Browsing by Subject "Suicide"
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Item Open Access Defying the odds on gun regulation: The passage of bipartisan mental health laws across the states.(The American journal of orthopsychiatry, 2015-05) Goss, Kristin AItem Open Access Effects of statewide job losses on adolescent suicide-related behaviors.(Am J Public Health, 2014-10) Gassman-Pines, Anna; Ananat, Elizabeth Oltmans; Gibson-Davis, Christina MOBJECTIVES: We investigated the impact of statewide job loss on adolescent suicide-related behaviors. METHODS: We used 1997 to 2009 data from the Youth Risk Behavior Survey and the Bureau of Labor Statistics to estimate the effects of statewide job loss on adolescents' suicidal ideation, suicide attempts, and suicide plans. Probit regression models controlled for demographic characteristics, state of residence, and year; samples were divided according to gender and race/ethnicity. RESULTS: Statewide job losses during the year preceding the survey increased girls' probability of suicidal ideation and suicide plans and non-Hispanic Black adolescents' probability of suicidal ideation, suicide plans, and suicide attempts. Job losses among 1% of a state's working-age population increased the probability of girls and Blacks reporting suicide-related behaviors by 2 to 3 percentage points. Job losses did not affect the suicide-related behaviors of boys, non-Hispanic Whites, or Hispanics. The results were robust to the inclusion of other state economic characteristics. CONCLUSIONS: As are adults, adolescents are affected by economic downturns. Our findings show that statewide job loss increases adolescent girls' and non-Hispanic Blacks' suicide-related behaviors.Item Open Access “Everyone is fighting their own battles”: A qualitative study to explore the context of suicidal ideation among people living with HIV in Kilimanjaro, Tanzania(2024) Shekibula, Ismail AmiriAbstractBackground: In 2020, Tanzania struggled with significant HIV-related challenges, including 1.4 million people living with HIV (PLWH), 33,000 new infections, and 22,000 AIDS-related deaths. Suicide emerged as a main cause of mortality among PLWH, accounting for over a quarter of all suicides. Despite these alarming statistics, mental health resources remained scarce, with only 55 psychologists and psychiatrists in the country. Clinic staff in HIV care were tasked with providing counseling despite limited mental health training, primarily focusing on HIV education. This study aimed to delve into the lived experiences of PLWH with recent suicidal ideation to inform tailored mental health interventions. Methods: Participants were screened for suicidal ideation during routine HIV clinic visits, with qualitative interviews conducted thereafter. Data was analyzed using thematic analysis facilitated by NVivo 12 software. Results: PLWH experiencing suicidal ideation encounter significant mental health challenges originating from factors such as their HIV diagnosis, societal stigma, financial stress, and broader social determinants. Death is sometimes perceived as an escape from the challenges associated with HIV. Coping mechanisms include seeking assistance from religious leaders. While participants expressed openness to counseling, limited treatment options hinder access. Conclusion: Suicide is an urgent public health challenge among PLWH in Tanzania, exacerbated by unique stressors like socioeconomic challenges, stigma, discrimination, and psychological distress. Despite the seriousness of these challenges, options for mental health treatment are scarce and not tailored to the needs of PLWH. Our findings can inform the improvement of mental health care for PLWH in Tanzania and other low-resource settings.
Key Words: Tanzania, HIV, Suicide, Suicidal ideation, Mental health, lived experience, Qualitative research, Stigma, Coping mechanisms, Counseling intervention, Socioeconomic challenges, Discrimination, Psychological distress, Treatment options and Low-resource settings.
Item Open Access Firearm Homicide-Suicides in North Carolina: Evidence from the North Carolina Violent Death Reporting System, 2004-2014(2016-05-17) Kerber, RoseHomicide-suicides are a patterned type of violence that is distinct from other suicides and other homicides. The evidence presented in this analysis suggests that compared to both homicides and suicides, homicide-suicides are less reflective of personal problems experienced by the perpetrator and more reflective of troubled and abusive relationships between the perpetrator and the victim(s). The evidence suggests that perpetrators become maximally violent when they have lost control of a relationship. The intense fixation on the victim suggests that these incidents may be primarily homicidal. The suicidal act may be less premeditated than the homicide, and may instead reflect the perpetrator’s complete loss of control and inability to function without their primary relationship. Homicide-suicides are often preceded by a history of domestic violence and interaction with law enforcement. Interactions with law enforcement and the court system present key opportunities for intervention in abusive relationships that might prevent escalation. With better screening and robust policies that empower law enforcement and the court system to confiscate firearms from abusive individuals, hundreds of deaths could be prevented over the next decade.Item Open Access Frequency of suicidal ideation and associated clinical features in Lewy body dementia.(Parkinsonism & related disorders, 2021-07-29) Armstrong, Melissa J; Moore, Kathryn; Jacobson, Charles E; Bedenfield, Noheli; Patel, Bhavana; Sullivan, Jennifer LIntroduction
Neuropsychiatric disturbance is common in individuals with Lewy body dementia (LBD). Despite this, there is minimal research regarding suicide risks in this population.Methods
This study was a retrospective review of a prospectively-collected database at a tertiary movement disorders clinic. Database participants with an LBD diagnosis at their most recent visit and at least one complete Beck Depression Inventory-II (BDI-II) were included. Additional measures included demographics and measures of cognition, psychiatric symptoms, motor function, and the Parkinson Disease Questionnaire-39. The frequency of suicidal ideation was assessed using question 9 of the BDI-II. Features associated with a BDI-II score greater than zero were assessed using logistic regression.Results
The database included 95 individuals with LBD and at least one BDI-II (visit years 2010-2020). Most participants were older men who identified as white. Eighteen individuals (18.9%; 95% CI 12.3%-28.0%) reported thoughts of killing themselves without an intent to carry them out (BDI-II = 1). No participants reported a desire or plan to kill themselves. The presence of SI was associated with measures of depression, anxiety, and emotional well-being, but not with demographics, measures of disease severity, or other psychiatric concerns.Conclusion
These findings emphasize the importance of routine screening for psychiatric symptoms in LBD and intervention when such concerns are identified. Interventions could include pharmacologic (e.g. depression treatment) and non-pharmacologic (e.g. firearm screening) approaches. More research is needed to assess suicidal ideation and suicide risks in large and more diverse LBD populations. Prospective studies should include measures of additional potential contributors to suicidality.Item Open Access Inhalant use among incarcerated adolescents in the United States: prevalence, characteristics, and correlates of use.(Drug and alcohol dependence, 2008-03) Howard, Matthew O; Balster, Robert L; Cottler, Linda B; Wu, Li-Tzy; Vaughn, Michael GOBJECTIVE: To characterize patterns and correlates of inhalant use among incarcerated youth. METHOD: Residents (N=723) of 27 Missouri Division of Youth Services facilities completed interviews assessing substance use, psychiatric symptoms, antisocial traits, trauma, suicidality, and criminality. RESULTS: Participants averaged 15.5 (S.D.=1.2) years of age, were ethnically diverse, and predominantly male. More than one-third (36.9%) reported lifetime inhalant use; 47.9% of users had tried four or more inhalant products. Comparatively high rates of use were observed for Hispanic and small town/rural youth. Commonly abused agents included gasoline (22%), permanent markers (15%), computer "air duster," (15%) and spray paint (12%). Inhalant users evidenced significantly higher levels of criminal behavior, antisocial attitudes, current psychiatric symptoms, earlier onset of offending and substance use, and more extensive histories of head injury, kidney disease, hormonal problems, mental illness, suicidality, trauma, and substance-related problems than nonusers. In multiple logistic regression models, race/ethnicity, geographic area of residence, fearlessness, suicidality, and polydrug use distinguished inhalant users and nonusers. Measures of cognitive impairment, impulsivity, fearlessness, blame externalization, polydrug use, and substance-related problems were positively associated with lifetime frequency of inhalant use. CONCLUSIONS: Inhalant use was widespread in this sample and associated with serious physical and mental health impairments.Item Open Access Living Life in the Face of Death: An Ethnographic Exploration of Healing, Temporality, and Connection in Suicide(2024) Sperber, BenjaminSuicidality is a visceral, frightening reality that many with mental illness face on a daily basis. Treated with contempt in society, much of the scholarship surrounding suicidality focuses on the family or the effectiveness of treatment options. This thesis represents an effort to hold space for those who suffer from suicidality. Through ethnographic research on reddit and through semi-structured interviews with those who have been involuntarily committed in the state of North Carolina, the author offers a new analysis of the contingencies of healing, time, and connection for those who fail in their aimed desire of death through suicide. Split into three chapters, the author first examines how western biomedicine and the telos of medicine (i.e., treating to cure) necessarily is complicated by mental illness, leaving those who experience suicidality to feel that they are incapable of healing. Moreover, the author undertakes an exploration of differing tropes within biomedicine in an attempt to shed light on how dominant notions of healing are confounded or complicated by suicidality. In Chapter Two, the author explores time; namely, how suicidality subverts productivity-centered, future-oriented understandings and experiences of time. To this end, the author poses a new temporal schema, suicidal temporality, which seeks to explain how those who fail at suicide attempts experience time, the accumulation of life stressors, administrative labor, and more. In the final chapter, the author explores two forms of relationships—those between patient and physician, as well as those between suicidal individuals—to demonstrate how differing contexts can afford or limit a suicidal person varying levels of connection, trust, and aid from their interlocutor. Offering no solutions to eradicate suicidality, the author instead hopes to allow readers to gain a greater understanding of the experiences, emotions, and sensorial experiences that accompany suicidality.Item Open Access Panic attacks and suicide attempts in mid-adolescence.(The American journal of psychiatry, 1999-10) Pilowsky, DJ; Wu, LT; Anthony, JCOBJECTIVE: The aim of this study was to investigate the association of panic attacks and suicide attempts in a community-based sample of 13-14-year-old adolescents. METHOD: The data are from a survey of 1,580 students in an urban public school system located in the mid-Atlantic region of the United States. Logistic regression methods were used to estimate associations between panic attacks and suicidal ideation and suicide attempts. RESULTS: Controlling for demographic factors, major depression, the use of alcohol, and the use of illicit drugs, the authors found that adolescents with panic attacks were three times more likely to have expressed suicidal ideation and approximately two times more likely to have made suicide attempts than were adolescents without panic attacks. CONCLUSIONS: This new epidemiologic research adds to the evidence of an association between panic attacks and suicide attempts during the middle years of adolescence.Item Open Access Substance Use and Suicide in Pacific Islander, American Indian, and Multiracial Youth.(American journal of preventive medicine, 2018-06) Subica, Andrew M; Wu, Li-TzyINTRODUCTION:National estimates of U.S. Native Hawaiian and other Pacific Islander (NHPI), American Indian/Alaskan Native (AIAN), and multiracial adolescent substance use and suicidality are scarce because of their small population sizes. The aim was to estimate the national prevalence of, and disparities in, substance use and suicidality among these understudied adolescents. METHODS:Analyses conducted in 2017 of U.S. adolescents (grades ninth to 12th) from the 1991-2015 Combined National Youth Behavioral Risk Surveys estimated (1) prevalence of lifetime and current (past 30-day) substance use, past 12-month depressed mood, and suicidality by racial group; and (2) AORs for depressed mood and suicidality regressed on current alcohol, cigarette, and marijuana use. RESULTS:Among 184,494 U.S. adolescents, alcohol, cigarettes, and marijuana were commonly used with lifetime prevalence of 75.32%, 58.11%, and 40.55%, respectively, and current prevalence of 44.51%, 24.58%, and 22.01%, respectively. Past 12-month prevalence of suicidal thoughts, suicide planning, and attempted suicide were 18.87%, 14.75%, and 7.98%, respectively. Relative to non-Hispanic whites, NHPI, AIAN, and multiracial adolescents had higher prevalence of using many illicit substances (e.g., marijuana, heroin), depressed mood, and suicidal thoughts, planning, and attempts (p<0.05). Except for NHPIs and current alcohol use, current alcohol and cigarette use were independently associated with 2.0-2.3 times greater AORs (p<0.05) for attempted suicide among the target adolescents. CONCLUSIONS:U.S. NHPI, AIAN, and multiracial adolescents are disproportionately burdened by illicit substance use, depressed mood, and suicidality. Current alcohol and cigarette use may predispose these adolescents toward suicidality, offering potential pathways to alleviate suicide risk.Item Open Access Suicidal Romanticism: Race, Gender, and the End(s) of Individualism(2015) Koretsky, Deanna PetraMoving beyond traditional conceptions of suicide in Romantic literature as indices of Romanticism's fascination with tragic or mad genius, this dissertation traces how Romantic-era writers also employed the trope of suicide as a political tool to argue for the rationality of individuals without rights, or with limited rights, such as slaves, women, and the poor. In both scholarly and post-Romantic artistic engagements with so-called Romantic suicide, suicide is typically interpreted as neither a critique of an unlivable society, nor even a mark of mental illness, but instead operates as a meta-critique of art itself, suggesting that the artist, by virtue of his creativity, is somehow beyond this world. But by showing how suicide also emerged, in the Romantic period, as a metaphor for challenging social structures associated with liberal individualism, Suicidal Romanticism posits that the emphasis on the link between creative and suicidal proclivities associated with Romanticism, which persists even in our contemporary imagination in spite of social scientific arguments to the contrary, troubles our capacity to talk either about the problem of mental illness or about the social injustices that would drive somebody to want not to live. The Romantic writers examined here--including Thomas Day and John Bicknell, Mary and Percy Shelley, and William Wordsworth--proposed an alternative conception of suicide, positing the need to open the social field to recognize all those who are considered "non-subjects." By using suicide as a metaphor to interrogate the roots of inequality within a social structure based on exclusive individualism, these writers suggest that acts of suicide represent responses not only to private phenomena, but also to social conditions, and that the two are not mutually exclusive. By thus reading Romantic-era discourses of suicide as radical interrogations of liberalism, Suicidal Romanticism also positions Romanticism itself as a response to political questions that first emerged in abolitionist and women's rights discourses of the long eighteenth century.
Item Open Access Suicide and substance use among female veterans: A need for research(Drug and Alcohol Dependence, 2013) Chapman, SLC; Wu, L-TBackground: The number of female veterans is increasing. Veterans Administration (VA) enrollment increased over 40% from past eras. However, little research has focused on their mental health. We reviewed literature to examine associations of substance use with suicide in female veterans, identify research gaps, and inform future studies. Methods: Google Scholar, Pub Med, and PsychINFO were searched using: substance use, female veteran, and suicide. Exclusion criteria (e.g., not discussing U.S. veterans) left 17 articles. Results: Nine studies examined completed suicide among veterans. In most recent years, rates of deaths were greater for veterans than nonveterans, including females. Completed suicide was associated with past trauma, young age, and a mental disorder. Studies have often not addressed substance use. Three studies examined completed suicide among VA treated veterans without examining substance use as an associated factor. Rates of completed suicides were also higher among veterans than nonveterans, including females. A large proportion of females also had a mental diagnosis. Five studies examined substance use and attempted or completed suicide among VA treated veterans. Veterans in poor mental health had increased odds of suicide mortality; women with a substance use disorder (SUD) had a higher hazard ratio for completed suicide than men with a SUD. Engagement in substance abuse treatment decreased odds of suicide attempt among veterans. Conclusion: Available data suggest that suicide rates are higher among female veterans than women in the general population. Substance use may increase the likelihood of suicidal behaviors among female veterans, particularly those with a mental diagnosis. © 2013 Elsevier Ireland Ltd. All rights reserved.Item Open Access Suicide and substance use among female veterans: a need for research.(Drug and alcohol dependence, 2014-03) Chapman, Shawna L Carroll; Wu, Li-TzyThe number of female veterans is increasing. Veterans Administration (VA) enrollment increased over 40% from past eras. However, little research has focused on their mental health. We reviewed literature to examine associations of substance use with suicide in female veterans, identify research gaps, and inform future studies.Google Scholar, Pub Med, and PsychINFO were searched using: substance use, female veteran, and suicide. Exclusion criteria (e.g., not discussing U.S. veterans) left 17 articles.Nine studies examined completed suicide among veterans. In most recent years, rates of deaths were greater for veterans than nonveterans, including females. Completed suicide was associated with past trauma, young age, and a mental disorder. Studies have often not addressed substance use. Three studies examined completed suicide among VA treated veterans without examining substance use as an associated factor. Rates of completed suicides were also higher among veterans than nonveterans, including females. A large proportion of females also had a mental diagnosis. Five studies examined substance use and attempted or completed suicide among VA treated veterans. Veterans in poor mental health had increased odds of suicide mortality; women with a substance use disorder (SUD) had a higher hazard ratio for completed suicide than men with a SUD. Engagement in substance abuse treatment decreased odds of suicide attempt among veterans.Available data suggest that suicide rates are higher among female veterans than women in the general population. Substance use may increase the likelihood of suicidal behaviors among female veterans, particularly those with a mental diagnosis.Item Open Access Suicide Prevention in Rural Nepal: A Cultural Adaptation of Dialectical Behavior Therapy(2015) Ramaiya, Megan KPublished research on suicide and suicidal behavior has expanded rapidly in recent years and indicates the presence of a growing global public health concern. In Nepal, suicide is the number one of cause of mortality in women of childbearing age, accounting for 16 percent of deaths within this age group. Although treatments and therapies for suicide vary considerably, adapting existing interventions to allow them to remain culturally congruent with the worldviews of ethnic and racial minority groups is becoming an essential practice. In this study, we conducted a cultural adaptation, training, and piloting of manualized dialectical behavior therapy (DBT) in rural Nepal. DBT is a pliable, evidence-based treatment that is proven effective for risk reduction of suicidal behavior and non-suicidal self-injury (NSSI). However, its feasibility and acceptability has yet to be studied in a low-resource, international setting. In this study, the formative process used to guide modification of the standard DBT regimen is outlined. Qualitative research including focus group discussions and key informant interviews aided in incorporation of crucial elements of Nepali ethnopsychology, and a training based on the manualized adaptation with psychosocial counselors was conducted. Culturally adapted DBT (CA-DBT) was then piloted with ten women in a rural district in Northwest Nepal. Preliminary data suggests that, with additional modification and piloting, CA-DBT holds promising potential as a psychological intervention in Nepal. A number of qualitative successes and challenges in implementation are highlighted, as are suggestions for program bolstering and further testing.
Item Open Access Troy in America: Soldier Suicide in American War Literature(2021) Portis, StoneyTroy in America: Soldier Suicide in American War Literature attempts to illuminate how a war mentality forces an acceptance of mortality that not only brings out the irrationality of life itself, but also makes suicide more thinkable. This dissertation is therefore about the different reasons soldiers and veterans depicted in literature choose to die by suicide, but also those who consider it and choose not to. Troy in America draws on examples of suicide found in Ancient Greek literature to contextualize similar genres of suicide depicted in American war literature. Four Ancient Greek warriors suffer from different forms of suicidal behavior: Achilles’s grief, Odysseus’s despair, Ajax’s honor, and Philoctetes’s pain. Each hero’s suicidality is characterized by unique features that forms a discrete archetype that endures and informs characters found in literature about the American Civil War to the wars in Afghanistan and Iraq.
The authors of the texts analyzed in Troy in America appear to be in substantial agreement that the experience of combat can be so troubling that, for some of its participants and veterans, suicide seems to be an answer. For many survivors, the end of war does not mark the end of their suffering. War removes its participants from society in an effort to preserve it. War thus becomes, in effect, a trip to the Underworld; a liminal experience where the social order becomes available for inspection. As a result, coming home can be as difficult emotionally as combat. After experiencing the irrationality of war and gaining insight into the irrationality of life, the warrior must change in order to return to society. But some do not change; instead, they choose to end their lives.
Item Open Access Understanding Suicidal Behavior Among Latin Adolescent Girls Living in the United States(2016-07-05) Ramirez Diaz Lombardo, EstefaniaSuicide in adolescents between the age of 10 and 24 years old is the second cause of death in the United States. This rate differentiates by ethnic and racial groups within the same country; Latino/Hispanic adolescent girls have the highest rate of suicide behavior. Considering that Latino/Hispanic is the fastest growing minority group in the nation, with an expected population of 30% by 2060, this issue should be a public health priority. This paper answers the following question: what are the conditions operating among Latin adolescent girls living in the United States that cause significantly higher suicidal behavior rates in the U.S. and compared with their peers in Latin American countries? And, how adequate are treatments such as Dialectical Behavioral Therapy and prevention programs in tackling the specific risk factors affecting this population? The paper is divided into five chapters; the first four are based on a comprehensive literature review of statistics of suicide, risk and protective factors, treatment, and prevention programs. The last chapter offers an analysis of the sociological phenomenon of suicidal behavior in this population and three brief narratives of attempters and non-attempters. Studies show that subjective distress, familism and immigration issues are the key risk factors of suicidal behavior in Latina adolescent girls. Understanding the risk factors is key in order to design promotion and prevention programs that are culturally relevant and that can have a positive impact in the reduction of this alarming phenomenon.