Suicide and unintentional poisoning mortality trends in the United States, 1987-2006: two unrelated phenomena?

Background Two counter trends in injury mortality have been separately reported in the US in recent times - a declining suicide rate and a rapidly rising unintentional poisoning mortality rate. Poisoning suicides are especially difficult to detect, and injury of undetermined intent is the underlying cause-of-death category most likely to reflect this difficulty. We compare suicide and poisoning mortality trends over two decades in a preliminary assessment of their independence and implications for suicide misclassification. Methods Description of overall and gender- and age-specific trends using national mortality data from WISQARS, the Web-based Injury Statistics Query and Reporting System, maintained by the Centers for Disease Control and Prevention (CDC). Subjects were the 936,633 residents dying in the 50 states and the District of Columbia between 1987 and 2006 whose underlying cause of death was classified as suicide, unintentional poisoning, or injury mortality of undetermined intent. Results The official US suicide rate declined 18% between 1987 and 2000, from 12.71 to 10.43 deaths per 100,000 population. It then increased to 11.15 deaths per 100,000 by 2006, a 7% rise. By contrast to these much smaller rate changes for suicide, the unintentional poisoning mortality rate rose more than fourfold between 1987 and 2006, from 2.19 to 9.22 deaths per 100,000. Only the population aged 65 years and older showed a sustained decline in the suicide rate over the entire observation period. Consistently highest in gender-age comparisons, the elderly male rate declined by 35%. The elderly female rate declined by 43%. Unlike rate trends for the non-elderly, both declines appeared independent of corresponding mortality trends for unintentional poisoning and poisoning of undetermined intent. The elderly also deviated from younger counterparts by having a smaller proportion of their injury deaths of undetermined intent classified as poisoning. Poisoning manifested as a less common method of suicide for this group than other decedents, except for those aged 15-24 years. Although remaining low, the undetermined poisoning mortality rate increased over the observation period. Conclusions The official decline in the suicide rate between 1987 and 2000 may have been a partial artifact of misclassification of non-elderly suicides within unintentional poisoning mortality. We recommend in-depth national, regional, and local population-based research investigations of the poisoning-suicide nexus, and endorse calls for widening the scope of the definition of suicide and evaluation of its risk factors

Race/ethnicity and potential suicide misclassification: window on a minority suicide paradox?

<p>Abstract</p> <p>Background</p> <p>Suicide officially kills approximately 30,000 annually in the United States. Analysis of this leading public health problem is complicated by undercounting. Despite persisting socioeconomic and health disparities, non-Hispanic Blacks and Hispanics register suicide rates less than half that of non-Hispanic Whites.</p> <p>Methods</p> <p>This cross-sectional study uses multiple cause-of-death data from the US National Center for Health Statistics to assess whether race/ethnicity, psychiatric comorbidity documentation, and other decedent characteristics were associated with differential potential for suicide misclassification. Subjects were 105,946 White, Black, and Hispanic residents aged 15 years and older, dying in the US between 2003 and 2005, whose manner of death was recorded as suicide or injury of undetermined intent. The main outcome measure was the relative odds of potential suicide misclassification, a binary measure of manner of death: injury of undetermined intent (includes misclassified suicides) versus suicide.</p> <p>Results</p> <p>Blacks (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 2.22-2.57) and Hispanics (1.17, 1.07-1.28) manifested excess potential suicide misclassification relative to Whites. Decedents aged 35-54 (AOR, 0.88; 95% CI, 0.84-0.93), 55-74 (0.52, 0.49-0.57), and 75+ years (0.51, 0.46-0.57) showed diminished misclassification potential relative to decedents aged 15-34, while decedents with 0-8 years (1.82, 1.75-1.90) and 9-12 years of education (1.43, 1.40-1.46) showed excess potential relative to the most educated (13+ years). Excess potential suicide misclassification was also apparent for decedents without (AOR, 3.12; 95% CI, 2.78-3.51) versus those with psychiatric comorbidity documented on their death certificates, and for decedents whose mode of injury was "less active" (46.33; 43.32-49.55) versus "more active."</p> <p>Conclusions</p> <p>Data disparities might explain much of the Black-White suicide rate gap, if not the Hispanic-White gap. Ameliorative action would extend from training in death certification to routine use of psychological autopsies in equivocal-manner-of-death cases.</p

Socioeconomic Status and Symptoms of Depression and Anxiety in African American College Students: The Mediating Role of Hopelessness

Factors such as socioeconomic status (SES) and hopelessness, a dimension of cognitive vulnerability, have been associated with the onset of depression and anxiety pathology in primarily European American study samples. The purpose of this brief article was to examine a main effect of SES and mediating effect of hopelessness in relation to acute symptoms of depression and anxiety in African American college students. Vulnerability-stress theories suggest that cognitively vulnerable individuals are more likely to develop depressive symptoms than individuals without cognitive vulnerabilities. Participants were 133 African American college students who completed self-report measures of hopelessness and symptoms of depression and anxiety. Results revealed that the relationship between participants\u27 SES and participants\u27 symptoms of depression was partially mediated by self-reported hopelessness. The relationship between participants\u27 SES and anxiety symptoms was fully mediated by their level of hopelessness. However, the direction of the findings was unexpected in that higher SES was associated with increased symptoms of depression and anxiety and also increased hopelessness. Future research and considerations for intervention are briefly discussed. © The Author(s) 2013

Anxiety symptomatology and perceived health in a community sample of African American adults: Moderating role of emotion regulation.

Though emotional health has been theoretically and empirically linked to physical health, the anxiety-physical health association in particular is not well understood for African American adults. This study examined anxiety as a specific correlate of perceived health in addition to testing the potential moderating role of emotion regulation, an index of how and when individuals modulate emotions, in the association for anxiety to perceived health. Study participants were 151 community-based African American adults who completed measures of anxiety symptomatology and emotion regulation in addition to responding to a self-report question of perceived health. Results showed that higher levels of anxiety symptomatology were associated with poorer health ratings for those who reported more limited access to emotion regulation strategies but not those who reported having more emotion regulation strategies. The findings suggest that anxiety-related distress and health problems may be interrelated when emotion regulation strategies are limited

Lay theories of suicide: An examination of culturally-relevant suicide beliefs and attributions

The purpose of this study was to examine African Americans' lay beliefs and attributions toward suicide. The Attitudes Toward Suicide Scale, Life Ownership Orientation Questionnaire, Stigma Questionnaire, and Suicide Ideation Questionnaire were administered to 251 undergraduate college students. Beliefs about stigma associated with suicide were comparable across ethnic groups. However, African American college students were significantly less likely than European American college students were to attribute suicide to interpersonal problems and to report that the individual or government is responsible for life. African American students were significantly more likely to report that God is responsible for life. These findings have important implications for suicide risk and also for developing culturally appropriate interventions

Consolidation rather than termination: Rethinking how psychologists label the final phase of psychological treatment

Some clinicians and theorists have noted that termination is an ill-advised choice for labeling and potentially conceptualizing the final, but critical phase of psychotherapy. The adoption of termination is believed to have been due, at least in part, to a 1930s mistranslation of Freud's original writings (e.g., Schlesinger, 2005). The purpose of this article is to discuss potential implications and contemporary limitations associated with the label, termination, and explicitly conceptualize an active, strengths-based approach to ending psychotherapy. Current areas of concern include the negatively valenced label and the seemingly absent tenor of positive collaboration despite previous efforts to formalize more productive psychotherapy endings. Consolidation is presented as preferred, novel terminology given its coherence with the aims of ending psychotherapy, utilizing a strengths-based approach, and also with current therapeutic paradigms. The process of ending psychotherapy typically involves solidifying improvements made over the course of psychotherapy and reorienting clients to life outside of formal psychotherapy—a consolidation conceptualization. We posit that the nature of this ending begins with careful language that appropriately captures this phase of treatment and that drives how psychotherapists collaborate with clients and patients to maximize clinical outcomes

Socioeconomic status and symptoms of depression and anxiety in African American college students: The mediating role of hopelessness

Factors such as socioeconomic status (SES) and hopelessness, a dimension of cognitive vulnerability, have been associated with the onset of depression and anxiety pathology in primarily European American study samples. The purpose of this brief article was to examine a main effect of SES and mediating effect of hopelessness in relation to acute symptoms of depression and anxiety in African American college students. Vulnerability-stress theories suggest that cognitively vulnerable individuals are more likely to develop depressive symptoms than individuals without cognitive vulnerabilities. Participants were 133 African American college students who completed self-report measures of hopelessness and symptoms of depression and anxiety. Results revealed that the relationship between participants’ SES and participants’ symptoms of depression was partially mediated by self-reported hopelessness. The relationship between participants’ SES and anxiety symptoms was fully mediated by their level of hopelessness. However, the direction of the findings was unexpected in that higher SES was associated with increased symptoms of depression and anxiety and also increased hopelessness. Future research and considerations for intervention are briefly discussed

Suicide Prevention In U.S. Ethnic Minority Populations

Suicide is a global phenomenon in which thousands of individuals die daily. In the U.S., these potentially preventable deaths include 3,000 people of color (Leong, Leach, Yeh, & Chou, 2007). Since suicide is often misclassified (cf. Rockett, Samora, & Cobin, 2006), we suggest that the necessity of suicide prevention for people of color is even more urgent than is currently reflected in the scientific literature. The associated burden of suicide involves billions of dollars in medical costs and the profound emotional distress of family and friends (U.S. Public Health Service, 2001). A model of suicide that delineates the unique needs of underrepresented groups such as American Indian, African American, Asian American, and Latinos enlightens suicide prevention efforts for these and other ethnic minority groups in the U.S. The unwavering reality is that people of color are often on the receiving end of marginal health services in the U.S. and worldwide. Suicide prevention efforts must keep the pace of an increasingly diverse world in which non-majority adults and youth demonstrate ever more needs for culturally relevant interventions

Hopelessness and suicidality in Turkish and American respondents

In samples of both Turkish and American students, the correlates of suicidal ideation were found to be similar, with depression, hopelessness, and attitudes toward the ownership of life predicting the level of suicidal ideation in both samples. Results using a Western measure of religiosity, however, were different in the two cultures, indicating the need for measures of religiosity specifically tailored for Turkish culture

The course of post-crisis suicidal symptoms: How and for whom is suicide cathartic ?

We investigated suicide catharsis as evidenced by decreased suicidality following a suicide attempt. Past research has examined this issue with mixed results (Bronisch, 1992; Davis, 1990; van Praag & Plutchik, 1985). In the present study, we examined Modified Scale for Suicide Ideation (MSSI) scores for 198 suicidal men during suicidal crisis, prior to entry into a treatment study, and again at 1-month and 12-month follow-ups. Patients were divided into ideators, single attempters, and multiple attempters. We found evidence for decreased suicidality, but interpreted it as the gradual action of interpersonal support, rather than as emotional catharsis. Also, multiple attempt status affected the long-term course of post-crisis suicidality