implications
The present study is limited by the definition and identification of self-harm. The distinction between self-strangulation and self-hanging, and the precise classification of an intent to die is difficult to make in practice, especially with limited prison data records available. The relevant literature addresses the complexity of the association between non-suicidal and suicidal behavior. Despite this, the combined category self-strangulations/hangings gives some indication of severe self-harm events, especially since the methodology of categorization employed was consistent throughout the entire period of the study. Other limitations include the small sample size and the lack of individual patient data and prison data to help control for confounding factors. Despite these drawbacks, pertinent data (socio-demographics and number of prisoners treated for mental health and drug abuse) remained stable over the years. Thus, there are no apparent changes in the inmate population that could be linked to an increase in self-harm. High-security placements and mean prisoner stay have increased over time, with a decrease in staff to prisoner ratio - and these must be looked into further as contributors. Additionally, qualitative methods such as semi-structured interviews and focus groups could delineate the impact of overcrowding on prisoner well-being and self-harm potential. 

Practical implications
The authors observed a significant increase in self-harm and self-strangulation/hangings over time, and overcrowding was significantly associated with self-strangulation/hangings (but not with all self-harm events). Overcrowding can impose destructive effects on the psychological and behavioral well being of inmates in prison, influencing a myriad of emotional and livelihood factors that predispose to harmful behavior. 

Originality/value
This report should alert public health and prison authorities to this issue, and garner resources to address such an alarming rise. The findings from this short report demonstrate the need for a further examination of the mechanisms affecting self-harm among prisoners in this population, particularly the relationship between self-strangulations/hangings and overcrowding.

Purchase full article at:   http://goo.gl/SD4HMx

By:  Wolff H1, Casillas A, Perneger T, Heller P, Golay D, Mouton E, Bodenmann P, Getaz L.

• 1Division of Correctional Medicine and Psychiatry, Geneva University Hospitals, University of Geneva, Geneva, Switzerland. 
• Int J Prison Health. 2016 Mar 14;12(1):39-44. doi: 10.1108/IJPH-04-2015-0009.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Perception of Suicide Risk in Mental Health Professionals

This study employed an independent-groups design (4 conditions) to investigate possible biases in the suicide risk perception of mental health professionals. 

Four hundred participants comprising doctors, nurses and social workers viewed a vignette describing a fictitious patient with a long-term mental illness. The case was presented as being drawn from a sample of twenty similar clinical case reports, of which 10 were associated with an outcome of suicide. 

The participant tasks were 

1. to decide whether the presented vignette was one of those cases or not, and 
2. to provide an assessment of confidence in that decision. 

The 4 conditions were used to investigate whether the presence of an associated face, and the nature of the emotional state expressed by that face, affected the response profile. In fact, there were no significant differences between conditions, but there was a significant bias across all conditions towards associating the vignette with suicide, despite the base rate being pre-determined at 50%. The bias was more pronounced in doctors and in male respondents. Moreover, many participants indicated substantial confidence in their decisions. 

The results are discussed in terms of availability bias and over-confidence bias.

Below: ‘Suicide’ responses for male and female participants by professional group

Full article at:   http://goo.gl/Uy2nFS

By:  

Tim M. Gale 

Department of Research, Hertfordshire Partnership University NHS Foundation Trust, Hatfield, United Kingdom

Tim M. Gale 

Department of Psychology, University of Hertfordshire, Hatfield, United Kingdom

Christopher J. Hawley 

Department of Post-graduate Medicine, University of Hertfordshire, Hatfield, United Kingdom

John Butler 

School of Health, University of Central Lancaster, Preston, United Kingdom

Adrian Morton 

Reigate Psychology Service, Reigate, Surrey, United Kingdom

Ankush Singhal 

Psychological Medicine Service, The Royal Oldham Hospital, Oldham, United Kingdom 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Dual Diagnosis and Suicide Probability in Poly-Drug Users

OBJECTIVE:

To determine the frequency of suicidal thoughts and suicidal probability among poly-substance abusers in Saudi population, and to examine the relation between dual diagnosis and suicidal thoughts.

STUDY DESIGN:

Case control study.

PLACE AND DURATION OF STUDY:

Al-Baha Psychiatric Hospital, Saudi Arabia, from May 2011 to June 2012.

METHODOLOGY:

Participants were 239 subjects, aged 18 - 45 years. We reviewed 122 individuals who fulfilled the DSM-IV-TR criteria of substance abuse for two or more substances, and their data were compared with that collected from 117 control persons.

RESULTS:

Suicidal cases were highly present among poly-substance abusers 64.75%. Amphetamine and cannabis were the most abused substances, (87.7% and 70.49%, respectively). Astatistically significant association with suicidality was found with longer duration of substance abuse (p &lt; 0.001), using alcohol (p=0.001), amphetamine (p=0.007), volatile substances (p=0.034), presence of comorbid psychiatric disorders (dual diagnosis) as substance induced mood disorder (p=0.001), schizo-affective disorder (p=0.017), major depressive disorders (p=0.001), antisocial (p=0.016) and borderline (p=0.005) personality disorder. Suicidal cases showed significant higher scores (p &lt; 0.001) of suicide probability scale and higher scores in Beck depressive inventory (p &lt; 0.001).

CONCLUSION:

Abusing certain substances for long duration, in addition to comorbid psychiatric disorders especially with disturbed-mood element, may trigger suicidal thoughts in poly-substance abusers. Depression and suicide probability is common consequences of substance abuse.

Full PDF article at:   http://goo.gl/4PcIgV

By:  Youssef IM1, Fahmy MT1, Haggag WL1, Mohamed KA1, Baalash AA2.

• 1Department of Neuropsychiatry, Suez Canal University, Ismailia, Egypt.
• 2Department of Psychiatry, Psychiatric Hospital, Al-Baha, Saudi Arabia. 
• J Coll Physicians Surg Pak. 2016 Feb;26(2):130-3. doi: 02.2016/JCPSP.130133.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Physical Compared to Mental Diseases as Reasons for Committing Suicide: A Retrospective Study

BACKGROUND:

Several studies investigated the relationship between mental disorders and suicidal ideation. However, little is known about physical illnesses being the major trigger for committed suicides. It is necessary to understand these risk factors to be able to meet the needs of patients in a palliative care setting.

METHODS:

Suicide, medical and police notes were retrospectively analysed from all autopsies conducted in 2009-11 at the University of Munich, Germany. Documented reasons for suicide were classified into a "physical disease" (PD) or "mental disease" (MD) group and compared with respect to their sociodemographic characteristics and autopsy outcomes.

RESULTS:

Of all 1069 cases, 18.9 % gave a PD as reason for committing suicide (MD, 32.7 %). Those indicating PD were older than MD (68.8 vs. 48.7 years) with more men being in this group (72.8 % vs. 59.1 %). In PD, 30.7 % suffered from cancer, 28.7 % from chronic pain and 12.4 % from lung disease. 38.8 % of MD and 12.4 % of PD had previous suicide attempts.

CONCLUSIONS:

In palliative care, it is necessary to screen patients on a regular basis for suicidal ideation, especially those with previous suicide attempts.

Circumstances of suicide

	Physical disease as reason for suicide	Mental disorder as reason for suicide	Difference
	n = 202	n = 350
Soft suicide method	67 (33.3 %)	107 (30.7 %)	χ2 = 0.422, p = 0.516
Hard suicide method	134 (66.7 %)	242 (69.3 %)
Suicide method
Strangulation	35 (17.3 %)	88 (25.1 %)	χ2 = 4.518, p = 0.03
Intoxication	59 (29.2 %)	90 (25.7 %)	χ2 = 0.793, p = 0.37
Shooting	41 (20.3 %)	9 (2.6 %)	χ 2 = 48.852, p  < 0.001
Breathing back	12 (5.9 %)	10 (2.9 %)	χ2 = 3.182, p = 0.07
Jump from height	34 (16.8 %)	80 (22.9 %)	χ2 = 2.838, p = 0.09
Sharp forces	15 (7.4 %)	21 (6.0 %)	χ2 = 0.427, p = 0.51
Jumping in front of vehicle	4 (2.0 %)	35 (10.0 %)	χ 2 = 12.546, p  < 0.001
Vehicle against barrier	2 (1.0 %)	2 (0.6 %)	χ2 = 0.312, p = 0.58
Gas inhalation	3 (1.5 %)	12 (3.4 %)	χ2 = 1.830, p = 0.18
Drowning	16 (7.9 %)	18 (5.1 %)	χ2 = 1.710, p = 0.19
Electricity	1 (0.5 %)	3 (0.9 %)	χ2 = 0.233, p = 0.63
Thermic force	1 (0.5 %)	8 (2.3 %)	χ2 = 2.561, p = 0.11
Previous suicide attempts	25 (12.4 %)	136 (38.8 %)	χ 2 = 51.369, p  < 0.001

Bold: Significant after Bonferroni correction (suicide method: p < 0.0042)

Full article at:  http://goo.gl/mjP1k8

By:  Fegg M1, Kraus S2, Graw M3, Bausewein C4.

• 1Department of Palliative Medicine, University of Munich, Munich, Germany. martin@fegg.de.
• 2Department of Forensic Medicine, University of Munich, Munich, Germany. sybille.kraus@gmx.de.
• 3Department of Forensic Medicine, University of Munich, Munich, Germany. matthias.graw@med.uni-muenchen.de.
• 4Department of Palliative Medicine, University of Munich, Munich, Germany. claudia.bausewein@med.uni-muenchen.de.
• BMC Palliat Care. 2016 Feb 9;15(1):14. doi: 10.1186/s12904-016-0088-5. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Sociodemographic Characteristics of Persons Committing Suicide in Durban, South Africa: 2006–2007

Background

Suicidal behaviour is a leading contributor to the burden of disease worldwide and varies widely between countries. South African figures are amongst the highest in the world, with recent trends indicating a disturbing rise, especially amongst the younger age groups, across all races.

Aim

This study analysed sociodemographic characteristics and trends relating to suicides committed in Durban, South Africa during the period of 2006–2007.

Method

A retrospective analysis of suicidal deaths (during 2006–2007), extracted from autopsy registers at all three government-run mortuaries in Durban, was conducted.

Results

The total number of suicides in Durban increased by 6.68% from 2006 to 2007. Suicide accounted for an average of 8.8% of all non-natural deaths per year of the study. The overall suicide rates of 14.53 (2006) and 15.53 (2007) per 100 000 population are comparable with national and global figures. The majority of suicides occurred in single unemployed persons, men and younger age groups. The largest number of suicides per year was recorded in black people, followed by Indian, white and mixed-race people. Hanging was the preferred method in the majority of victims, followed by self-poisoning, shooting and jumping.

Conclusions

The findings indicate a disturbingly high suicide rate amongst the various population and age groups in Durban. The dominant methods used may be influenced by ease of access. The reported trends may worsen unless there is a swift and decisive public health response and cohesive community-based programmes which include a supportive multidisciplinary network.

Below:  Suicide frequency by month and year

Below:  Number of suicides by race

Below:  Most common suicide methods in (a)2006 and (b) 2007

Full article at:  http://goo.gl/ygZCCs

By:  Soornarain S. Naidoo¹ and Lourens Schlebusch²

¹Department of Family Medicine, University of KwaZulu-Natal, South Africa

²Department of Behavioural Medicine, University of KwaZulu-Natal, South Africa

Corresponding author.

Correspondence to: Soornarain Naidoo, Email:Email: az.ca.nzku@97soodian, Postal address: Department of Family Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013

How to cite this article: Naidoo SS, Schlebusch L. Sociodemographic characteristics of persons committing suicide in Durban, South Africa: 2006–2007. Afr J Prm Health Care Fam Med. 2014;6(1), Art. #568, 7 pages. http://dx.doi.org/10.4102/phcfm.v6i1.568

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Mysore Study: A Study of Suicide Notes

BACKGROUND:

Suicide is one of the leading causes of preventable deaths. Recent data suggest South India as one of the regions with highest suicide rates in the world. In 2013, 134,799 people committed suicide in India according to the statistics released by the National Crime Records Bureau. Suicide note is one of the most important sources to understand suicide, which may be beneficial in suicide prevention. Studies on suicidal notes from this part of the world are sparse.

OBJECTIVE:

The aim was to study the themes in suicide notes that might be useful in prevention strategies.

MATERIALS AND METHODS:

A descriptive study of all suicide notes of those individuals who committed suicide between 2010 and 2013 available with Police Department, Mysore district was obtained and analyzed.

RESULTS:

A total of 22 suicide note were available. A majority of suicide note was in age group of 16-40 years (86%) and most were men (59%). All suicide notes were handwritten, the majority (70%) in regional language Kannada. Length of notes varied from just few words to few pages. Contents of suicide notes included apology/shame/guilt (80%), love for those left behind (55%) and instruction regarding practical affairs (23%). Most have blamed none for the act (50%). 23% mentioned that they are committing suicide to prove their innocence. 32% mentioned a last wish.

CONCLUSION:

The majority of suicidal note contained "guilt" which is a strong indicator of possible depression in deceased. Creating awareness about suicide among public and ensuring access to professionals trained in suicide prevention is need of the hour in this part of the world.

Below:  Gender and marital status of those who left suicide note

Below:  Overall content in 22 suicide notes

Full article at:   http://goo.gl/gazM4W

By:  P. Namratha, M. Kishor, T. S. Sathyanarayana Rao, and Rajesh Raman

Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore, Karnataka, India

Address for correspondence: Dr. M. Kishor, Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore - 570 004, Karnataka, India. E-mail: moc.liamg@dmrohsikrd

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health