New Risk Factors for Suicide: Mining the National Violent Death Reporting System (NVDRS): Analysis of 30,000 Suicides Dr. Steven Stack * Dept of Psychiatry & Dept. of Criminology, Wayne State University Paper presented at the annual meetings of the Midwest Injury Prevention Association , Ann Arbor, MI Monday, Sept 30, 10:30-Noon, Great Lakes Room, Central, Palmer Commons Session: C. Violence: How Data Informs Prevention . *email: aa1051@wayne.edu {MIPA.NVDRS.091213c}
Background with NVDR: (a) Book (2011) testing the artistic construction hypothesis, do 1400 suicides in films reflect patterns in suicides in the real (NVDRS) world? (b) Study (2011) using the narratives in NVDRS to locate 71 Russian roulette (RR) suicide to test the link between ethnic minority status & RR suicides. One of first academics to gain access to the Nat'l database.
A search through Medline found 41 articles using the NVDRS for a variety of purposes • • Develop understanding of suicide for a Locate trends, areas, & demographic groups high in suicide in a state for group of interest(e.g. suicide among prevention & program evaluation pregnant women) for prevention (Gold et purposes (Powell, et al., 2006). al., 2012)
Present paper: Uses the NVDRS to locate new/neglected social predictors of suicide • Social Disorders vs. Mental Disorders. Since Durkheim’s (1897) Suicide, there has been on ongoing debate on the causes of suicide: is suicide primarily a individual/psychiatric problem or a social problem. • Social Disorders. Social aspects of suicide include strains in groups such as work, and family – unemployment & divorce are examples. • Mental Disorders. Psychiatric problems including major depression, substance abuse, dysthymia, & schizophrenia have dominated suicide studies. Disorders such as depression have received far more attention as contributing factors to suicide than social strains. • Table 1 illustrates the number of suicide articles carried by psychiatry journals and sociology journals (a discipline most apt to publish articles stressing social factors related to suicide) from 1980-2013. (MEDLINE, accessed 9-12 — 13). • NVDRS can be used to draw more attention to the social causes of suicide and to suggest strategies for prevention.
Neglect of Social Causes of Suicide: Articles Published in Psychiatry vs. Sociology Journals, 1980-2013 (source: Medline, accessed 9-12-13)
NVDRS: Present Analysis • Reviews full NVDRS restricted data on 30,593 suicides, NVDRS 2003- 2006. Data are from up to 17 states in the NVDRS network. • The version of the NVDRS we received from CDC included the rich qualitative investigator/police reports or narratives. • Took about ten months to get dual human subjects approvals & to transform & merge the 4 CDC data files into an SPSS readable file. • Assesses the prevalence of major categories of selected social strains and their subtypes in the NVDRS. Strains include: – Economic Factors, Legal problems, Intimate Partner Problems. • NVDRS & related data suggest new varieties of social strain: • Economic including demotions, indebtedness • Legal, including automobile accidents • Suggests suicide prevention efforts might be expanded from such modalities as media guidelines/school based programs to also include courts and the workplace.
JOB PROBLEMS & SUICIDE • The NVDRS main codes contain this category. It includes: tensions with a coworker, poor performance reviews, increased pressure, unemployment, having trouble finding a job, lay offs, &fear of layoffs. • Incidence of Job Problems in the NVDRS: Number of Suicide Percent of Suicides with problem with Problem Job Problems 3,049 10.0%
Previous Research on Job Problems: MEDLINE Search, 1980-2113 Job Problem Number of Articles in Medline with subject=suicide Unemployment 571 Job demotions 0 Under-employment 1 (Australia) Work strains 0 Co worker 0 Work pressure 0 Poor performance review 0 {Comparison (Depression)} 7,806 Most of the NVDRS sub categories of job problems are relatively new. The NVDRS narratives could be reviewed to further breakdown which subcategories are most/least frequent & to explore their co morbidities with other social &psychiatric factors.
DETROIT SUICIDE PROJECT & Work Problems: Selected Case Studies • Case 1. Mrs. Smith was notified of a demotion by her supervisor at work. At 5PM she drove home and suicided by Carbon Monoxide poisoning in her garage. • Case 2. After months of disputes with a colleague at a steak house. 2 workers engaged in a vicious knife fight. Shortly thereafter one suicided when faced with assault charges. • Case 3. A sexist male worker in an auto plant had a long term conflict with his female foreman. When she put him on unpaid leave, he suicided (Stack & Wasserman, 2008). • Elsewhere, using the NMFBS, persons who were demoted in the 12 months before their death were 6.1 times more apt to die through suicide than employed persons (Stack, 2009). • Stack, S. & Wasserman, I. (2007). Economic strain and suicide risk: A qualitative analysis. Suicide & Life Threatening Behavior . 37, 103- 112. Stack, S. (2009). The suicide of Ajax: A note on occupational strain as a neglected factor in suicidology. Pp.49-53 in Stack, S & Lester, D. (eds.). Suicide & the creative arts . New York: Nova Science.
FINANCIAL PROBLEMS & SUICIDE • NVDRS main codes contain this category. It includes: bankruptcy, overwhelming debts, foreclosure of a home or business, a gambling problem with mounting debts,& a husband and wife arguing about money. • Incidence of Financial Problems in the NVDRS: Number of Suicide Percent of Suicides with problem with Problem Financial 3,044 9.9% Problems
Previous Research on Financial Problems: MEDLINE Search, 1980-2013 Number of Articles in Medline with Job Problem subject=suicide Indebtedness 7 Eviction or foreclosure 1 bankruptcy 4 (OR=7.1, India) {Comparison (Depression Problem)} 7,806 {Comparison (Alcohol Problem)} 2,817 Most of the NVDRS sub categories of financial strain Are relatively new. The NVDRS narratives could be reviewed to further breakdown which subcategories are most/least frequent. & to explore their social/psychiatric contexts or comorbidities
DETROIT SUICIDE PROJECT & Financial Problems: Selected Case Studies • Case 1. Mrs. Jones was under a court order to pay back taxes in full or she would be imprisoned for defiance of a court order. The day before her hearing, not having the money, she suicided. • Case 2-10. Evictions. 8 of 9 persons with no where to go, suicided the night before their evictions. • Stack, S. & Wasserman, I. (2007). Economic strain and suicide risk: A qualitative analysis. Suicide & Life Threatening Behavior . 37, 103-112.
SOCIAL STRAIN: Legal Problems • Criminal legal problems include impending arrest, police pursuit , impending court date. Specifics can include: awaiting a criminal court date for a drunk driving charge, arrested for possession of cocaine, committed suicide while incarcerated . • Civil/Other Legal Issues. Examples include involvement in a heated court case involving child custody, child protective services recently removed a child from the victim’s home, being sued by a former business partner. • Incidence of Recent Legal Problems in the NVDRS: Number of Suicide with Percent of Suicides with problem Problem Criminal Legal Problems 2,845 9.3% Civil/other legal problems 1,010 3.3%
Previous Research on Legal Problems: MEDLINE Search, 1980-2013 Legal Problem Number of Articles in Medline with subject= suicide “legal problems” 0 ‘criminal litigation” 0 “court cases” 0 “civil courts” 0 Criminal arrests 4 Crime victimization 54 Crime perpetrators 28 courts Hits not relevant- on assisted suicide & related legal changes {Comparison (Depression Problem)} (7806)
Legal Problems & Suicide Risk: Pioneering Study, 1 county Legal Problem Suicides (255) Controls (510) w Odds Ratio w problem Problem Domestic Violence 5.1% 2.2% 2.4* Misdemeanors 12.9% 4.7% 3.0* All Criminal Cases 18.0% 8.2% 2.5* Motor Vehicle Accidents 5.1% 1.6% 3.0* All traffic Cases 17.6% 10.4% 1.9* Foreclosures 5.1% 1.8% 3.0* Multiple Civil Cases 3.1% 0.4% 8.2* * p< .05 Cook, T. & Davis, M. (2012). Assessing legal strains & risk of suicide. Suicide & Life Threatening Behavior , 42,495-506.
Intimate Partner Problems(IPP) & SUICIDE • IPP can include situations such as the victim goes to his old house shoots his estranged wife and then shoots himself, victim was engaged in a bitter custody dispute with her ex husband, (c )the victim reports that she & her husband had been arguing and she spent the night at her mother’s. (d) a mother forbid her 14 year old daughter from talking to a 19 year old male she had met online& the victim & her boyfriend broke up. • Incidence of IPP Problems in the NVDRS: Number of Suicides Percent of Suicides with problem with Problem Intimate Partner 8,260 27.0% Problems
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