RESUMO
OBJECTIVE: The aim of this work is to examine suicide intent disclosures to identify patterns to support an improved understanding of the impetus for suicidal behavior in late life, which may offer insight useful in aiding prevention efforts. METHODS: Using restricted access data from the National Violent Death Reporting System for years 2016-2018, we conducted qualitative content analysis of included narrative descriptions of 2,969 cases in which the decedent was aged 65 years or older and disclosed their intent to die by suicide. RESULTS: The majority of suicide intent disclosures were direct statements of intent to die by suicide (37.19%), followed by a smaller proportion of indirect (implied) statements (25.29%). When response of disclosure recipient was described, such disclosures were frequently dismissed as insincere. Uncontrolled or chronic pain was cited by 11.62% of decedents as the rationale for suicide. CONCLUSION: Findings from this work suggest the content of suicide intent disclosures may vary considerably but demonstrate consistent patterns. Dismissal of such disclosures is a common response, likely due to inability to assess sincerity. Given the high rate of lethality among suicide attempts in late life, any intent disclosures should be critically evaluated.
RESUMO
The street homeless, those who spend their nights either in shelters or unofficial camps, whether in tents on a street or in society's hidden spaces such as beneath an overpass, face multiple challenges beyond finding a safe place to sleep. Of further concern is how official actions can worsen these situations, through day-to-day activities or planned intervention strategies. In this paper we explore how a planned intervention may be negatively perceived-even as a form of "structural violence"-and may prevent Narcan (naloxone) use to stop an overdose related death in the Skid Row of Los Angeles. Data for this study consisted of a combination of Spatial Video Geonarratives (SVGs) and 325 incident reports from the Homeless Health Care Los Angeles Center for Harm Reduction (HHCLA-HRC) between November 2014 and December 2015. Chi-square and simple logistic regression models were used to examine the association between fear-of-arrest and other covariates of interest. Mapping results are presented with different sets of shapefiles created for (1) all Narcan uses, (2) all homeless, (3) all homeless with a worry about being arrested, (4) all Narcan uses where an ambulance attended, (5) and the same as 4 but also with police attendance. In the multivariable model, the estimated adjusted odds of fear-of-arrest is over three times higher among Narcan users ages 30-39 when compared to users under the age of 30. Analyzing the association of calling 9-1-1 on Narcan user demographics, socio-contextual characteristics, and overdose victim demographics, the crude estimated probability of calling 9-1-1 for Narcan users aged 50 and older is nearly three times higher when compared to Narcan users aged 19-29. Conclusion: Results suggest that the fear-of-arrest and calling 9-1-1 during an overdose is still a concern among Narcan users despite protective legislation and access to harm reduction resources.