Impact of suicide mortality on life expectancy in the United States, 2011 and 2015: age and sex decomposition.

OBJECTIVES: This study examined (1) potential differences in life expectancy when suicide as a cause of death was discounted and (2) suicide's contributions to changes in life expectancy by age group and sex. METHODS: Data were from the 2011 and 2015 National Violent Death Reporting System on all suicide decedents aged 10 years or older in 17 US states. Life tables were constructed based on the total population and all-cause mortality data from the Centers for Disease Control and Prevention. Differences in life expectancy were calculated using Arriaga's decomposition method. RESULTS: The numbers of suicide deaths in both 2011 and 2015 were 3-4 times higher among males than females in all age groups. The highest impact for both males and females was in the 55-64 age group, with changes in life expectancy of 1.64 years in 2011 and 1.60 years in 2015 for men, and 1.30 years in 2011 and 1.27 years in 2015 for women. Between 2011 and 2015, the percent change in suicide mortality rates for all age groups was 7.44% in males and 15.72% in females. However, the groups that negatively impacted changes in life expectancy due to significant increases in suicide mortality were males aged 25-34 (22.80%) and 55-64 (15.45%) and females aged 15-19 (34.74%) and 55-64 (23.15%). Eliminating suicide as a cause of death would have increased life expectancy at birth by 1.92 years for males and 1.36 years for females from 2011 to 2015. CONCLUSIONS: This study updates information on suicide and adds to calls for more effective suicide prevention efforts, especially for older adolescent girls, young men, and middle-aged men and women.

Self-help group meeting attendance among clients with dual diagnoses.

This study explores factors associated with self-help group meeting attendance in the aftercare of 81 clients with dual diagnoses of severe mental illness and chemical dependency following their discharge from an inpatient chemical dependency treatment program. It also explores the association between self-help group meeting attendance and treatment outcomes. Data were collected from patient records and results of the Addiction Severity Index (ASI) administered as part of an earlier experiment that evaluated the effectiveness of the treatment program. Collaterals also provided follow-up information. Of thirteen variables examined, only two were associated with increased self-help group meeting attendance: having more years of education and having a major substance problem that did not include alcohol. No association was found between self-help group meeting attendance and treatment outcome regarding psychiatric problem severity or five other domains of the ASI. A moderate association was found indicating that more self-help group meeting attendance was related to improvements in the legal problems domain of the ASI. Implications are discussed for future research and for improving self-help group meeting attendance and its influence on treatment outcomes for individuals with dual diagnoses.

Gender differences in social and psychological problems of substance abusers: a comparison to nonsubstance abusers.

This study examines gender differences in 16 social and psychological problems among substance abusers and nonsubstance abusers in a community population to determine whether such differences are simply a reflection of differences between men and women in the general population. Data were gathered from 119 respondents using the Addiction Severity Index. Loglinear analysis suggests that problems typically attributed to "being a female substance abuser" may be due to the effect of gender or substance abuse alone. Only two problems significantly distinguish female substance abusers from the other comparison groups: psychiatric hospitalizations and relatives with substance abuse. However, women in the overall sample were more troubled by family problems, had more parents with psychiatric problems, and received more outpatient psychiatric treatment. Problems associated with substance abuse, not gender, include divorce, problems controlling violence, and parents with substance abuse problems. These findings suggest that substance-abusing women experience a "double whammy" because they incur both the problems of women and the problems of substance abusers. Disaggregating gender and substance abuse effects has implications for treatment-matching and relapse prevention, specifically for suggesting strategies that address the special vulnerabilities of substance-abusing women.

Organizational affiliation and effectiveness: the case of rape crisis centers.

Many rape crisis centers (RCCs) that were founded as autonomous organizations have affiliated with other organizations. The relationship of affiliation type and effectiveness is examined in a sample of 25 RCCs in Florida. Effectiveness is defined in terms of range of services for rape victims and involvement in rape prevention (social change) activities. The data show that 23 RCCs are affiliated with six types of organizations and two are free-standing. Each affiliation type has advantages and disadvantages but, overall, free-standing RCCs appear to be most effective and RCCs affiliated with community mental health centers, least effective. Of the seven types, free-standing agencies are most involved in rape prevention activities aimed at social change.

The rape exam: beyond the hospital emergency room.

Data from 31 Florida post-rape examination sites reveal a number of dilemmas associated with rape exams. The sites include regular hospital ERs (N = 25), specialized sexual assault treatment centers (SATCs) on hospital grounds (N = 2), a nonhospital-based SATC, a proprietary OB/GYN clinic, a medical examiner's office, and a law enforcement crime lab. Open-ended interviews indicate that major problems with hospitals as exam sites stem from physicians' dislike of the exam and physician and hospital fears of legal and court entanglements. Prosecutors (and judges) are a major obstacle to nonphysician examiners. A challenge to rethink the post-rape exam, including where and by whom it is performed, is posed.