Gaps in Crisis Mental Health: Suicide and Homicide-Suicide

Gaps in crises of mental health emerge from poor distinction between the qualities of people who suicide and those who murder and then kill themselves. The role, if any, that substance use has in such lethal violence is an example of such a lack of distinction. 

In this study, a sample of medical examiner investigative and toxicology reports from Los Angeles and Orange counties in California were available for analysis for 432 suicide cases and 193 homicide-suicide cases. This informed clearer toxicological and pharmacological distinction of suicide from homicide-suicide. 

• Blood alcohol levels were higher in persons committing suicide than in homicide-suicide perpetrators (p=.004). 
• Homicide-suicide perpetrators had almost twice the level of stimulants in their system than people who suicide (p=.022) but did not have comparatively elevated levels of drugs or alcohol. 

Predictors of suicide included the following: 

• substance abuse history, 
• high number of drugs in system, 
• death inside a house, 
• and legal impairment by alcohol. 

Predictors of homicide-suicide included 

• gunshot as the cause of death, 
• female gender, 
• domestic conflict, 
• children living in the home, 
• and prior arrest for substance abuse.

Via:  http://ht.ly/SMnwy  Purchase full article at: http://goo.gl/7Islzk

By: Carretta CM1, Burgess AW2, Welner M3.

• 1School of Nursing, Rutgers The State University of New Jersey, Newark, NJ
• 2William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.
• 3The Forensic Panel, New York, NY.

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Deinstitutionalization and The Rise of Violence

The deinstitutionalization of individuals with serious mental illness was driven by 4 factors: public revelations regarding the state of public mental hospitals, the introduction of antipsychotic medications, the introduction of federal programs to fund patients who had been discharged, and civil libertarian lawyers. 

The result is approximately 3.2 million individuals with untreated serious mental illness living in the community. Beginning in the 1970s in the United States, there began to be reported increasing incidents of violent behavior, including homicides, committed by these untreated individuals. Such incidents became more numerous in the 1980s and 1990s, and have further increased since the turn of the century. 

Existing studies suggest that individuals with untreated severe mental illness are responsible for at least 10% of all homicides and approximately half of all mass killings. 

Studies have also shown that when these individuals are treated, the incidence of violent behavior decreases significantly. Examples of treatment mechanisms that have proven effective include assisted outpatient treatment (AOT), conditional release, and mental health courts.

Via: http://ht.ly/Ss9Pl Purchase the full article at: http://goo.gl/jDpmVx

By: Fuller Torrey E1.

• 1Department of Psychiatry,Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA; Stanley Medical Research Institute,Chevy Chase, Maryland, USA.

Disparities in Work-Related Homicide Rates in Selected Retail Industries in the United States, 2003–2008

Below: *Homecide rate per 100,000 workers for all retail workers, foreign-born workers, selected retail workers and selected retail workers who are foreign-born, United States — 2003–2008.

*This research was conducted with restricted access to Bureau of Labor Statistics (BLS) data. The views expressed here do not necessarily reflect the views of the BLS.

Problem

Segments within the retail industry have a substantially higher rate of work-related fatality due to workplace violence compared to the retail industry overall. Certain demographic subgroups may be at higher risk.

Method

National traumatic injury surveillance data were analyzed to characterize the distribution of fatality rates due to workplace violence among selected retail workers in the United States from 2003 through 2008.

Results

Overall, the highest fatality rates due to work-related homicide occurred among men, workers aged ≥ 65 years, black, Asian, foreign-born and Southern workers. Among foreign-born workers, those aged 16–24 years, non-Hispanic whites and Asians experienced substantially higher fatality rates compared to their native-born counterparts.

Conclusions

The burden of work-related homicide in the retail industry falls more heavily on several demographic groups, including racial minorities and the foreign-born. Further research should examine the causes of these trends. Interventions designed to prevent workplace violence should target these groups.

Read more at: http://ht.ly/RTQ71 

By: Cammie Chaumont Menéndez,* Srinivas Konda, Scott Hendricks, and Harlan Amandus
National Institute for Occupational Safety and Health, Division of Safety Research, 1095 Willowdale Rd., Morgantown, WV 26505, USA

A Method for Reclassifying Cause of Death in Cases Categorized as “Event of Undetermined Intent”

Below: Russian trends in standardized death rates per 100,000 residents for non-transport accidents, suicides, homicides, and external deaths due to events of undetermined intent

Below:  Distributions of the three imputed causes of death (both sexes) depending on constraints on the estimated classification probability, per 1000 cases

Background

We present a method for reclassifying external causes of death categorized as “event of undetermined intent” (EUIs) into non-transport accidents, suicides, or homicides. In nations like Russia and the UK the absolute number of EUIs is large, the EUI death rate is high, or EUIs comprise a non-trivial proportion of all deaths due to external causes. Overuse of this category may result in (1) substantially underestimating the mortality rate of deaths due to specific external causes and (2) threats to the validity of studies of the patterns and causes of external deaths and of evaluations of the impact of interventions meant to reduce them.

Methods

We employ available characteristics about the deceased and the event to estimate the most likely cause of death using multinomial logistic regression. We use the set of known non-transport accidents, suicides, and homicides to calculate an mlogit-based linear score and an estimated classification probability (ECP). This ECP is applied to EUIs, with varying levels of minimal classification probability. We also present an optional second step that employs a population-level adjustment to reclassify deaths that remain undetermined (the proportion of which varies based on the minimal classification probability). We illustrate our method by applying it to Russia. Between 2000 and 2011, 521,000 Russian deaths (15 % percent of all deaths from external causes) were categorized as EUIs. We used data from anonymized micro-data on the ~3 million deaths from external causes. Our reclassification model used 10 decedent and event characteristics from the computerized death records.

Results

Results show that during this period about 14 % of non-transport accidents, 13 % of suicides, and 33 % of homicides were officially categorized as EUIs. Our findings also suggest that 2011 levels of non-transport accidents and suicides would have been about 24 % higher and of homicide about 82 % higher than that reported by official vital statistics data.

Conclusions

Overuse of the external cause of death classification “event of undetermined intent” may indicate questionable quality of mortality data on external causes of death. This can have wide-ranging implications for families, medical professionals, the justice system, researchers, and policymakers. With our classification probability set as equal to or higher than 0.75, we were able to reclassify about two-thirds of EUI deaths in our sample. Our optional additional step allowed us to redistribute the remaining unclassified EUIs. Our method can be applied to data from any nation or sub-national population in which the EUI category is employed.

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High Rates of Homicide in a Rural South African Population (2000-2008): Findings From a Population-Based Cohort Study

Below:  External causes of death (2000–2008)

Below:  Homicide-free survival among men and women (2000–2008)

Below:  Incidence of homicide trend across a nine-year period (2000–2008)

Below:  Male and female incidence of homicide by age group (2000–2008)

Below:  Location of two significant clusters (p < 0.05) with elevated rates of homicide (2000–2008) across the surveillance area. Red dots represent the approximate location of each homicide victim’s place of residence (with intentional random error introduced) and all homesteads (black dots) are depicted

With 536 homicide-related deaths, and a median seven years of follow-up, the study found an overall homicide incidence rate of 66 deaths per 100, 000 person-years of observation (PYOs) (95 % CI 60-72) for the period under study. Death related to the use of firearms was the leading reported method of homicide (65 %) and most deaths occurred over weekends (43 %). Homicides are the second-most common cause of death in men aged 25–34 after HIV-related deaths (including TB) in this community, at 210 deaths per 100,000 PYOs, and was highest among 55–64 year old women, at 78 deaths per 100,000 PYOs. Residency status, age, socioeconomic status, and highest education level attained independently predicted the risk of homicide death. The spatial distribution of homicide deaths was not homogenous and the study identified two clear geographical clusters with significantly elevated homicide risk.

The high rates of homicide observed in this typical rural South African population – particularly among men – underscore the need for urgent interventions to reduce this tragic and theoretically preventable loss of life in this population and similar South African settings.

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Homicide-Suicide and Duty to Warn

Via: http://ht.ly/K4Fol HT @BostonCollege 

Unnatural Deaths in Shanghai from 2000 to 2009: A Retrospective Study of Forensic Autopsy Cases at the Shanghai Public Security Bureau

Below:  Forensic Cases in Shanghai from SPSB (2000–2009)

Shanghai is the most developed city in China and has a soaring population. This study uses forensic epidemiology to determine the relationship between unnatural deaths and the development in Shanghai, based on recently released forensic autopsy cases from the 2000s at the Shanghai Public Security Bureau (SPSB). There were 5425 accidental deaths, 2696 homicides, 429 suicides, 186 natural deaths, and 1399 deaths of undetermined cause. There was a male-to-female ratio of 2.02:1, and the average age was 40.9±18.7 years. Traffic accidents (84.2%) were the number one cause of accidental deaths, which decreased during the study period. Sharp force injury (50.6%) was the leading cause of homicides, different from Western countries, where firearms are the leading cause. Hanging (24.5%) was the leading cause of suicides, whereas drug and chemical intoxication was the leading cause in the previous decade; pesticide ingestion decreased in the 2000s. In addition to traffic accidents, manual strangulation was the leading cause of death in childhood fatalities. Children under age 2 were vulnerable to homicides. In the 2000s, there were a large number of drug overdoses, and illegal medical practices and subway-related deaths first appeared in Shanghai. A new type of terrorist attack that involved injecting people with syringes in public places was reflected in the SPSB archives. The forensic epidemiology and changes in unnatural deaths in this decade reflected their relationship with the law, policy and changes in Shanghai. Illegal medical practices, subway-related deaths and terrorist attacks were closely related to the development in Shanghai. Identifying the risks of unnatural deaths will improve public health.

Via:   ht.ly/PfQmG HT @FudanUniversity