Encyclopedia of Suicide 3-Volume Set [Hardcover ed.] 163485084X, 9781634850841

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PSYCHOLOGY RESEARCH PROGRESS

ENCYCLOPEDIA OF SUICIDE (3 VOLUME SET)

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PSYCHOLOGY RESEARCH PROGRESS

ENCYCLOPEDIA OF SUICIDE (3 VOLUME SET)

OLIVER B. TORRES EDITOR

New York

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NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works. Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. Additional color graphics may be available in the e-book version of this book.

Library of Congress Cataloging-in-Publication Data Names: Torres, Oliver B., editor. Title: Encyclopedia of suicide : (3 volume book) / editor, Oliver B. Torres. Description: Hauppauge, New York : Nova Science Publishers, Inc., 2016. | Series: Psychology research progress Identifiers: LCCN 2016012409 (print) | LCCN 2016023494 (ebook) | ISBN 9781634850841 (hardcover) | ISBN 9781634851022 (ebook) | ISBN 9781634851022 (H%RRN) Subjects: LCSH: Suicide--Encyclopedias. Classification: LCC HV6545 .E53 2016 (print) | LCC HV6545 (ebook) | DDC 362.2803--dc23 LC record available at https://lccn.loc.gov/2016012409

Published by Nova Science Publishers, Inc. † New York

CONTENTS VOLUME 1 Preface

ix

Chapter 1

The Culture of Violence and Suicidality Steven Stack

Chapter 2

Space and Earth Weather Mirrored in Patterns of Suicide Incidence Germaine Cornélissen, Borislav D. Dimitrov, Franca Carandente and Franz Halberg

Chapter 3

Recognising Suicidality: General Practitioner Training and Education David Smith and Andrea Stewart

1

13

27

Chapter 4

Suicidal Ideation: A Comprehensive Overview Gianluca Serafini, Paola Solano and Mario Amore

35

Chapter 5

Suicide in India David Lester and Kavita Naik

67

Chapter 6

Psychopathology of Suicide in Bali Toshiyuki Kurihara and Motoichiro Kato

75

Chapter 7

Estimating the Effects of Casinos and of Lotteries on Suicide: A Panel Data Set Approach Bogdan Daraban and Clifford F. Thies

89

The Hypotheses for the Pathogens of Antimicrobial - Induced Mania and Suicide Da-Yong Lu, Ting-Ren Lu, Peng-Peng Zhu and Hong-Ying Wu

97

Chapter 8

Chapter 9

Serotonin is a Key Neurotransmitter in Suicide Jun Kohyama

105

Chapter 10

Toxoplasma gondii, Suicide and Homicide David Lester

115

vi

Contents

Chapter 11

MicroRNAs, Major Affective Disorders and Suicidal Behaviour Gianluca Serafini, Maurizio Pompili, Marco Innamorati, Yogesh Dwivedi, Noam Shomron and Paolo Girardi

121

Chapter 12

Indigenous Populations and Suicide Prevention Said Shahtahmasebi

147

Chapter 13

Youth Suicide Prevention at Grassroots Said Shahtahmasebi

153

Chapter 14

Improvement of Child and Adolescent’s Mood Instability, Impulsivity, Aggression and Suicidal Attempts: Results of an Open Trial of Add-On Lamotrigine Strategy Daniel Serrani

Chapter 15

Preventing School Shootings: A Public Health Approach to Gun–Related Homicide and Murder–Suicide in Schools David N. Miller and Kristin D. Sawka-Miller

165

179

Chapter 16

Suicidal Behaviour among Adolescents from Ethnic Minorities L. Nrugham, A. Silviken and V. V. Prakash

205

Chapter 17

Acculturation and Suicidal Behavior in College Students David Lester, Rheeda L. Walker, Frauk Gençöz and Sevginar Vatan

225

Chapter 18

Burnout as a Risk Factor for Strain, Depressive Symptoms, Insomnia, Behavioral Outcomes, Suicide Attempts, and Well-Being among Full-Time Workers Tsukasa Kato

Chapter 19

Chapter 20

Utilization of Mental Health Services by Adults with Suicidal Thoughts and Behavior Substance Abuse and Mental Health Services Administration

251

Further Evidence for Epidemiological Transition Hypothesis for Elderly Suicides Ajit Shah, Ravi Bhat and Sofia Zarate-Escudero

259

Chapter 21

The Risk of Suicidal Behaviors in Affective Disorders P. Mendez-Bustos, V. de Leon-Martinez and J. Lopez-Castroman

Chapter 22

Theoretical and Methodological Weaknesses of Current Psychiatric Models of Suicidal Behavior María Dolores Braquehais and Agustín Madoz-Gúrpide

Chapter 23

231

The Comparisons of Psychological Well-Being, Suicidal Ideation, Using Alcohol, and Coping Strategies between Nursing Students and Business Students in the USA Pi-Ming Yeh and Cheng-Huei Chiao

273

305

313

Contents

vii

VOLUME 2 Chapter 24

Chapter 25

Chapter 26

Chapter 27

Revisiting Aggression and Impulsivity in Suicidal Behavior: A Comparison between Schizophrenia and Depression Ana Fresán, Ricardo Saracco, Emmanuel Sarmiento, Izabelén Garza-Gutiérrez, Rebeca Robles-García and Beatriz Camarena Suicidal Ideation Associated with PCL Checklist-Ascertained PTSD among Veterans Treated for Substance Abuse Jack R. Cornelius, Gretchen L. Haas, Cathleen J. Appelt, Jon D. Walker, Lauren J. Fox, John W. Kasckow, James F. Luther and Ihsan M. Salloum Suicidal Symptoms among Veterans with Chronic PTSD Evaluated for Treatment at a VA Hospital Jack R. Cornelius, Jon D. Walker, Gloria Klima and Barry Fisher Genetic Markers in Suicidal and Non-Suicidal Veterans with Combat-Related Posttraumatic Stress Disorder Nela Pivac, Dragica Kozarić-Kovačić, Gordana Nedić, Matea Nikolac, Maja Mustapić, Ana Babić, Mirjana Grubišić-Ilić, Zrnka Kovačić and Dorotea Mück-Šeler

329

341

353

363

Chapter 28

Suicide: Risk Factors and Prevention Barbara Schneider

Chapter 29

Suicide Prevention Using the Internet: Mini-Review and a Case Study in Online Gatekeeping Activity Hajime Sueki

399

The Challenge and the Promise: Strengthening the Force, Preventing Suicide and Saving Lives The Department of Defense

411

Chapter 30

Chapter 31

Suicide Prevention Efforts of the Veterans Health Administration Erin Bagalman

393

603

VOLUME 3 Chapter 32

2012 National Strategy for Suicide Prevention: Goals and Objectives for Action U.S. Surgeon General and National Action Alliance for Suicide Prevention

623

Chapter 33

How You Can Play a Role in Preventing Suicide U.S. Department of Health and Human Services

779

Chapter 34

Preventing Veteran Suicide Hearing—Harrell Testimony Margaret C. Harrell

783

viii Chapter 35

Contents Suicide Data Report: Veterans Health Administration Response and Executive Summary Robert A. Petzel

795

Chapter 36

Suicide Data Report, 2012 Janet Kemp and Robert Bossarte

799

Chapter 37

Health Care for Veterans: Suicide Prevention Erin Bagalman

837

Chapter 38

Statement of Dr. Harold Kudler, Chief Mental Health Consultant, Veterans Health Administration. Hearing on "Mental Health and Suicide Among Veterans'' Harold Kudler

Chapter 39

Chapter 40

Chapter 41

Chapter 42

VA Health Care: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data United States Government Accountability Office Opening Statement of Ann Marie Buerkle, Chairwoman House Committee on Veterans Affairs, Subcommittee on Health Hearing on: Understanding and Preventing Veteran Suicide Ann Marie Buerkle House Committee on Veterans Affairs, Subcommittee on Health Hearing on: Understanding and Preventing Veteran Suicide Witness Testimony of Commander René A. Campos, USN (Ret.), Deputy Director, Government Relations, Military Officers Association of America René A. Campos Witness Testimony of Tom Tarantino, Senior Legislative Associate, Iraq and Afghanistan Veterans of America House Committee on Veterans Affairs, Subcommittee on Health Hearing on: Understanding and Preventing Veteran Suicide Tom Tarantino

Chapter 43

Preventing Veteran Suicide Hearing— Ilem Testimony Joy J. Ilem

Chapter 44

Suicide, PTSD, and Substance Use among OEF/OIF Veterans Using VA Health Care: Facts and Figures Erin Bagalman

855

863

903

905

917 923

933

Chapter 45

Preventing Veteran Suicide Hearing—Watkins Testimony Katherine E. Watkins

941

Chapter 46

Preventing Veteran Suicide Hearing—Kemp Testimony Jan E. Kemp

955

Index

965

PREFACE Suicide is a serious problem, hallmarked by complexity and ranked as a leading cause of death worldwide. International studies of suicide epidemiology show that suicide rates are generally greater in males than females and increase with age, with the elderly having the highest suicide rates (WHO, 2002). The prevention of suicide is, in part, contingent on the ability to identify individuals and populations at high risk and to offer prompt, effective interventions. However, evidence exists that suicidal individuals remain commonly undetected, rendering appropriate intervention unlikely. This encyclopedia presents important research on suicide.

In: Encyclopedia of Suicide (3 Volume Set) Editor: Oliver B. Torres

ISBN: 978-1-63485-084-1 © 2016 Nova Science Publishers, Inc.

Chapter 1

THE CULTURE OF VIOLENCE AND SUICIDALITY Steven Stack* Wayne State University, MI, US

ABSTRACT While there has been a great deal of empirical research that links the culture of violence to homicide, there has been no rigorous assessment of the possible link between cultural support of violence and suicide risk. Given that suicidality is often association with higher levels of aggression and fearlessness (e.g., Joiner 2005), it is plausible that normative supports for violence would enhance risk of suicide. The present analysis tests the hypothesis: the greater the adherence to cultural norms supportive of violent behavior, the higher the risk of suicide. Methodology. The data are from the National Mortality Follow Back Survey and refer to data gleaned from 15,739 psychological autopsies; these include 1,302 suicides. Predictor variables include an index of the culture of violence (use of violence against objects, verbal violence, and violence against persons), economic strain, social ties such as marriage, psychiatric morbidity, and opportunity factors (e.g., firearm in the home). Results. The results from a multivariate logistic regression analysis found that, even after controlling for 19 other socio-psychiatric constructs, for a one unit change in the index of the culture of violence the risk of death from suicide increased 3.1%. The leading predictors of suicide risk were not, however, cultural markers. These included having a firearm in the home, which increased suicide risk3.8 times. Conclusion. While cultural supports for violence have not attracted any rigorous attention in suicide studies, the present results confirm the hypothesis linking culture with suicide. Professionals in suicide prevention may want to focus more resources on suicidal patients with high levels of approval of the use of violence.

In the field of criminology there has been a considerable amount of research concerning the association between a subculture of violence and the externalization of aggression including homicides and aggravated assaults (Baller, Zevenbergen, & Messner, 2009; *

Email: [email protected].

2

Steven Stack

Bernberg & Thorlindsson, 2005; Brezina, Agnew, Cullen, & Wright 2004; Chon, 2011; Cohen, 1996; Corzine & Huff-Corzine, 1989; D’Antonio-Del Rio, Doucet, & Chauvin 2010; Felson & Pare, 2010; Gastil, 1971; Huff-Corzine, Corzine, & Moore, 1986; Ousey & Wilcox 2005; Stack, 2002, 2007; Wolfgang & Ferracuti, 1967). Persons or groups which adhere to, or are thought to adhere to, cultural values, norms, and/or beliefs supportive of violence tend to be at greater than average risk of homicide, and other forms of violent behavior against others. For example, the rates of homicide continue to be relatively high in the South, a social fact going back more than 100 years. The ecological foundations of the southern subculture of violence have been recently traced, in part, to the agricultural roots surrounding the herding culture of the Scotch Irish settlers in the 19th century (Baller et al., 2009). The historical values of the threat of and use of physical violence against slaves have also been widely used in explaining the high incidence of lethal violence in the South (e.g., Cohen, 1996; Gastil, 1971; Huff-Corzine, Corzine, & Moore, 1986; Stack, 2002). The value of violence as a problem solving mechanism can be culturally transmitted through the socialization process (Cohen, 1996; Stack, 2007). Sociological work on cultural supports for violence has been, however, overwhelmingly restricted to other directed forms of violence, principally homicide. A possible connection between cultural supports for violence and inner directed violence, such as suicide, has been relatively under-developed in sociology. In addition to neglect by sociology, historically the interdisciplinary field of suicidology has also neglected inquiries on a link between external forms of aggression and suicide (for reviews see Nock & Marzuk, 2000; Plutchik, 2000). Given that the possible link between membership in a subculture of violence and inner directed aggression, such as suicide, has received scant attention (for an exception see Stack, 2006); the present study focuses on such a link. The present investigation tests a hypothesis: H1. Persons involved in a subculture of other directed violence will be more apt than their counterparts to die through suicide. To the best of the writer’s knowledge a subculture of violence perspective has not been tested in the published literature on suicidality (O’Connor, Platt & Gordon, 2011; Stack, 2000a, 2000b; Wasserman & Wasserman, 2009).

BACKGROUND Compared to the voluminous work on standard psychiatric predictors of suicide, such as major depression and schizophrenia, and neurological deficits in brain functioning, there is relatively little work on the impact of aggression against others and suicide risk (Lester, 2000; Nock & Marzuk, 2000; O’Connor, Platt, & Gordon, 2011; Plutchik, 2000; Stack 2000a, 2000b; Wasserman & Wasserman, 2009). Further, and importantly, unlike the work done in sociology which links homicide to a subculture of violence, the work on suicide and aggression has neglected cultural explanations. Instead of linking suicidal violence to cultural norms, values, and beliefs, suicide is more typically linked to aggressive behaviors. In other words, research on the link between aggression and risk of suicidal behavior has tended to adopt a behavioral model where aggressive behavior in individuals predicts suicide ideation and/or suicide attempts in individuals (for reviews see Nock & Marzuk, 2000; Plutchik, 2000). This research has been mostly done on samples of youth (e.g., Garrison, et al., 1993; Papolos, Hennen, & Cockerham, 2005; Vermeiren, Schwab-Stone, Ruchkin, et al., 2003). For

The Culture of Violence and Suicidality

3

example, the degree of behavioral aggression was a risk factor for a reported suicide attempt among rural adolescents in China (Liu, Tien, Sandler, & Zhao, 2005). Investigations based on the American Youth Risk Behavior Survey have reported significant associations between suicide attempts and reported violent behaviors (Garrison, et al., 1993; Simon & Crosby, 2000; Sosin et el., 1995). Odds ratios for the association between suicidality and violent behaviors increased in magnitude with the intensity of suicidal behaviors (Garrison, et al., 1993). Several studies connect violent behavior with suicidal behavior for specialized samples. One study, restricted to 219 clinically depressed subjects, determined that for those with a history of alcoholism, for each incremental unit increase in the Brown-Goodwin Aggression History Scale the odds of being a suicide attempter were increased by 10% (Sher et al., 2005). The same scale of aggression predicted suicide attempts in samples of depressed patients in New York state (Dervic et al., 2004; Placidi et al., 2000). However, it remains unclear if the results of studies which are based on specialized groups of subjects (e.g., depressed, history of alcoholism) can be generalized to the general population. Some research employs indirect measures of violent behavior as risk factors for suicide attempts. These include prisoners, clients of the criminal justice system, and other groups known to have a higher than average involvement in violent behavior. For example, in a longitudinal investigation in Denmark, youth who were eventually imprisoned were 2.9 times more apt to attempt suicide than their counterparts (Christoffersen, Poulsen, & Neilsen, 2003). In a six year follow-up study of probationers, the probationers had a suicide rate that was nine times that of the general adult population (Pritchard, Cox, & Dawson, 1997). Alcoholic men involved as perpetrators of domestic violence have been reported to be at higher than average risk of suicide than alcoholic men not involved in domestic violence (Conner, Duberstein, & Conwell, 2000). Perpetrators of bullying have been found to be at an elevated risk of suicide ideation (Van der Wal, et al., 2003). Four recurrent limitations of the body of research on aggression and suicidality remain. First, the dependent variable typically falls short of the ultimate degree of suicidality: the suicide completion (e.g., Garrison, McKeown, Valois, & Vincent, 1993; Kaslow et al., 2004; Liu, Tien, Sandler, & Zhao, 2005; Miotto et al., 2003; Simon & Crosby, 2000; Sosin et el., 1995; Vermeiren, Schwab-Stone, Ruchkin, et al., 2003; for a review see Nock & Marzuk, 2000). To the extent that suicide attempts and suicide completions follow somewhat different etiologies, the results of research on suicide attempts may not be generalizable to completions. For example, gender has the opposite impact on attempts compared to completions. For attempts, women are at greater risk than men. However, for completions, men are 3 to 4 times more to complete suicide than women (Lester, 2000; Stack, 2000a; Wasserman & Wasserman, 2009). Second, the research is disproportionately based on adolescents (e.g., Garrison, et al., 1993; Papolos, Hennen, & Cockerham, 2005; Simon & Crosby, 2000; Sosin et el., 1995; Vermeiren, Schwab-Stone, Ruchkin, et al., 2003). It is not fully clear if aggression will predict suicide in adult samples. Third, research has stressed measures of behavioral aggression (e.g., Liu, Tien, Sandler, & Zhao, 2005; Miotto et al., 2003; Simon & Crosby, 2000; Sosin et el., 1995; Van der Wal, et al., 2003). It is not clear if cultural measures of aggression based on beliefs, attitudes, and/or norms supportive of violence will predict suicidality. Fourth, the interpretation of the link between aggression and suicide has not focused on cultural mediators. Instead, psychiatric and psychological mediators have typically been used. Such constructs include impulsiveness, affective lability,

4

Steven Stack

problems with reasoning and decision making, genetic predispositions, and disinhibition (for reviews see Nock & Marzuk, 2000 Plutchik, 2000). The present paper adds to the literature on the link between aggression and suicide in several ways. It uses suicide completions (not attempts) as its outcome variable. It extends the analysis from youth to adults. It also uses a cultural measure of aggression: the extent to which respondents reportedly approved of the use of aggression when they were offended by the behavior of others. This is in contrast to explanations that link aggression to suicide in behavioral, psychological and/or psychiatric terms. Finally, it is based on a representative, national sample of persons from the general population. This has the advantage of promoting the generalizability of the findings. Much previous work is based on nonrepresentative clinical samples such as depressed inpatients. The link between membership in a subculture of violence and suicide could also be interpreted from the standpoint of the interpersonal theory of suicide. Joiner (2005) has suggested that the ability to commit suicide is one key risk factors for suicide. Ability to commit suicide involves familiarity with pain and violent behavior. Persons suffering injuries in contact sports, persons having endured surgery for life threatening physical conditions such as cancer, and persons badly injured in motor vehicle accidents, have been socialized to pain. Socialization to pain and violence involves a desensitization process to pain. This provides for a greater ability to suicide in that suicidal acts often involve pain, blood and bodily disfigurement. Examples would include cutting writs, hanging, high speed car crashes done on purpose, and gunshot wounds. Hence, we would expect that persons desensitized to violent acts through committing such acts on themselves, would be more likely to engage in the taking of their own lives than their counterparts.

METHODOLOGY All data are taken from National Mortality Followback Survey (National Center for Health Statistics, 2000). The survey is based on a national representative sample of 22,000 deaths. Psychological autopsies were done by trained interviewers. The respondents were the significant others familiar with the social, economic, health histories, and other aspects of the lives of the deceased individuals. Complete data were available for 15,739 deceased persons. These deaths included 1,302 suicides. The dependent variable is the cause of death. Herein, the cause of death=1 if it is suicide, and zero for all other causes. Since the dependent variable is a dichotomy, logistic regression techniques are appropriate (Borooah, 2002).

Index of Subculture of Violence Adherence to the norms of the subculture of violence was measured in terms of three attitudes regarding the acceptability of violence: (1) How wrong did (the deceased) think it was to start an argument and use insulting language even though it really isn’t called for? Responses were 0=very wrong through 3= not wrong. (2) How wrong did (the deceased) think it was to deliberately damage something that belongs to someone else because you are

The Culture of Violence and Suicidality

5

angry at that person? Responses were 0=very wrong through 3= not wrong. (3) How wrong did the deceased think it was to start a fight and hit someone because you didn’t like what that person said or did? Responses were 0=very wrong through 3= not wrong. The responses were summed. The range was 0-9. The higher the score the higher the adherence to norms supporting violence. The alpha reliability coefficient for the index was alpha= .86. Other measures of aggression, such as the Buss and Perry Aggression Questionnaire include several dimensions of aggression including both the verbal and physical modalities of aggression (Kaslow et al., 2004). The data set at hand did not contain alternative measures of the approval of violence.

Control Variables A series of variables measuring constructs from previous research are incorporated into the model to serve as controls (Lester, 2000; O’Connor Platt, & Gordon, 2011; Stack, 2000a, 2000b; Wasserman & Wasserman, 2009). These variables are grouped into five categories: psychiatric, social integration, economic strain, opportunity factors, and demographic. Depression is a key psychiatric predictor of suicide (Lester, 2000; Wasserman & Wasserman, 2009). An index of depression was constructed from eight relevant items in the survey. The items covered feelings of worthlessness, being withdrawn, problems concentrating, a wish to die, changes in sleep patterns, changes in weight, crying spells, and sluggish. Responses ranged from often to never. The index coded “often” as a one and all others as zero. The range in scores on the index was from zero through eight. The alpha reliability coefficient for the index was .7414. Five measures of social integration are incorporated. These include bonds to religion or the degree of involvement in religious activities: how often did the deceased participate in religious activities? The responses ranged from 0=never through 5=every day. Four binary variables serve as measures of four additional dimensions of integration: migration: changed residences during the last year of life (0, 1), international migration is indexed as foreign born (0, 1), social isolation is captured as lives alone (0,1), and having no reported friends (0,1). Opportunities for suicide are restricted by residence in a controlled environment and the control of the means for suicide (Stack, 2000a). For example, nursing homes involve supervision of the activities of residents by trained staff, and firearms are generally not allowed. The presence of guardians and absence of guns, an effective means of suicide, would be expected to lower opportunities for suicide. We measure opportunity theory in terms of a binary variable: residence in a nursing home (0,1). Economic strain is measured in terms of loss of status and/or power at work. Specifically, a binary variable is employed to capture job demotion at work during the last year of life (0,1). Four demographic variables are used to measure demographic influences on suicide. Age is measured in years at death. Gender is a binary variable (0,1) where 1=male. Race is measured by a binary variable where 1=white and all others=0. Marital status is captured by a series of binary variables: single (0,1), widowed (0,1), and divorced (0,1). Married is the reference category. Region of residence is also measured as a series of dichotomous variables: Midwest (0,1), South (0,1), West (0,1). The reference category is the Northeast, a region typically having the lowest suicide rates.

6

Steven Stack Table 1. The Effect of the Subculture of Violence Index, Psychiatric Morbidity, Social Integration, Economic Strain, Opportunity, and Demographic Controls on the odds of Dying By Suicide (N=1,302 suicides) vs. All Other Causes (N=14,437). National Mortality Follow back Survey, 1993 Variable

Subculture of Violence Index Psychiatric Morbidity: Index of Major Depression Social Integration: Religious Activities Change of residence, last year Foreign born Lives Alone No Friends Economic Strain Job Demotion Opportunity Lives in an Institution Demographic Age Male (female=0) Race White All others=reference) Marital Status Single Widowed Divorced Married = reference Region Midwest South West Northeast=reference Constant Term Model chi square * p < .05 Model correctly classified 91.77% of cases Nagelkerke r-squared Culture of violence and suicidology.

Logistic Regression Coefficient .0357* .150*

Odds Ratio

-.19* 1.26*

.82 3.53

.62 .47* -.28*

1.87 1.59 .75

1.52*

4.58

-1.21*

.29

-.01* .30*

.99 1.35

1.07*

2.92

-.58* -.33* -.43*

.55 .71 .64

.49* .35* .29*

1.63 1.43 1.34

-3.23* 1087.09 *

----

1.036 1.16

.153

RESULTS Table 1 presents the results of the multivariate logistic regression analysis., The coefficient of the subculture of violence term is over two times its standard error (p < .015).

The Culture of Violence and Suicidality

7

Controlling for the other predictor variable a one unit change in the subculture of violence index is associated with a 3.6% increase in the odds of death by suicide. Several measures of social integration were predictive of death by suicide. Controlling for the other variables, a one unit increase in religious activities decreased the risk of suicide by 18%. From the odds ratio, a change of residence in the last year of life increased the risk of suicide 3.53 times. Persons who lived alone were 1.59 times more apt to die of suicide compared to persons who did not live alone. Other significant associations were found in the variables measuring key constructs. These included the measure of economic strain. Persons encountering a demotion at work were 4.58 times more apt to die of suicide than their counterparts. The index of opportunity for suicide also predicted suicide risk. Persons living in an institution (e.g., rest home) were 81% less apt to die of suicide than persons living in all other settings. Males were 1.35 times more apt than females to die by suicide. Whites were 2.92 times more apt than persons of other races to die through suicide. The dichotomous variables representing regions of the nation were also significant predictors of suicide. For example, controlling for the other independent variables, the odds ratio for residence in the Western United States indicates that persons residing in the West are 1.34 times more apt than persons residing in the Northeast to die through suicide. However, the strongest predictors of death by suicide did not include cultural approval of violence. While cultural approval of violence was a significant predictor of suicide, several other factors were more important in predicting death by suicide. Judging from the relative sizes of the Wald Chi Square statistics (not shown in table 1), and associated probability levels of each logistic regression coefficient, the most important predictor was change of residence (Wald Chi Square= 245.2, p < .0000), Caucasian race (Wald=148.4, p < .0000), and depression (Wald=99.9, p < .0000). In contrast, the subculture of violence index statistics were not as substantial (Wald chi square=6.02, p < . 01). According to the Nagelkerke r-squared statistic, a pseudo r-squared measure, 15.3% of the variance in suicide risk is explained by the model. The model correctly classified 91% of the cases as either suicide or non suicide deaths. The model chi square also demonstrates that the model provides a good fit for the data.

CONCLUSION Cultural values, attitudes, and beliefs supportive of violent behaviors have received substantial attention in the criminological literature (e.g., (Baller, Zevenbergen, & Messner, 2009; Bernberg & Thorlindsson, 2005; Brezina, Agnew, Cullen, & Wright 2004; Chon, 2011; Cohen, 1996; Corzine & Huff-Corzine, 1989; D’Antonio-Del Rio, Doucet, & Chauvin 2010; Felson & Pare, 2010; Gastil, 1971; Huff-Corzine, Corzine, & Moore, 1986; Ousey & Wilcox 2005; Stack, 2002, 2007; Wolfgang & Ferracuti, 1967). There has been, however, scant attention directed to the culture of violence in suicide studies. Work in suicide studies has preferred to link actual aggressive acts of violence (behavioral violence) to suicide. The bulk of this work on behavioral violence indicators and suicidality has been restricted to suicide attempts, leaving the applicability of the findings to suicide completions somewhat tenuous (e.g., Garrison, McKeown, Valois, & Vincent, 1993; Kaslow et al., 2004; Liu, Tien, Sandler,

8

Steven Stack

& Zhao, 2005; Miotto et al., 2003; Simon & Crosby, 2000; Sosin et el., 1995; Vermeiren, Schwab-Stone, Ruchkin, et al., 2003). In addition, the emphasis of previous studies has been on adolescent and youth samples. The present investigation adds to the literature by simultaneously addressing a series of limitations of previous work. It explores the link between cultural norms of violence (as opposed to violent actions) and completed suicide among adults. An index of the degree of approval of violence is found to be predictive of death by suicide. The extent to which people reportedly approve of verbal violence, violent acts against objects and violent attacks on others predicts the probability of lethal violence against self, suicide. This relationship holds even when well known predictors of suicide, such as depression, low kevels of religiosity, social isolation, opportunity and demographic factors are controlled. The impact of the subculture of violence on other forms of violent behavior including suicide attempts, suicide plans, and homicide can be the subject of future research. In results not fully reported here, the analysis presented in Table 1 was repeated, but the dependent variable was death by homicide. In the analysis of homicide deaths, there was a stronger association between the index of the subculture of violence and homicide than that found for the subculture of violence predicting suicide. While a unit change in the subculture of violence index enhanced the odds of death by suicide by 3.6%, the same increase in the subculture of violence raised the odds of death by homicide by 15.8%. The Wald chi square for the subculture of violence index was larger, 75.1. The significance level improved to p < .0000. Hence, while adherence to the norms in the subculture of violence predicts suicide deaths, adherence to these norms is a better predictor of homicide deaths. Some caution needs to be exercised in interpreting these findings, however. They refer to the victims of homicides, not the perpetrators. Nevertheless, it is often assumed that the social and psychological characteristics are roughly the same between homicide victims and offenders. For example, they come disproportionately from the same social groups based on gender, age, and ethnicity (Wolfgang & Ferracuti, 1967; Stack, 2007). The findings are consistent with a previous analysis which linked actual violent behavior in the last year of life with increased odds of death by suicide (Connor, et al., 2001). The previous study found that persons who have engaged in violent actions against others “sometimes or often” were 4.6 times more apt to die through suicide than their counterparts. Unlike the previous study, we explored cultural or attitudinal antecedents of the approval of violence. Hence, both cultural and behavioral measures of violence predict death through suicide. Future work is needed to integrate these two constructs to unravel which may be more critical to the prediction of suicide. The results have implications for suicide prevention. Persons who are known to approve of verbal violence, violence against objects and/or attacks against others, are at risk for suicide. These behaviors might be added to a psychiatric checklist by medical personnel for screening out persons at high risk of suicide. Resources of suicide prevention agencies and personnel might be disproportionately directed towards the prevention of suicide in this high risk subgroup. Finally, while there is a significant association between aggression and completed suicide, aggression both in terms of cultural attitudes towards aggression as well as aggression against others, there is a question of the extent to which this is reflected in non scientific venues. That is, are the constructions of suicide in the media (e.g., newspapers and film) apt to make a connection between suicide and other directed aggression? Far more

The Culture of Violence and Suicidality

9

people turn to the media for information and understandings of behaviors and events than turn to scientific journals. To the extent that media portrayals of suicide are inaccurate, they can contribute to public misunderstandings of suicide. Such misunderstandings can present a challenge to widespread adoption of viable suicide prevention programs (Stack & Bowman, 2012). In an analysis of 1,377 portrayals of completed suicide in American feature films, 254 involved the suicides of psychopaths. Nearly one in five cases of film suicides drew connections between highly aggressive actions and suicide completions. Typically the psychopaths had murdered one or more persons before their suicides. In addition, these acts of violence were largely carried out in the absence of any remorse. Examples of psychopaths who suicide after committing multiple murders include unemployed, divorced men played by Robert DeNiro in The Fan (1996) and Michael Douglas in Falling Down (1993), a hit man, played by Morgan Freeman, in Nurse Betty (2000), and a serial killer played by Kevin Spacey in Se7en (1995). American film provides substantial coverage of a link between violent aggression preceding completed suicides. An analysis of 135 suicide in British films found a higher percentage of suicides by psychopaths: 23.7% (Stack & Bowman, 2012). The roots of the suicide of the violent psychopath rest in literary traditions. The extent of portrayals of psychopaths in cinematic suicides matches that in popular classic works of literature. Fully 24.1% of the 107 suicides in classic works of literature involve psychopaths (Stack & Bowman, 2012). These include the ultimate suicides of several of the ruthless assassins in Shakespeare’s Julius Caesar, and characters in the Bible. The latter include the suicide of Ambimilech who ruthlessly killed all his brothers in order to become King. As in the case of many modern cinematic suicides, the murderous psychopath in classic world literature often suicides only to avoid capture and torture by his enemies. Artistic representations of suicide provide substantial documentation of a link between the subculture of violence and suicide completions.

REFERENCES Baller, R.D., Zevenbergen, M.P., & Messner, S. F. (2009). The heritage of herding and Southern homicide: Examining the ecological foundation of the code of honor thesis. Journal of Research in Crime and Delinquency, 46, 275-300. Bernberg, J.G. & Thorlindsson, T. (2005). Violent values, conduct norms, and youth aggression. Sociological Quarterly, 46, 457-478. Borooah, V.K. (2002). Logit and probit. Beverly Hills, Ca.: Sage. Brezina, T., Agnew, R., Cullen, F., & Wright, J. P. (2004). The code of the street: A quantitative assessment of Elijah Anderson’s subculture of violence thesis and its contribution to youth violence research. Youth Violence and Juvenile Justice, 2, 303-328. Chon, D.S. (2011). Contributing factors for high homicide rate in Latin America: a critical test of Neapolitan’s regional subculture of violence thesis. Journal of Family Violence, 26, 299-307. Christoffersen, M.N., Poulsen, H.D., & Neilsen, A. (2003). Attempted suicide among young people: risk factors in a prospective register based study of Danish children born in 1966. Acta Psychiatrica Scandinavica, 108, 350-358.

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Cohen, D. (1996). Law, social policy, and violence: the impact of regional subcultures, Journal of Personality and Social Psychology,70,961-978. Connor, K., Cox, C., Duberstein, P., Tian, L., Nisbet, P., & Conwell, Y. (2001). Violence, alcohol, and completed suicide: a case control study. American Journal of Psychiatry, 158, 1701-1705. Connor, K., Duberstein, P., & Conwell, Y. (2000). Domestic violence, separation, and suicide in young men with early onset alcoholism: Reanalysis of Murphy’s data. Suicide & Life Thratening Behavior, 30, 354-359. Corzine, J. & Huff-Corzine, L. (1989). On cultural explanations of southern homicide. American Journal of Sociology, 95, 178-182. D’Antonio-Del Rio, J.M., Doucet, J.M., & Chauvin, C.D. (2010). Violent and vindictive women: A re-analysis of the Southern subculture of violence. Sociological Spectrum, 30, 484-503. Dervic, K., Oquendo, M., Grunebaum, M.F., Ellis, S., Burke, A.K., & Mann, J.J. (2004). Religious affiliation and suicide attempt. American Journal of Psychiatry, 161, 23032308. Felson, R.B. & Pare, P.P. (2010). Firearms and fisticuffs: Region, race, and adversary effects on homicide and assault. Social Science Research, 39,272-284. Garrison, C.Z., McKeown, R.E., Valois, R.F., & Vincent, M.L. (1993). Aggression, substance use and suicidal behaviors in high school students. American Journal of Public Health, 83, 179-184. Gastil, B. (1971). Homicide and a regional subculture of violence. American Sociological Review, 36, 412-427. Huff-Corzine, L., Corzine, J., & Moore, D. (1986. Southern exposure: deciphering the South’s influence on homicide rates. Social Forces, 64, 906-924. Joiner, T. (2005). Why people die by suicide. Cambridge, Ma.: Harvard University Press. Kaslow, N.J., Price, A.W., Wyckoff, S., Grall, M.B., Sherry, A., & Young, S. (2004). Person factors associated with suicidal behavior among African American women and men. Cultural Diversity and Ethnic Minority Psychology, 10, 5-22. Lester, D. (2000). Why people kill themselves. Springfield, Il.: Charles Thomas. Liu, X., Tein, J.Y., Sandler, I.N. & Zhao, Z. (2005). Psychopathology associated with suicide attempts among rural adolescents of China. Suicide & Life Threatening Behavior, 35, 265-276. Miotto, P., DeCoppi, M., Freeza, M., Petretto, D., Masala, C., & Preti, A. (2003). Suicide ideation and aggressiveness in school aged youths. Psychiatry Research, 120, 247-255. National Center for Health Statistics. (2000). National mortality follow back survey, 1993. Codebook. Ann Arbor, Michigan. Inter University Consortium for Political and Social research. Nock, M.K. & Marzuk, P.M. (2000). Suicide and violence. In Hawton, K. & van Heeringen, K. (Eds.). The international handbook of suicide and attempted suicide, pp. 437-456. New York: Wiley. O’Connor, R., Platt, S., & Gordon, J. (2011). International Handbook of suicide prevention. Malden, Ma.: Wiley-Blackwell. Ousey, G. & Wilcox, P. (2005). Sub cultural values and violent delinquency: A multilevel analysis in middle schools. Youth Violence & Juvenile Justice, 3, 3-33.

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Placidi, G.P.A., Oquendo, M. A.,, Malone, K.M., Brodsky, B., Ellis, S.P., & Mann, J.J. (2000). Anxiety in major depression: Relationships to suicide attempts. American Journal of Psychiatry, 157, 1614-1618. Plutchik, R. (2000). Aggression, violence and suicide. In Maris, R.,Berman, A.L., & Silverman, M. (Eds.). Comprehensive textbook of suicidology, pp.407-423, New York: Guilford. Papolos, D., Hennen, J., & Cockerham, M. S. (2005). Factors associated with parent – reported suicide threats by children and adolescents with community diagnosed bipolar disorder. Journal of Affective Disorders, 86, 267-275. Pritchard, C., Cox, M., & Dawson, A. (1997). Suicide and violent death in a six-year cohort of male probationers compared with pattern of mortality in the general population: evidence of accumulative socio-psychiatric vulnerability. Journal of the Royal Society of Health, 117, 180-185. Sher, L., Oquendo, M., Galfalvy, H.C., Grunebaum, M.F., Burke, A.K., Zalsman, G., & Mann, J. (2005). The relationship of aggression to suicidal behavior in depressed patients with a history of alcoholism. Addictive Behaviors, 30, 1144-1153. Simon, T.R. & Crosby, A. E. (2000). Suicide planning among high school students who report attempting suicide. Suicide & Life Threatening Behavior, 30, 213-231. Sosin, D.M., Koepsell, T.D., Rivara, F.P., & Mercy, J. (1995). Fighting as a marker for multiple problem behaviors in adolescents. Journal of Adolescent Health, 16, 209-215. Stack, S. (2000a). Suicide: A 15-year review of the sociological literature, Part I. Suicide and Life Threatening Behavior, 30, 145-162. Stack, S. (2000b). Suicide: A 15 –year review of the sociological literature, Part II. Suicide and Life Threatening Behavior, 30, 163-176. Stack, S. (2002). Southernness, migration, and homicide risk: An analysis of individual level data. American Journal of Criminal Justice, 26, Stack, S. (2006). The effect of violent attitudes on suicide. Paper read at the annual meetings of the American Association of Suicidology, Seattle, Washington, April 27-30. Stack, S. (2007). The effect of marital status on male homicide victimization: A race specific analysis. In Froeling, K. (Ed.). Criminology: research focus, pp. 161- 174. New York: Nova Science. Stack, S. & Bowman, B. (2012). Suicide movies: Social patterns, 1900-2009. Cambridge, Ma.: Hogrefe. Van der Wal, de Wit, C.A.M., & Hirasing, R.A. (2003). Psychological health among young victims and offenders of direct and indirect bullying. Pediatrics, 111, 1312-1317. Vermeiren, R., Scwwab-Stone, M., Ruchkin, V. V., King, R.A., Van Heerington, C., & Deboutte, D. (2003). Suicidal behavior and violence in male adolescents: A school based study. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 41-48. Wasserman, D & Wasserman, C. (2009). Oxford handbook of suicidology and suicide prevention. Oxford University Press. Wolfgang, M. & Ferracuti, M. (1967). The subculture of violence. London: Tavistock.

In: Encyclopedia of Suicide (3 Volume Set) Editor: Oliver B. Torres

ISBN: 978-1-63485-084-1 © 2016 Nova Science Publishers, Inc.

Chapter 2

SPACE AND EARTH WEATHER MIRRORED IN PATTERNS OF SUICIDE INCIDENCE Germaine Cornélissen1,, Borislav D. Dimitrov2, Franca Carandente3 and Franz Halberg1 1

Halberg ChronobiologyCenter, University of Minnesota, Minneapolis, MN, US 2 Dept General Practice, RoyalCollege of Surgeons in Ireland, Dublin, Ireland 3 University of Milan, Milan, Italy Support:U.S. National Institutes of Health (GM-13981) (FH); University of Minnesota Supercomputing Institute (GC, FH)

ABSTRACT Exploring any non-photic as well as photic components in the spectrum of the incidence pattern of suicides, we find gender differences in Minnesota, USA, and Australia, notably in the para-annual range of the spectrum. A trans-tridecadal BEL cycle (also more liberally referred to as para-tridecadal) with a period of about 35 years is found in data pooled from both genders and separately for both men and women in Finland (1969-2007). When fitted separately as a single component, the estimated period and its 95% confidence interval (CI) (in years) is 35.5 [26.7, 44.3] overall, 36.4 [25.3, 47.5] for males, and 38.9 [28.5, 49.3] for females, with respective amplitudes (N/100,000) of 170 [119, 222], 145 [98, 192], and 29 [18, 40]. Differences between a Schwabe cycle and an about 7-year component (possibly a harmonic of the Hale cycle) characterizing suicide patterns of Finnish men and women, respectively, remain to be examined in longer series. In Bulgaria (1929-1945), a far-transyear with a period of about 1.3 years is noteworthy as is a quinmensal component with an about 5-month period. In France (1979-2008), in males and females, suicides are characterized by about 10.0-year and 10.1-year cycles, respectively. In Japan (1987-1999), an about 12.7-year component is detected, albeit with a broad uncertainty. A better understanding of the origin of these patterns, notably in terms of the relative contribution of non-photic and photic (daily and yearly) cycles, may lead to better prediction of incidence dynamics and to novel interventions for the prevention of major depression and suicide. Germaine

Cornelissen [email protected].

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Germaine Cornélissen, Borislav D. Dimitrov, Franca Carandente et al.

INTRODUCTION Among conditions shown to be affected by space weather, insofar as they exhibit transyears (cycles with a period of about 1.3 years) characteristic of solar wind speed [1], are sudden cardiac death [2-4], terrorism [5] and suicide. It is hence of interest to examine the incidence patterns of all three conditions in the search for a possibly common underlying factor. A depressive mood has already been documented to independently relate to stroke and cardiovascular events [6], a further reason to study the incidence patterns of the extreme depression of suicide, the topic of this paper. It is written in the steps of Düll and Düll who in 1938 found by superposed epochs on 45,190 cases that the incidence of human suicide increases in association with the occurrence of solar calcium plages [7]. Evidence based on correlation analysis is much weaker and potentially misleading in view of the various cycles characterizing both incidence patterns of suicide and natural environmental variables.

BACKGROUND While positive affect (PA) gauged by the PANAS scale [8] is characterized by a large about 24-hour (circadian) component, negative affect (NA) is prominently 7-day (circaseptan) periodic [9]. An extreme negative affect, the severe depression leading to suicide, in turn is characterized by a non-random distribution along the scales of a day, a week and a year [1016], illustrated in Figures 1A-C for an Italian cohort [11].

F

M

M F

(a) Figure 1. (Continued).

Space and Earth Weather Mirrored …

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(b)

F

M

M F

(c) Figure 1. (A) Circadian, (B) circaseptan and (C) circannual rhythm of attempted suicides (N: 431, 1475 years of age, 19780627 to 19801111 in Milan, Italy[11]. © Halberg.

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Germaine Cornélissen, Borislav D. Dimitrov, Franca Carandente et al. Suicides in Minnesota (1968 - 2002) 0.10

Week Half-Year

Amplitude (N/day)

0.08

Half-Week

0.06 Year 0.04

0.02

0.00 0

20

40

60

80

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Frequency (cycles in 52 weeks)

Figure 2. Population-mean cosinor spectrum of the daily incidence of suicides in Minnesota (19682002). Data analyzed over consecutive years and summarized across years at each frequency, considering results from consecutive years as replications. Spectral peaks with larger diamonds are detected with statistical significance (P