计量经济分析 = Econometric analysis

Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs—thwarted belongingness and perceived burdensomeness (and hopelessness about these states)—and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory’s hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory’s hypotheses.

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The Interpersonal Theory of Suicide

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.

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Suicide and Suicidal Behavior

Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record

Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research.

Background 

Psychiatric disorders are common during young adulthood and comorbidity is frequent. Individual psychiatric disorders have been shown to be associated with negative economic and educational outcomes, but few studies have addressed the relationship between the total extent of psychiatric disorder and life outcomes.

Aims 

To examine whether the extent of common psychiatric disorder between ages 18 and 25 is associated with negative economic and educational outcomes at age 30, before and after controlling for confounding factors.

Method 

Participants were 987 individuals from the Christchurch Health and Development Study, a longitudinal study of a birth cohort of individuals born in Christchurch, New Zealand, in 1977 and followed to age 30. Linear and logistic regression models were used to examine the associations between psychiatric disorder from age 18 to 25 and workforce participation, income and living standards, and educational achievement at age 30, before and after adjustment for confounding factors.

Results 

There were significant associations between the extent of psychiatric disorder reported between ages 18 and 25 and all of the outcome measures (all P 0.10).

Conclusions 

After due allowance had been made for a range of confounding factors, psychiatric disorder between ages 18 and 25 was associated with reduced workforce participation, lower income and lower economic living standards at age 30.

/pdf/burden-of-psychiatric-disorder-in-young-adulthood-and-life-kki16wd9o8.pdf

Burden of psychiatric disorder in young adulthood and life outcomes at age 30.

Objective: To examine further suicide attempts and mortality in the 10 years after a suicide attempt requiring hospital admission.Method: Participants were a consecutive series of 3690 individuals admitted to Christchurch Hospital for attempted suicide during the 10-year period 1993–2002. Data were obtained on admissions to Christchurch Hospital for attempted suicide during the study period. Mortality subsequent to the index suicide attempt was established from the National Mortality Database. The influence of age, gender and method of index suicide attempt on mortality and further suicide attempts requiring hospitalization were examined.Results: Within 10 years, 28.1% of those who had been admitted for an index suicide attempt were readmitted for a further non-fatal suicide attempt, and 4.6% died by suicide. Risks and rates of readmission were higher in: females; those under 55; and those whose index attempt involved a method of low lethality. Risks and rates of suicide were higher in: males; those aged ...

Mortality and further suicidal behaviour after an index suicide attempt: A 10-year study.

Gender differences in educational achievement were examined in a cohort of 1265 individuals studied from birth to age 25. There was a small but pervasive tendency for females to score better than m...

Gender Differences in Educational Achievement to Age 25.

Background 

Self-harm and suicidal behaviour are common reasons for emergency department presentation. Those who present with self-harm have an elevated risk of further suicidal behaviour and death.

Aims 

To examine whether a postcard intervention reduces self-harm re-presentations in individuals presenting to the emergency department.

Method 

Randomised controlled trial conducted in Christchurch, New Zealand. The intervention consisted of six postcards mailed during the 12 months following an index emergency department attendance for self-harm. Outcome measures were the proportion of participants re-presenting with self-harm and the number of re-presentations for self-harm in the 12 months following the initial presentation.

Results 

After adjustment for prior self-harm, there were no significant differences between the control and intervention groups in the proportion of participants re-presenting with self-harm or in the total number of re-presentations for self-harm.

Conclusions 

The postcard intervention did not reduce further self-harm. Together with previous results this finding suggests that the postcard intervention may be effective only for selected subgroups.

/pdf/postcard-intervention-for-repeat-self-harm-randomised-1ee4bn9giy.pdf

Postcard intervention for repeat self-harm: randomised controlled trial.

Objectives: Safety barriers to prevent suicide by jumping were removed from Grafton Bridge in Auckland, New Zealand, in 1996 after having been in place for 60 years. This study compared the number of suicides due to jumping from the bridge after the reinstallation of safety barriers in 2003.Methods: National mortality data for suicide deaths were compared for three time periods: 1991–1995 (old barrier in place); 1997–2002 (no barriers in place); 2003–2006 (after barriers were reinstated).Results: Removal of barriers was followed by a fivefold increase in the number and rate of suicides from the bridge. These increases led to a decision to reinstall safety barriers. Since the reinstallation of barriers, of an improved design, in 2003, there have been no suicides from the bridge.Conclusions: This natural experiment, using a powerful a-b-a (reversal) design, shows that safety barriers are effective in preventing suicide: their removal increases suicides; their reinstatement prevents suicides.

https://www.researchgate.net/profile/Annette_Beautrais/publication/24425987_Removing_bridge_barriers_stimulates_suicides_an_unfortunate_natural_experiment/links/0fcfd509ab1553093e000000.pdf

Sheree J. Gibb

Papers

Burden of psychiatric disorder in young adulthood and life outcomes at age 30.

Mortality and further suicidal behaviour after an index suicide attempt: A 10-year study.

Gender Differences in Educational Achievement to Age 25.

Postcard intervention for repeat self-harm: randomised controlled trial.

Removing bridge barriers stimulates suicides: an unfortunate natural experiment