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  • 2005-10
    Pictures taken from various Earthwatch expeditions over the years. Learn more about Earthwatch at http://www.earthwatch.org.

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Suicide

August 07, 2008

Losing Your Reputation

A study published in the June 2008 issue of Australasian Psychiatry takes a look at the relationship between reputation damage and suicide. By examining public record of the last 20 years, Fifteen cases were identified of individuals with no evidence of mental disorder who suffered actual or threatened reputation damage and committed suicide shortly thereafter. An additional eighteen cases that were less completed were also examined. Of the 15 individual cases, the average age was 55 years, with a range of 40 to 76 years. The available details of the 18 additional cases were consistent with these findings. The authors conclude that middle-aged males without clear evidence of mental disorder, who suffer actual or threatened reputation damage, may be at increased risk of suicide. They particularly caution against the use of "naming and shaming" media campaigns which may have fatal consequences.

Click here for the abstract.

July 29, 2008

Doctors Remove Eight-Centimeter Long Nail Following Bizarre Suicide Attempt

Surgeons at a hospital in Meerut, India successfully removed an eight-centimeter-long nail from the skull of a 24-year old patient following an apparent suicide attempt. The patient had reportedly been suffering from post-traumatic stress disorder after witnessing a fire in 2005 that had killed more than 50 people. After seeing the charred bodies he had expressed a desire to die as well. “He had earlier attempted suicide by consuming poison,” said his father, a local resident. On the evening of July 22, he had rammed the rusted nail into his skull using a wooden board lying in the bathroom and then went to bed assuming that he would die in his sleep. The family saw the nail sticking out of his skull on the following morning when he came down to the ground floor.

After being rushed to Lala Lajpat Rai Medical College, doctors operated upon him and removed the nail. Pradeep Bharti, head of the neurosurgery department at the hospital, said: “The nail damaged certain parts of the youth’s brain. The operation was performed successfully. A team of eight medical and paramedical professionals took two and a half hours to take out the nail. The youth is fully conscious and well, but we are keeping him under observation.” Sona Kaushal Bharti, a psychiatrist, said the patient was under treatment of psychologists but did not receive counseling after he went into depression in 2005.

Click here for more information.

July 17, 2008

Treatment Compliance in Adolescents Who Attempt Suicide

The June 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry presents the results of a two-year follow-up study looking at the benefits of treatment in adolescents who have attempted suicide. A sample of eighty-five adolescents (ages 13-18) who had attempted suicide were recruited along with their families from four psychiatric hospitals and were evaluated for symptoms of emotional problems. Later assessments were conducted every 6 months over the course of a two-year period to determine whether the adolescents had participated in treatment and how well they had complied with the treatment recommendations (whether they had taken prescribed medication or attended treatment sessions), their attitudes toward treatment, and further suicide attempts and ideation. The results showed that adolescents with a disruptive behavior disorder diagnosis were less compliant with individual psychotherapy, as were those with a substance dependence other than alcohol or marijuana. Adolescents who were diagnosed with a mood or anxiety disorder were less compliant with prescribed medication (6 months post-attempt). While parents` perception of treatment as being helpful was predictive of greater treatment compliance, adolescents' attitudes toward treatment did not appear to play a role. Finally, compliance with treatment was not generally found to be a predictor of later suicide attempts. The authors concluded that attempts at increasing treatment compliance in adolescent suicide attempters should vary according to the adolescent`s symptoms as well as parental attitudes toward treatment.

Click here for the abstract.

July 01, 2008

Stories I've Been Following

Just catching up a bit.  I'm still in Italy enjoying la dolce vita. Things should be back to normal by next week.

Just some stories I've been following:

Letter Causes Woman to Kill Herself

A Worcestshire woman with a history of depression drowned herself after receiving a letter from a mental health institute telling her to go for a psychiatric assessment. She had apparently been afraid that she would be held involuntarily due to her suicide history.

Click here for more information

Convicted Pedophile Could Seek Chemical Castration

One of my pet peeves.  The term "chemical castration" is misleading since it involves using chemical to suppress serum testosterone levels in the offender's system. It is not analogous to physical castration (also known as a bilateral orchidectomy) which is irreversible.Chemical suppression is only effective while the offender remains on the medication. It is a controversial practice in many countries (more on that later).

Click here for more information

After Escape, Oregon Closes Psychiatric Facility

The state has closed a Washington County center for mentally ill patients after one resident alone in the backyard for a nighttime smoke climbed a chair, cleared a fence and fled.
Alex Volobuev, 53, told police he didn’t want to go back to the Connell House in Cornelius last week because “the staff is crazier than the residents.”

Click here for more information

June 12, 2008

How Prevalent is Physician Suicide?

An essay in a recent issue of Annals of Family Medicine examines the complex issues surrounding physician suicide. Best estimates place the number of physician suicides in the United States at 250 per year. The essay's author expresses her personal grief and guilt over the recent suicide of a colleague while discussing the unacknowledged problems associated with physician suicide and the stigma that prevent it from being adequately addressed. While physicians are as vulnerable to depression as the general population, fears regarding loss of professional stature and respect often prevent depressed physicians from accessing needed mental health services. This same stigma can also compound the mourning process of the colleagues and family of those physicians who complete suicide. The medical profession must provide greater access to existing resources for affected colleagues and work collaboratively to destigmatize treatment for mental illnesses.

Click here for the abstract.

Click here for more information on physician suicide

June 05, 2008

Violent Deaths in the United States

A report in a recent issue of the Morbidity and Mortality Weekly Report summarizes data from CDC's National Violent Death Reporting System (NVDRS) concerning violent deaths from 16 U.S. states for 2005. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. A total of 15,495 fatal incidents involving 15,962 violent deaths occurred in the 16 NVDRS states included in the report.

The majority (56.1%) of deaths were suicides, followed by homicides and deaths involving legal interventions (29.6%), violent deaths of undetermined intent (13.3%), and unintentional firearm deaths (0.7%). Fatal injury rates varied by sex, race/ethnicity, age group, and method of injury. Rates were substantially higher for males than for females and for American Indians/Alaska Natives (AI/ANs) and blacks than for whites and Hispanics. Rates were highest for persons aged 20-24 years.

For method of injury, the three highest rates were reported for firearms, poisonings, and hanging/strangulation/suffocation. Suicides occurred at higher rates among males, AI/ANs, whites, and older persons and most often involved the use of firearms in the home. Suicides were precipitated primarily by mental illness, intimate partner or physical health problems, or a crisis during the previous 2 weeks. Homicides occurred at higher rates among males and young adult blacks and most often involved the use of firearms in the home or on a street/highway. Homicides were precipitated primarily by an argument over something other than money or property or in conjunction with another crime.

The results indicate that deaths resulting from self-inflicted or interpersonal violence occur to a varying extent among males and females of every age group and racial/ethnic population. Key factors affecting rates of violent fatal injuries include sex, age group, method of injury, location of injury, and precipitating circumstances (e.g., mental health and substance abuse). The data provided in the report is preliminary in nature given the sampling procedures used and states participating in the survey.

Accurate, timely, and comprehensive surveillance data are necessary for the occurrence of violent deaths in the United States to be understood better and ultimately prevented. NVDRS data can be used to track the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths and injuries at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states using NVDRS, with an ultimate goal of full national representation.

Click here for the abstract.

June 01, 2008

The Suicide Song

It all began in 1933 when a Hungarian composer named Reszo Servess first wrote the melancholy classic, Gloomy Sunday. Born in Hungary in 1899, Servess was a largely self-taught musician with little to show for his career as a songwriter. One of the legends surrounding the song is that it was written in thirty minutes on a gloomy Sunday afternoon after Servess broke up with a girlfriend. The bleak lyrics that he had originally written for the song were later replaced with lyrics by his friend, Ladislas Javor. Even in its revised form, the lyrics “Gloomy is Sunday/With shadows I spend it all/My heart and I/Have decided to end it all” conveyed the underlying feeling of hopelessness and despair all too clearly.

While Gloomy Sunday attracted little notice at first, most sources agree that the first rash of suicides related to the song occurred in Hungary three years after it was written. A magazine article published in Time Magazine in 1936 described seventeen suicides that had been linked to the song including a shoemaker named Joseph Keller who had left a suicide note quoting the lyrics. Hungarian authorities later banned what international record companies would call the “Hungarian Suicide Song”.

The aggressive marketing campaign designed for the song's release played up its “spooky” reputation. While there were 79 subsequent recordings by American and British artists over the years, it was the Billie Holiday recording in 1941 that made Gloomy Sunday an international hit. To combat the song’s deadly reputation, the Holiday version was rewritten with an extra verse to provide a less despairing ending. Despite the changes, the urban legends surrounding the song and its legacy of death continued for decades afterward. Not only did the song continue to be banned in Hungary but the British Broadcasting Corporation’s policy against playing the song in the U.K. was only lifted in 2002.

Given the urban legends that sprang up around the song, separating fact from fiction tends to be difficult. In a recent review of the Gloomy Sunday controversy, the rash of suicides in Hungary appear to be the most well-documented of the song-related deaths. Possible reasons for the song's association with suicide include the political and economic turmoil in Hungary during the 1930s and the elevated suicide rate among Hungarians compared to the rest of Europe. The song may well have helped to reinforce preexisting feelings of hopelessness and despair in listeners.

On January 13, 1968, Reszo Servess, the composer who had started it all, committed suicide by jumping from his apartment at the age of 67. His obituary noted that Servess had complained of the success of his song and despaired of ever writing another hit. The fact that the composer of the song committed suicide himself helped to strengthen its fatal reputation (just about every Internet page dedicated to the Gloomy Sunday “suicide epidemic” refers to Servess’ suicide).

While Gloomy Sunday is not the only song that has been linked to suicides, it is by far the most well-known and has even been made into a movie. Other examples of suicide related song include Metallica’s Fade to Black, Blink 182’s Adam’s Song, and Ozzy Ozbourne’s Suicide Solution (Ozbourne was sued by the parents of a teenager who had committed suicide while listening to the song). Copycat suicides have also been sparked by celebrity suicides such as Kurt Cobain and Yukiko Okada (the term Yukko syndrome was coined in Japan due to the rash of deaths that followed Okada’s suicide).

Music continues to have a powerful effect on listeners and the possible role of certain songs in shaping human behaviour needs to be recognized. While Gloomy Sunday 's deadly legacy is largely urban legend, there is enough substance to warn of the potential dangers of cultural influences on the suicidally depressed.

*A hat tip to Dr. Steven Stack of Michigan's Wayne State University for providing me with a reprint of his research.

May 15, 2008

What Depressive Symptoms and Disorders Are Linked to Adolescent Suicide?

A study reported in the April 2008 issue of the Journal of Affective Disorders examines the role of depressive symptoms and disorders as potential predictors of suicidal behaviour in adolescents. The authors used a representative sample of 2464 Norwegian school students (average age 13.7 years) who were initally tested (T1).  These same subjects were followed up and reassessed a year later (T2). All subjects who scored significantly high on the depresson questionnaire at the one year mark (T2) were matched with low- or middle-scoring respondents according to age and gender.  A subset of 345 subjects were diagnostically assessed by face-to-face interviews (mean age=14.9 years) and then reassessed after five years (T3) using telephone interviews and questionnaires. There were 265 subjects tested with a participation rate of 76.9%. The results indicated that cognitive symptoms were predominant among suicide attempters, regardless of age. Among younger adolescents, suicidal thoughts and acts of self-harm without suicidal intent were associated with suicidal acts. Recurrent thoughts about death, hopelessness, disturbed concentration and middle insomnia were associated with suicidal acts among older adolescents. Perceived worthlessness by the age of 15 was a significant predictor of suicidal acts between 15 to 20 years.  Major depression was significantly associated with suicidal acts among younger adolescents, while dysthymia by the age of 15 years remained a significant predictor of suicidal acts between 15 to 20 years, even when controlling for depressive symptoms. The authors conclude that acts of self-harm without suicidal intent, middle insomnia, cognitive depressive symptoms and a formal psychiatric diagnosis of any depressive disorder should alert professionals in the risk assessment of suicidal adolescents.

Click here for the abstract.

May 06, 2008

Indian Health Ministry Reports 16,000 Student Suicides In The Past Three Years

A representative of India’s Health Ministry has reported that over 16,000 school and college students in India have committed suicide in the last three years and announced plans to deal with the problem by reforming the national health care system.

According to the ministry, there were 5,857 student suicides in 2006, 5,138 in 2005 and 5,610 in 2004. While some private schools have started providing counselors to address the problem, government-run schools have been slow to follow suit.

Cherian Verghese, a specialist with the Indian branch of the World Health Organization, said: "The mental health system needs an overhaul. Our schools might be giving good education but we need education in life skills. From counseling to increasing the number of mental health workers, the strategy should be holistic.  Students are a vulnerable group. Age, competition and relations in the family are all contributing to the growing cases of suicide among school goers”.

"There is a gamut of problems; India lacks the required number of psychiatrists as well. The social taboo around mental health also fuels the problem. A country which houses a huge number of youngsters must not take mental health lightly," Verghese added.

Potential factors that have limited greater access to counseling include social stigma surrounding mental illness, the high doctor-patient ratio, and societal pressures. Despite India’s burgeoning population, there are only 3,500 psychiatrists for a population of more than a billion people.

The health ministry is planning to modernize psychiatric hospitals, expand community mental health services, and introduce counseling in schools.

Click here for more information.

March 27, 2008

Casualties of War

The Winter issue of Perspectives in Biology and Medicine presents a thoughtful overview on war and its casualties. Throughout America's first 145 years of war, far more of the country's military personnel died from infectious diseases than from combat injuries. This only began to change in World War II due to better methods of disease prevention and treatment. The authors suggested that soldier deaths throughout U.S. history can be divided into a Disease Era (1775-1918), during which infectious diseases were the major killer of America's armed forces, and a Trauma Era (1941-present), in which combat-related injuries were the major cause of fatalities. Using the 3,400 U.S. military fatalities in Iraq as a comparison, suicide deaths have become more prevalent than deaths from infectious disease.  Given the rising rate of suicides in U.S. soldiers posted overseas, this trend is not expected to change.

Click here for the abstract.

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