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Homicide and suicide risks associated with firearms in the home: A national case-control study

ANNALS OF EMERGENCY MEDICINE 2003年第6期41卷 771-782页

作者： Wiebe, DJ Univ Calif Los Angeles Sch Publ Hlth Violence Prevent Res Grp Los Angeles CA 90024 USA

Study objective: I test the hypothesis that having a gun in the home is a risk factor for adults to be killed (homicide) or to commit suicide. Methods: Two case-control analyses were based on national samples of subjects 18 years of age or older. Homicide and suicide case subjects were drawn from the 1993 National Mortality Followback Survey. Living control subjects were drawn from the 1994 National Health Interview Survey. Ten control subjects matched by sex, race, and age group were sought for each case subject. Results: The homicide sample consisted of 1,720 case subjects and 8,084 control subjects. Compared with adults in homes with no guns, the adjusted odds ratio (OR) for homicide was 1.41 (95% confidence interval [CI] 1.20 to 1.65) for adults with a gun at home and was particularly high among women (adjusted OR 2.72;95% CI 1.89 to 3.90) compared with men (adjusted OR 1.23;95% CI 1.01 to 1.49) and among nonwhite subjects (adjusted OR 1.74;95% CI 1.37 to 2.21) compared with white subjects (adjusted OR 1.27;95% CI 1.03 to 1.56). Further analyses revealed that a gun in the home was a risk factor for homicide by firearm means (adjusted OR 1.72;95% CI 1.40 to 2.12) but not by nonfirearm means (OR 0.83;95% CI 0.62 to 1.11). The suicide sample consisted of 1,959 case subjects and 13,535 control subjects. The adjusted OR for suicide was 3.44 (95% CI 3.06 to 3.86) for persons with a gun at home. However, further analysis revealed that having a firearm in the home was a risk factor for suicide by firearm (adjusted OR 16.89;95% CI 13.26 to 21.52) but was inversely associated with suicide by other means (adjusted OR 0.68;95% CI 0.55 to 0.84). Conclusion: Having a gun at home is a risk factor for adults to be shot fatally (gun homicide) or commit suicide with a firearm. Physicians should continue to discuss with patients the implications of keeping guns at home. Additional studies are warranted to address study limitations and to better understand the implications of firea

关键词：病例对照研究家庭特征火器/统计学和数值数据杀人/统计学和数值数据 Logistic模型比值比危险因素自杀/统计学和数值数据美国/流行病学青少年成年人老年人女(雌)性人类男(雄)性中年人

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Violence, homicide and suicide: strong correlation and wide variation across districts

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BRITISH JOURNAL OF PSYCHIATRY 1999年第5期175卷 462-466页

作者： Kennedy, HG Iveson, RCY Hill, O Chase Farm Hosp N London Forens Serv Enfield EN2 8JL Middx England Royal Free Hosp Sch Med London England St Lukes Hosp London England

Background The clinical assessment and management of the risk of violence and suicide by people with mental illness may have to focus on environmental as well as individual factors. Aims To investigate possible associations between violence, homicide and suicide rates, population density and indices of deprivation, with particular reference to inner-city boroughs. Method Coroners' statistics in London for homicide and suicide were obtained. with police-reported homicide and violence rates as a validity check. Correlations were made between these data and population density, the Jarman under-privileged areas score, and the Mental Illness Needs Index for each of the 32 London boroughs. Results Homicide rates had a 14.3-fold range, suicide a 4.4-fold range and interpersonal violence a 6.6-fold range. The variables under study were strongly correlated with each other. Rates were highest in boroughs with high population density and deprivation scores. The associations persisted when covarying for deprivation, age structure or population density. Conclusions Because violence, homicide and suicide are so closely correlated. they are likely to be valid indices of the differences between adjacent boroughs;this has implications for the delivery of preventive and mental health services and for clinical management of risk. Declaration of interest None.

关键词：年龄因素杀人/统计学和数值数据伦敦/流行病学人口密度贫困区统计学非参数自杀/统计学和数值数据市区人口/统计学和数值数据暴力/统计学和数值数据青少年成年人老年人儿童儿童学龄前人类婴儿婴儿新生中年人

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The North Staffordshire Suicide Study: A case-control study of suicide in one health district

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PSYCHOLOGICAL MEDICINE 1999年第1期29卷 27-33页

作者： Boardman, AP Grimbaldeston, AH Handley, C Jones, PW Willmott, S Guys Hosp Div Psychiat & Psychol London SE1 9RT England S Staffordshire Hlth Author Stafford England Keele Univ Dept Psychiat Postgrad Med Sch Keele Staffs England Keele Univ Dept Math Keele Staffs England

Background. The aim of the study was to identify sociodemographic and clinical risk factors for death from suicide and undetermined injury in residents of one health district. Method. Data were collected on all cases of suicide (ICD-9 E950-959) and undetermined injury (ICD-9 E980-989) for residents in North Staffordshire Health District between 1991 and 1995. Controls, identified from the Coroner's inquest register, who died from other causes, were matched for age and sex. Results. Two hundred and twelve pairs of cases and matched controls were identified. Multivariate analysis (conditional logistic regression) showed that the risk of death due to suicide and undetermined death was associated with: recent separation, relationship difficulties, experience of financial difficulties, history of past criminal charges or contact with the police, a past history of deliberate self-harm, being on psychotropic medication at the time of death and a diagnosis of bipolar affective disorder. For sociodemographic variables, a univariate analysis found associations between the cases and being separated, living alone, having a past history of criminal charges and unemployment. Cases were more likely to have a psychiatric disorder, past history of deliberate self-harm and a past history of psychiatric contact for themselves or a family member. Controls were more likely to have a current medical disorder. Cases were more likely than controls to be on any form of medication at the time of death and to have received a prescription for psychotropic or nonpsychotropic medication in the week and month before death. Cases were more likely than controls to have had contact with medical services in the week and month before death, with the general practitioner in the week before death and with psychiatric services at any time in the year before death. Strong associations were found between suicide and undetermined injury and life events such as recent separation and bereavement, and financia

关键词：病例对照研究生活变动事件病人接受卫生保健的程度回顾性研究危险因素农村人口/统计学和数值数据自杀/心理学自杀/统计学和数值数据市区人口/统计学和数值数据青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Suicide incidence in the Lalitpur district of Central Nepal

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TROPICAL DOCTOR 2000年第4期30卷 200-203页

作者： Thapa, B Carlough, MC United Mission Nepal Community Dev & Hlth Project Kathmandu Nepal

Suicide is an important cause of death in developing and developed countries. Because of its multifactorial nature it is often difficult to study. Suicide also brings with it social stigma and, in some cases, legal repercussions. Suicide is generally underreported and, therefore, services directed at decreasing its incidence are not given *** retrospective study of suicide deaths over a period of 2 years in the Lalitpur district of rural Nepal demonstrates the complicated issues involved, and suggests some appropriate strategies for addressing suicide risk.

关键词：发病率尼泊尔/流行病学问卷调查回顾性研究危险因素社会经济因素自杀/预防和控制自杀/统计学和数值数据青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Suicide in prisons - Reflection of the communities served, or exacerbated risk?

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BRITISH JOURNAL OF PSYCHIATRY 1999年第1期175卷 50-55页

作者： Gore, SM MRC Biostat Unit Cambridge CB2 2SR England

Background A recent review showed that opioid users' deaths from suicide were 10 times as common as expected on the basis of age and gender. Surveys showing prisoners' high prevalence of injecting or opioid dependence have led to a new statistical approach to prison suicides. Aims To estimate the expected number of UK prison suicides annually, having taken account of inmates' age, gender and opioid dependence. Method By gender, estimate the effective number of individuals (in terms of community-equivalent suicide risk) For whom prisons have a duty of care as 10 times the number of opioid-dependent inmates plus the number of non-opioid user inmates. Apply the gender and age-appropriate national suicide rates to work out the expected number of prison suicides. Results The Scottish Prison Service can expect 7.1 suicides per annum, and annual totals up to 12 without exacerbation of suicides due to incarceration. For the Prison Service in England and Wales, 19.3 suicides per annum can be expected in prisons. and annual totals may range up to 28 without indicating incarceration;the total of self-inflicted deaths was 47 in 1993-94. Conclusions Prisons cannot prevent all suicides. An alert may be warranted if prison suicides exceed 12 per annum in Scotland, or 28 in England and Wales. Liebling (1996) has criticised naive statistical approaches to prison suicide which do not adequately account for the vulnerability profile of prisoners, including previous psychiatric contact, major drink or drug problems and unstable employment history;see also Lewis & Sloggett (1998), and Platt et al (1988) on the striking relationship between parasuicide and social class. Recently, and importantly, Harris & Barraclough (1998) have reviewed the age and gender-adjusted excess mortality of mental disorder, with one section devoted to the high excess mortality, including from suicide, associated with opioid use. Opioid users' deaths from suicide were 10 times as numerous as expected on the bas

关键词：年龄分布阿片相关性障碍/流行病学患病率囚犯/统计学和数值数据危险因素苏格兰/流行病学性别分布自杀/预防和控制自杀/统计学和数值数据青少年成年人女(雌)性人类男(雄)性中年人

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Changes in suicide in England and Wales, 1960-1997

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BRITISH JOURNAL OF PSYCHIATRY 2000年第1期176卷 64-67页

作者： McClure, GMG Chelsea & Westminster Hosp Imperial Coll Sch Med London SW10 9NH England

Background Methods of suicide and suicide rates in England and Wales have fluctuated considerably since the 1960s. Aims To review the changes that have occurred in suicide rates in England and Wales between 1960 and 1997. Method Suicide rates, derived from total annual suicides and the estimated annual resident population, were obtained from the Office for National Statistics. Results Suicide rates decreased in both genders between the early 1960s and the mid-1970s. The rate for males then increased between 1975 and 1990, while the rate for females continued to fall. Between 1990 and 1997, the rate decreased for males and females in all age groups, particularly for those using motor vehicle exhaust gas;the latter finding is associated with increasing use of catalytic converters. Conclusions Following the increase in suicide among males until 1990 there was a decrease for both genders between 1990 and 1997, consistent with the 'Health of the Nation' target. Declaration of interest National Health Service funding for honorary senior lecturer sessions with Imperial College.

关键词：年龄分布因果律大不列颠/流行病学性别分布自杀/预防和控制自杀/统计学和数值数据自杀/发展趋势青少年成年人老年人女(雌)性人类男(雄)性中年人

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The Confidential Inquiry comes of age

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BRITISH JOURNAL OF PSYCHIATRY 1999年第4期175卷 301-302页

作者： Thompson, C Royal S Hants Hosp Southampton SO14 0YG Hants England

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Suicide in farmers

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BRITISH JOURNAL OF PSYCHIATRY 1999年第2期175卷 103-105页

作者： Malmberg, A Simkin, S Hawton, K Univ Oxford Warneford Hosp Dept Psychiat Oxford OX1 2JD England

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Ethnic minority suicide: a small area geographical study in south London

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PSYCHOLOGICAL MEDICINE 1999年第2期29卷 429-436页

作者： Neeleman, J Wessely, S Univ Groningen Dept Social Psychiat NL-9700 RB Groningen Netherlands Inst Psychiat Dept Psychol Med London England

Background. The relationship between ethnicity and suicide risk is ill-understood. It is unclear whether, and if so, how, the ethnic mix of local areas affects risk in local individuals. Methods. Coroners' records of 329 suicides were used to obtain ethnic (White, Afro-Caribbean, Asian) suicide rates in South London (population 902008) for 1991-3. Geographical variation and associations of ethnic suicide rates with small area (mean population 8274) ethnic densities (proportion of residents of given ethnic groups) and deprivation, were examined with random effects Poisson regression. Results. Adjusted for deprivation, age and gender, suicide rates in wards with larger minority groups were higher among Whites (relative rate (RR) per standard deviation (S.D.) increase in minority density 1.18;95 % CI 1.02-1.37) but lower among minority groups (RR 0.75 (0.59-0.96)) (LR-test for interaction chi(2) = 9.2 (df = 1);P = 0.003). Similar patterns were also apparent for Afro-Caribbeans and Asians separately. With White suicide rates as baseline, ethnic minority status is a risk factor for suicide in wards with small, but a protective factor in neighbourhoods with large minority populations. The RR of minority versus White suicide declines with a factor (relative RR) 0.67 (0.51-0.87) per S.D. increase in local minority density. Conclusions. Minority suicide rates are higher in areas where minority groups are smaller. This effect is ethnic-specific and not due to confounding by gender, age, deprivation or unbalanced migration. Dependent on address, a suicide risk factor for a White individual may protect an ethnic minority individual and vice versa. This has implications for research and prevention.

关键词：年龄分布人种群/心理学人种群/统计学和数值数据伦敦/流行病学少数民族/心理学少数民族/统计学和数值数据人口密度性别分布自杀/统计学和数值数据成年人女(雌)性人类男(雄)性中年人

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Sluggish economics affect health of Japanese 'business warriors'

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BRITISH JOURNAL OF PSYCHIATRY 2000年第5期176卷 494-495页

作者： Takei, N Kawai, M Mori, N Hamamatsu Univ Sch Med Dept Psychiat & Neurol Hamamatsu Shizuoka 4313192 Japan

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