Threats of school violence in Pennsylvania after media coverage of the Columbine High School massacre: examining the role of imitation.

BACKGROUND: Following the April 20, 1999, massacre at Columbine High School, Littleton, Colo, school administrators, law enforcement officials, and the media reported a rash of successive bomb threats and threats of school violence that were attributed to imitation. OBJECTIVE: To establish that the clustering of threats of school violence following the Columbine massacre was initiated by imitation. DESIGN: A database of threats of school violence reported to the Pennsylvania Emergency Management Agency, Harrisburg, during the 50 days following the Columbine incident was examined to determine the daily frequency of threats. To determine factors that predict the occurrence of these threats, counties and school districts in which threats occurred were noted. RESULTS: Pennsylvania school districts reported 354 threats of school violence during the 50 days after the Columbine massacre, far exceeding the 1 or 2 threats per year estimated by school administrators before 1999. The frequency of these threats over time demonstrated a crescendo-decrescendo pattern. Fifty-six percent of the threats were made on or before day 10 after the incident, and more than one third occurred on days 8, 9, and 10. Factors that predicted the likelihood of a school's receiving a threat after the massacre included a greater proportion of white students and larger school enrollment. CONCLUSIONS: Successive threats of violence follow a publicized act of school violence. The media should recognize that imitation threats can occur and craft their stories accordingly.

Suicidal ideation and the choice of advance directives by elderly persons with affective disorders.

The charts of 191 geriatric psychiatric inpatients with major depressive disorder or bipolar disorder were examined to determine demographic and psychiatric factors associated with the advance directive to have cardiopulmonary resuscitation (CPR) or not to have it in a life-threatening situation. Overall, 48 percent of patients wanted no CPR, 12 percent wanted CPR only, and 41 percent wanted all therapy performed. Patients with suicidal ideation (26 percent of the sample) were significantly more likely to choose not to have CPR. Sixty percent of patients with suicidal ideation chose not to have CPR. Patients with bipolar disorder and patients under age 70 were more likely to choose CPR.

Alaska native suicide: lessons for elder suicide.

Suicide rates in Alaska Native elders are studied to further explore cultural factors in elderly suicide. Data for the 1960s and 1970s are reviewed, and new data on Alaska Native suicide rates are presented for the 10-year period of 1985 through 1994. In many areas throughout the world, suicide rates are the highest for the elderly. During the Alaska "oil boom," suicide rates more than tripled for the general population but decreased to zero for Alaska Native elders. Cultural teachings from the society's elders were more important during this time of culture upheaval. During the study period, the cultural changes dissipated, and suicide rates for Alaska Native elders, although lower than those of White Alaskans, increased. This provides further evidence that suicide rates for elders can be influenced by social factors--both to raise to lower rates.

Incidence of asystole in electroconvulsive therapy in elderly patients.

The authors prospectively investigated the incidence of asystole (absence of heartbeat for 5 seconds) in elderly patients receiving electroconvulsive therapy (ECT) at a university-based geriatric psychiatry unit. In all, 65.8% of patients experienced asystole at some time during their course of ECT. Those who experienced asystole were significantly younger (average age, 72.2) than those without asystole (average age, 77.0; P = 0.026) and were also less likely to have cardiac rhythm disturbances on electrocardiogram (P = 0.024). Medical history, history of cardiac disease, electrode placement, energy level, and number of ECT treatments did not predict asystole. Asystole is a common side effect of ECT in elderly patients. It was not associated with any untoward outcome. The fact that "old-old" patients and those with cardiac disease are less likely to experience asystole than younger, healthier patients is reassuring to practitioners of ECT.

Seasonal differences in suicide birth rate in Alaska Natives compared to other populations.

Seasonal differences in suicide birth rates among Alaska Natives and for populations at different latitudes (residents of the Yukon, Saskatchewan, Montana, Wyoming, and Pennsylvania) were investigated. Seasonal birth rates for the general population were similarly examined. Suicide birth rates showed small seasonal variations for Alaska Natives with summer births showing more suicides. However, at lower latitudes, suicide birth rates among other populations showed no seasonal differences. Hours of daily sunlight at the summer and winter solstice correlated with the proportion of suicide victims born during those seasons. Seasonal differences in birth rates of suicide victims correlated strongly with latitude and seasonal differences in daylight. General population birth rates did not show significant seasonal differences, and did not correlate with differences in latitude or sunlight length at the summer or winter solstice.

Sexual harassment of health care students by patients.

1. Forty percent of the 158 nursing and occupational therapy students surveyed reported being victims of sexual harassment. 2. When confronted with sexual advances or assaults, students used previously learned coping strategies. Thirty-nine percent ignored the behavior or joked about it. 3. A training program was designed and implemented to make students feel better able--and more empowered--to handle sexual harassment.

Alcohol and suicide in Alaska Natives.

A retrospective review of hospital records from the Alaska Native Medical Center, controlled for age, sex, and race, is presented for 33 Alaska Native suicide completers who died between 1980 and 1984. Suicide rates for Alaska Natives were twice the national average during the study period. The only significant differences between the suicide and control groups was the history of a prior suicide attempt (p 0.003). Alcohol abuse was diagnosed more often than any other psychiatric disorder in the suicide group and appears to be the most important antecedent of suicide in this study.

Suicide in Alaska Natives, 1979-1984.

Alaska native suicide data were reviewed for every Alaska native suicide (N = 90) from death certificate data for the years 1979-1984 and compared to suicide statistics of age- and sex-matched groups of the entire U.S. population. The yearly suicide rate for Alaska natives was about twice that for the United States. Most of this difference was accounted for by dramatically and significantly greater rates for young, single, Alaska native men compared to white men in the U.S.; this was true for both the 15-24 and 25-34 age groups. With advancing age, suicide rates among Alaska natives decreased; the rates for the 35-44 and 45-54 male groups were still much greater, but not significantly so, than the rates for the comparable U.S. groups. After age 55, no suicides were reported for Alaska natives while U.S. white men had their highest suicide rates in the 55-64 and 65 and above groups. A number of social factors appear to have fueled the rise in suicide rates in young Alaska native men, including: economic growth, industrialization and changing lifestyles; prevalence of firearms; and a high rate of alcoholism.

Neurological factors in obsessive compulsive disorder. Two case reports and a review of the literature.

Two patients are described in whom an obsessive-compulsive disorder began just after the onset of epilepsy. Neurological factors in OCD are then reviewed, and clinical reports of patients with OCD and co-existing brain pathology, EEG abnormalities, CT scan changes and electrical stimulation of the brain discussed. It is concluded that neurological factors are present in only a minority of cases of OCD. Successful behavioural treatment is independent of such factors.