Pop-rock music as precipitating cause in youth suicide.

The plaintiffs in a law suit alleged that the heavy metal rock band Judas Priest, and its publisher CBS, were liable for damages to two youths who shot themselves after listening to the band's album. Crucial issues included "proximate cause" and "precipitating cause" in suicide, and the alleged role of subliminal messages. The judge ruled that although the "heavy metal" music might have had a toxic influence, the sounds and words are protected by the free speech first amendment. The influence of subliminal messages on behavior is unproven. There were many other elements in the personalities and situations of the victims to account for their self-destructive behavior.

Changes in grief and mental health of bereaved spouses of older suicides.

Comparisons are made of the impact of a suicide death on the surviving spouse (55 years and older) with that of a natural death on spouse survivors and a married nonbereaved control group over a bereavement period of 2 1/2 years after death. Regardless of mode of death, the loss of a loved one is a difficult psychological trauma, accompanied by depression, confusion, and pervasive feelings of emptiness. Few differences in the impact of the deaths in the early months of bereavement were reported, but changes appeared over the course of the 2 1/2-year measurement period. Compared with natural death survivors, the process of bereavement was found to be more difficult for the survivors of a suicide death, whose severe depressive feelings do not seem to lessen significantly and whose feelings of mental health do not seem to improve until after the first year. Women, in general, report greater feelings than men of anxiety, tension, and apprehension, especially within the first 6 months. By the end of the observation period, most of the differences between the two bereaved groups have disappeared, and both report functioning adequately despite continuing feelings of sadness and loss.

The role of social supports in the bereavement process of surviving spouses of suicide and natural deaths.

This report examines the changing role of social supports in the bereavement of spouses of elderly suicide and natural deaths, focusing on differences and similarities in relation to gender, time, and mode of death. Measurements were obtained 4 times after death (within 2 months, at 6 months, at 12 months, and at 2 to 2 1/2 years) on 79% of the 108 survivors of elderly suicide, 89% of the 199 natural death survivors, and 79% of the nonbereaved controls. The results indicated that the suicide survivors received significantly less emotional support for their feelings of depression and grief than the natural death survivors, and that they did not confide in the persons in their network any more than the nonbereaved controls did. Women report receiving more support overall than men. A low spot in social supports occurred at the 6-month point after loss for both bereaved groups, but primarily in practical help received by natural death survivors. By the end of the second year, both practical and emotional supports had increased to at least the same level as immediately after death.

Interaction of depression and bereavement on mental health in the elderly.

Three hundred ninety-three elderly adults aged 55 and older were divided into 1 of 9 subgroups in a 3 (bereavement group: survivors of spouses who died by natural death or by suicide and nonbereaved control Ss) x 3 (depression group: none, mild, and moderate-severe) design over 4 times of measurement--1 month, 6 months, 1 year, and 2.5 years after death of spouse. Significant Bereavement x Depression Group effects were obtained on Brief Symptom Inventory scores. The moderate-severe depression/suicide subgroup had the greatest psychiatric complications with bereavement. Results indicated that elderly persons with significant clinical depression at the time of a spouse's death were at significant risk for psychological complications during the bereavement process, and survivors of spouses who had committed suicide were even more at risk within the greatest depression group.

Combat experience and postservice psychosocial status as predictors of suicide in Vietnam veterans.

The authors examined potential risk factors for suicide among 38 Vietnam veterans using 46 Vietnam veterans who died from motor vehicle accidents as a comparison group. The veterans were selected from Los Angeles County Medical Examiner's file (1977-1982). Data for these veterans were obtained from military service records, the coroner's reports, and the psychological autopsy conducted with the decedents' family members. No military service factor was associated with suicide. The characteristics of Vietnam veteran suicide cases were not substantially different from non-Vietnam veteran suicide cases with respect to known demographic risk factors. The psychological profile of Vietnam veteran suicide cases are also similar to non-Vietnam veteran suicide cases in most instances. Symptoms related to posttraumatic stress disorder were observed more frequently among suicide cases than accident cases. However, suicides were not associated with specific combat experiences or military occupation. The extent of combat experience in Vietnam per se as measured in this study is not a good predictor of suicide death.

A cross-cultural comparison of ideal and undesirable qualities of crisis line workers.

Telephone crisis line workers in two different crisis centers (Los Angeles, USA, and Ljubljana, Yugoslavia; LA and LJ) self-assessed the most important ideal and undesirable personality traits for their work. Both LA and LJ counselors rated the most important traits as: motivated for the work and being a good listener. LA counselors rated themselves as possessing the majority of the required positive traits, while the LJ counselors thought themselves lacking in several significant qualities. In their listing of undesirable traits, the LJ workers again tended to be more critical of themselves than the LA workers but with fewer differences than on the desirable traits. The source of the differences may lie between the use of volunteers in LA and professional and semi-professional counselors in LJ. The ratings of a sample of US crisis center directors on both desirable and undesirable traits tended to parallel those of the LJ counselors more closely than those of the LA workers. Center directors were also critical of their own counselors on a number of the listed traits.

Suicidal behavior in adolescent and young adult gay men.

The relationship of homosexuality to suicidal behavior was explored by questionnaire responses from 52 men in gay-and-lesbian college organizations and 56 men in gay rap groups. A family background of alcoholism and physical abuse, social supports perceived as rejecting of homosexuality, and no religious affiliation were associated with a history of suicidal ideation, reported by 55% of the participants. Racial/ethnic minorities tended to be overrepresented among suicidal as compared to nonsuicidal gay men. Suicide attempts, reported by 20% of the sample, were most often associated with intrapersonal distress, and occurred most often while individuals were "closeted" and/or in the context of recent rejection for being homosexual. Nearly all attempters were aware of their homosexual feelings, but had not yet established a "positive gay identity" at the time of their first suicide attempt. Suicidal behavior in gay youths may be the product both of familial factors that predispose youths to suicidal behavior, and for social and intrapersonal stressors involved in coming to terms with an emerging homosexual identity.

Youth suicide in California: a comparative study of perceived causes and interventions.

Comparative survey data were obtained from five sample groups of respondents composed of young people 12 to 20 years of age, parents of young people within this age range, and respondents to psychological autopsies of decreased youth. The findings revealed that family dysfunction, intrapersonal psychopathology and distress, problems with interpersonal relationships, and drug and alcohol abuse were most frequently mentioned by the respondents as the major causes of youth suicide. In terms of solutions, the availability of social support from family and friends and access to formal intervention programs for troubled adolescents were seen as the most effective measures that could be taken to stop young people from intentionally hurting themselves.

The development of an Indirect Self-Destructive Behaviour Scale for use with chronically ill medical patients.

The development and content of a scale to measure indirect self-destructive behaviour (ISDB) among chronically ill medical patients is described. Findings for a sample of predominantly elderly, male, chronically ill patients indicate a generally high incidence of ISDB over a seven-day period continuous observation. Most frequently observed were behaviours involving noncompliance with the treatment programme, and conflicts with the medical staff. Based upon an analysis of nine classes of behaviour included in the ISDB Scale, three groups of patients emerged with distinct patterns of indirect self-destructive activity: two consisting largely of noncompliant acting-out behaviours, and one involving more direct forms of self-injury.

Suicide prevention in the hospital.

Hospitals, both neuropsychiatric and medical-surgical, are responsible for perventing the suicide of patients under their care. Hospital populations are at higher risk because they include people in heightened physical or emotional distress and because the patients frequently have no other resources, making the hospital a primary source of support. Suicide does, in fact, occur in the hospital at a rate higher than in the general community. Review of such cases and of the suicide pervention policies of a wide variety of hospitals suggests a number of guidelines for suicide prevention in the areas of identification, environmental and procedural safeguards, communication, and general attitudes. Legal attitudes over the years have changed markedly with the courts continuing to stress the principle of foreseeability but now recognizing that pursuit of therapeutic goals requires the hospital to assume "therapeutic risks". These risks are evaluated primarily by the criterion of accepted community standards of care.

Indirect self-destructive behavior in chronic hemodialysis patients.

As one of a series of investigations of indirect self-destructive behavior, a pilot study was conducted with a group of 32 chronic hemodialysis patients for those characteristics of such behavior which had emerged as most salient in earlier studies: self-esteem, locus of control, rigidity, impulsivity, futurity, risk-taking and denial. Using an average of ratings of cooperativeness obtained from the head nurse, physician, dietician, technician, and staff nurse, the group was divided into two subgroups of more and less cooperative patients, and the demographic, medical, and psychological data from the two groups were compared. The findings suggest that the less cooperative hemodialysis patients have experienced the illness as a more severe blow to their self-concept and have failed to integrate their illness into an effective adaptive life pattern. The uncooperative patients feel less valued and less appreciated not only by their family but also by fellow patients and by hospital staff. They show significantly more anger and withdrawal than the more cooperative group and appear to have compensated for a significantly greater sense of powerlessness by the development of manipulative behaviors in relating to their medical caretakers.

Indirect self-destructive behavior in the elderly nursing home patient.

The incidence of indirect self-destructive behavior (ISDB) is explored in a sample of 99 male, predominantly elderly nursing home patients, using a rating scale (ISDB Scale) developed by the authors in a previous study. Scores from the ISDB Scale are correlated with psychological test material, background information, and other descriptive data for the sample of patients. Findings indicate that the use of ISDB in the elderly patient group is associated with direct suicide potential, dissatisfaction with the treatment program and with life in general, confused reasoning and judgment, poor prognosis for discharge, the absence of religious commitment, and significant losses in the patient's life. It appears from the findings that ISDB serves as an alternative form of suicide for many of these patients.

Indirect self-destructive behavior in patients with Buerger's disease.

Patients with Buerger's disease (a circulatory illness) were studied to evaluate indirect self-destructive behavior (ISDB), evidence by neglect in following medical regimen, disregard of suggestions for environmental imporvements (avoidance of undue exposure to cold) and refusal to abstain from smoking. Personality characteristics and behavioral phenomena associated with ISDB were obtained by comparison of the files of 26 uncooperative patients with 26 matched cooperative controls with Buerger's disease and with 25 Buerger's disease patients representing a unselected annual population in a Veterans Administration (VA) hospital. The experimental group was characterized as more often complaining, manipulative, and aggressive. They manifested denial, negligence, and a tendency to minimize their illness. They were more likely to complain of pain and to demand relief. In a second clinical investigation of patients still in the hospital, 12 experimentals were compared with 12 controls using interview data and psychological tests measuring attitudes toward time and toward death. The experimentals did not seem to value time nor to be interested in achievement. They felt that a dull life was worse than death.

The certification of suicide in eleven western states: an inquiry into the validity of reported suicide rates.

From Durkheim's time to the present social researchers interested in the problem of suicide have relied upon officially reported rates of suicide to develop and test their theories. Despite the fact that the validity of any theory rests upon the accuracy of its underlying data, the relative accuracy of reported suicide rates have rarely been questioned or systematically evaluated. This paper investigates the process of death certification as practiced by a sample of 191 coroners in 11 western states. Findings indicate extensive variation in the backgrounds, professional resources, operating procedures, and governing statutes of coroners and coroners' offices and in policies concerning the use of the suicide mode. Since the coroner is generally charged with the official responsibility for certifying the mode of death when unnatural mode is suspect, the extent of variation found here calls into question the validity and comparability of reported suicide rates.

Suicide: who's counting?

A study of suicide certifications explored their accuracy in the light of the difficulties inherent in the certification of death. The primary question addressed was whether the variation in reported suicide rates was significantly related to the structure, function, and procedures of coroners' offices, in comparison with traditional social aspects of the community, such as demographic factors, socioeconomic status, and residential mobility. A stratified sample of 202 counties in the 11 continental western States was selected, and data on coroners' offices were obtained from 191 of these counties. These data were analyzed by means of weighted least squares, which separately related coroner's office variables and community variables to indirectly age-standardized suicide rates. Data for counties with populations of 30,000 or more and those with less than 30,000 were also separately analyzed. Assessment of the multiple regression analyses suggests that the coroner's office variables compare favorably with the community variables in predicting suicide rates, provided a distinction is made between large and small counties. The coroner's office variables in counties with 30,000 or more population explained 37 percent of the variation in reported suicide rates, whereas the community characteristics explained 41 percent. In the counties with less than 30,000 coroner's office variables explained 24 percent of the variation, while community variables explained 13 percent. In the more populous counties, the characteristics of the coroners most predictive of the suicide rates were a nonrejecting attitude toward suicide, an interest in the personal aspects of the deceased, and concern with the physical circumstances of the death. In the less populous counties, the variables most predictive of the suicide rates were related to the physical aspects of the death.

An assessment of the utility of suicide prediction.

Efforts to predict a future event assume varying levels of confidence depending on its base rate and the error rate of the prediction instrument. Most researchers working with suicide prediction instruments seem tacitly to assume they will be able to predict a future suicide most of the time. Applying basic decision theory on a neuropsychiatric hospital population indicates that researchers using a prediction schedule will be unlikely to predict a future suicide beyond a 20% level of efficiency. Contrary to the general clinical view, eliminating false negatives was shown to be more practical than eliminating false positives in increasing the efficiency of a predictive schedule.

Prediction of suicide: a replication study.

As part of an ongoing study on the prediction of suicide, a replication study was carried out on the Neuropsychiatric Hospital Suicide Potential Scale (NPHSPS), a recently constructed schedule for prediction of potentiality for committed suicide among hospitalized neuropsychiatric patients at the time of release from the hospital. The population consisted of 54 patients who had committed suicide and 50 patients who had not. Overall accuracy of the scale was 81.7 percent, with 95.2 percent accuracy for prediction of the high risk group and 80.0 percent accuracy for prediction of nonsuicidal controls. By computation of posterior probability, the scale is shown to increase accuracy of prediction more than five-fold over use of the base rate (or prior probability) alone, but it is also evident the level of prediction of suicide is still too minimal to permit individual clinical application.