Medical Marijuana Laws and Suicide.

In the current study we use a synthetic control group design to estimate the causal effect of a medical marijuana initiative on suicide risk. In 1996, California legalized marijuana use for medical purposes. Implementation was abrupt and uniform, presenting a "natural experiment." Utilizing a panel dataset containing annual frequencies of Total, gun, and non-gun suicides aggregated by state for the years 1970-2004, we construct a control time series for California as a weighted combination of the 41 states that did not legalize marijuana during the analysis period. Post-intervention differences for California and its constructed control time series can be interpreted as the effects of the medical marijuana law on suicide. Significance of the effects were assessed with permutation tests. Our findings suggest that California's 1996 legalization resulted in statistically significant (p<.05) reductions in suicides and gun suicides, but only a non-significant reduction in non-gun suicides (p≥.488). Since the effect for non-gun suicides was indistinguishable from chance, we infer that the overall causal effect was realized through gun suicides. The mechanism could not be determined, however. Participation in the medical marijuana program legally disqualifies participants from purchasing guns. But since most suicides involve guns, it is possible that the effect on total suicide is driven by gun suicide alone.

Controlling Gun Violence: Assessing the Impact of Australia's Gun Buyback Program Using a Synthetic Control Group Experiment.

Gun Buyback programs have been implemented in various forms in countries such as the UK, USA, Brazil, Australia, and Argentina. Whether or not these programs are an effective approach for reducing national violent crime and homicides, however, remains unclear. Much of the uncertainty is due to the different ways in which Gun Buyback programs have been implemented. The Australian Gun Buyback program is distinguished from Gun Buyback programs in other countries by its abrupt implementation, its narrow focus on a particular class of firearms, and its broad application across the entire population. We assess the impact of Australia's 1996 Gun Buyback program on national homicide rates using a synthetic control group quasi-experimental design, comparing the results to suicide and motor vehicle fatality trends to test for plausible alternative hypotheses. Results suggest that the Gun Buyback program significantly reduced Australia's homicide rate in the decade following the intervention (1997-2007).

Length of stay for 25,791 California patients found incompetent to stand trial.

Referrals and admissions to state psychiatric hospitals of criminal defendants found Incompetent to Stand Trial (IST) are on the rise in the state of California and other parts of the country. Studies of treatment outcomes of this population have primarily focused on factors that determine competency and/or restorability. However, as IST patients place an increasing resource burden on state psychiatric hospital systems, other outcomes such as length of stay (LOS) are becoming increasingly important for practitioners and policy makers to understand. This study employs the largest sample of IST patients in the literature; it includes all IST patients admitted to California's state psychiatric hospitals between 2003 and 2016. This study analyzes demographics, clinical diagnoses, and hospital placement as predictors of LOS. Results suggest that demographics, with the exception of age, are poor predictors of LOS. However, diagnoses, especially of severe mental disorders (e.g., schizophrenia) were strongly related to LOS. Hospital placement was the strongest predictor of LOS. Explanations of these results and implications for forensic practitioners are discussed.

Characteristics of Forensic Patients in California With Dementia/Alzheimer's Disease.

Criminal defendants found incompetent to stand trial (IST) are sent to state hospitals for treatment to be restored to competency. IST patients diagnosed with dementia and related disorders present a particular challenge to clinicians, because they must be restored successfully within a statutorily mandated time frame (e.g., 3 years in California for defendants charged with a felony offense). This study examined a comprehensive data set that included all forensic patients served by California's Department of State Hospitals from September 2003 to February 2016. The findings revealed that, although most IST patients with a dementia diagnosis were restored to competency within the statutory time frames, they spent, on average, over twice as long confined than IST patients without a dementia diagnosis and were less likely than the latter group to be successfully restored. One implication of these findings is that forensic clinicians ought to assess whether IST patients diagnosed with dementia are likely to be restored or not as early as possible in the evaluation and triage process and report to the court any IST patients with a dementia diagnosis who are unlikely to be restored successfully. This would both prevent such patients from gratuitous confinement as well as free up treatment resources for other patients.

Building Virtual Watersheds: A Global Opportunity to Strengthen Resource Management and Conservation.

Modern land-use planning and conservation strategies at landscape to country scales worldwide require complete and accurate digital representations of river networks, encompassing all channels including the smallest headwaters. The digital river networks, integrated with widely available digital elevation models, also need to have analytical capabilities to support resource management and conservation, including attributing river segments with key stream and watershed data, characterizing topography to identify landforms, discretizing land uses at scales necessary to identify human-environment interactions, and connecting channels downstream and upstream, and to terrestrial environments. We investigate the completeness and analytical capabilities of national to regional scale digital river networks that are available in five countries: Canada, China, Russia, Spain, and United States using actual resource management and conservation projects involving 12 university, agency, and NGO organizations. In addition, we review one pan-European and one global digital river network. Based on our analysis, we conclude that the majority of the regional, national, and global scale digital river networks in our sample lack in network completeness, analytical capabilities or both. To address this limitation, we outline a general framework to build as complete as possible digital river networks and to integrate them with available digital elevation models to create robust analytical capabilities (e.g., virtual watersheds). We believe this presents a global opportunity for in-country agencies, or international players, to support creation of virtual watersheds to increase environmental problem solving, broaden access to the watershed sciences, and strengthen resource management and conservation in countries worldwide.

Reduction in incidence of hospitalizations for psychotic episodes through early identification and intervention.

OBJECTIVE: This study examined whether the incidence of hospitalization for psychosis was reduced by a communitywide system of early identification and intervention to prevent onset of psychosis. METHODS: The Portland Identification and Early Referral program (PIER) was initiated in 2001. Youths and young adults ages 12-35 were identified by professionals in a wide variety of educational, health, and mental health settings. PIER program staff assessed, confirmed risk of psychosis, and provided treatment for 24 months to eligible and consenting young people (N=148). The monthly rate of first hospital admission for psychosis was the outcome measure for efficacy of identification and intervention. Admission rates before and after the program began accepting referrals were compared, both in the experimental area (Greater Portland) and in aggregated urban areas of Maine (control areas). Autoregressive integrated moving-average (ARIMA) models were used to assess the effect. RESULTS: On the basis of ARIMA models, the rate of first hospital admission for psychosis decreased significantly by 26% (95% confidence interval [CI]=-64% to -11%) in the Greater Portland area. The rate increased by 8% (CI=-5% to 36%) in the control areas. Taking into account the increase in the control areas, the actual percentage reduction in Greater Portland during the intervention period was 34% (26% plus 8%). The reduction in admissions was largest for individuals with nonaffective nonschizophrenic psychosis. CONCLUSIONS: PIER has demonstrated that populationwide early identification is feasible. Preventive intervention can reduce rates of initial hospitalizations for psychosis in a midsized city.

Categorical and Dimensional Definitions and Evaluations of Symptoms of ADHD: History of the SNAP and the SWAN Rating Scales.

An earlier version of this article was originally submitted for publication in early 2000 to introduce a new dimensional of concept of Attention Deficit Hyperactivity Disorder (ADHD) provided by the Strengths and Weaknesses of ADHD-symptoms and Normal-behavior (SWAN) rating scale. The SWAN was developed to correct some obvious deficiencies of the Swanson, Nolan and Pelham (SNAP) rating scale that was based on the categorical concept of ADHD. The first submission was not accepted for publication, so a draft of the article was posted on a website (www.ADHD.net). The SWAN scale was published as a table in a review article (Swanson et al, 2001) to make it available to those interested in this dimensional approach to assessment of ADHD. Despite its relative inaccessibility, the SWAN has been used in several genetic studies of ADHD (e.g., Hay, Bennett, Levy, Sergeant, & Swanson, 2005; Cornish et al, 2005) and has been translated into several languages for European studies of ADHD (e.g., Lubke et al, 2006; Polderman et al, 2010) and into Spanish for studies in the United States (e.g., Lakes, Swanson, & Riggs, 2011; Kudo et al., this issue). Recently, invitations to include the SWAN in the PhenX Toolkit (www.phenx.org) for genomic studies (Hamilton et al, 2011) and to describe thedimensional approach of the SWAN for discussion of diagnostic (Swanson, Wigal, & Lakes, 2009) and ethical (Swanson, Wigal, Lakes, &Volkow, 2011) issues has convinced us that the unpublished article is still relevant after more than a decade, so it is presented here with some minor updates. We use examples (a) to document some consequences (e.g., over-identification of extreme cases) of using statistical cutoffs based on the assumption for a distribution of SNAP ratings that is highly skewed and (b) to show how the SWAN corrects the skewness of the SNAP by rewording the items on the scale and using a wider range of rating alternatives, which corrects the tendency to over-identify extreme cases.

Does legalized gambling elevate the risk of suicide? An analysis of U.S. counties and metropolitan areas.

This study addresses a possible link between suicide and casino gambling. Resident suicide rates are analyzed for (a) a 1990 cross-section of 148 U.S. metropolitan areas and (b) before and after the advent of legalized casinos in five U.S. counties. Data are drawn from government and gaming industry sources. In cross-section, metro area suicide is strongly correlated with region, accidental death and homicide rates, age and race composition, and economic vitality, followed by a modest net positive correlation with casino presence. By contrast, the time series analysis yields no evidence of a gambling effect.