Suicidal ideation among low-income women on family assistance programs.

Low-income women face significant adversities. Many of the adversities they contend with have been associated with suicidal ideation in other groups. However little is known about low-income women's suicidal ideation and its correlates. The purpose of this study was to evaluate prevalence of and risk factors associated with suicidal ideation in a randomly drawn sample of 2,112 women ranging in age from 18 to 59 years and enrolled in family assistance programs. As in other studies of low-income women, this group had high rates of mental and physical health problems. Yet, the overall prevalence rate of suicidal ideation was not substantially higher than those found in other populations. Emotional difficulties, substance abuse/dependence, physical limitations, having been arrested, and injuries were associated with suicidal ideation. Increasing numbers of adversities were associated with increasing prevalence of suicidal ideation. Employment and pregnancy were inversely associated with suicidal ideation when controlling for adverse events. This study provided important information on prevalence and risk factors associated with suicidal ideation among low income women on family assistance programs as well as suggested areas for future work to improve the health of these women.

Underascertainment of child maltreatment fatalities by death certificates, 1990-1998.

OBJECTIVE: Child fatality review teams have emerged across the United States in the past decade to address the concern that systems of child protection, law enforcement, criminal justice, and medicine do not adequately assess the circumstances surrounding child fatality as a result of maltreatment. METHODS: We compared data collected by a multidisciplinary child fatality review team with vital records for all children who were aged birth to 16 years and died in Colorado between January 1, 1990, and December 1, 1998. Odds ratios and 95% confidence intervals for ascertainment by the death certificate were estimated using logistic regression. RESULTS: Only half of the children who died as a result of maltreatment had death certificates that were coded consistently with maltreatment. Black race and female gender were associated with higher ascertainment, whereas death in a rural county was associated with lower ascertainment. Deaths resulting from violent causes (eg, shaking, blunt force trauma, striking) were more likely to be ascertained than those that involved acts of omission (eg, neglect and abandonment, drowning, fire). The most common perpetrators of maltreatment were parents. However, maltreatment by an unrelated perpetrator was 8.71 times (95% confidence interval: 3.52-21.55) more likely to be ascertained than maltreatment by a parent. CONCLUSIONS: The degree of underascertainment found in this study is of concern because most national estimates of child maltreatment fatality in the United States are derived from coding on death certificates. In addition, the patterns recognized in this study raise concern about systematic underascertainment that may affect children of specific sociodemographic groups.