An application of Durkheim's theory of suicide to prison suicide rates in the United States

E. Durkheim (1897) suggested that the societal rate of suicide might be explained by societal factors, such as marriage, divorce, and birth rates. The current study examined male prison suicide rates and suicide rates for men in the total population in the United States and found that variables based on Durkheim's theory of suicide explained prison suicide rates better than suicide rates for total population. Possible reasons for these findings are discussed.     

Gay identity, interpersonal violence, and HIV risk behaviors: an empirical test of theoretical relationships among a probability-based sample of urban men who have sex with men.

The highest absolute number of new HIV infections and AIDS cases still occur among men who have sex with men (MSM). Numerous theoretical approaches have been used to understand HIV risk behaviors among MSM; however, no theoretical model examines sexual risk behaviors in the context of gay identity and interpersonal violence. Using a model testing predictive correlational design, the theoretical relationships between childhood sexual abuse, adverse early life experiences, gay identity, substance use, battering, aversive emotions, HIV alienation, cue-to-action triggers, and HIV risk behaviors were empirically tested using confirmatory factor analysis and structural equation modeling. The relationships between these constructs are complex, yet childhood sexual abuse and gay identity were found to be theoretically associated with HIV risk behaviors. Also of importance, battering victimization was identified as a key mediating variable between childhood sexual abuse, gay identity, and adverse early life experiences and HIV risk behaviors among urban MSM.     

Ignoring the evidence dictating the practice: sexual orientation, suicidality and the dichotomy of the mental health nurse

International epidemiological studies demonstrate that gay and bisexual males are four times more likely to report a serious suicide attempt than their heterosexual counterparts. Data on completed suicides, usually derived from mortality statistics misrepresent the rate of suicides among homosexual populations. However, an increasing number of studies comparing representative samples of gay, lesbian and bisexual youths with heterosexual controls demonstrate increased rates of mental health problems and subsequent suicide among the homosexual population. Homosexual orientation must therefore be considered a risk factor for mental distress and as such should be a focus for any contemporary public health agenda. One of the difficulties of addressing the problem through a public health agenda is the juxtaposition proffered by our political and social environment. The Diagnostic and Statistical Manual of Mental Disorder ceased to define homosexuality as pathological in 1973 replacing it with a new 'illness' of 'gender identity disorder'. Until recently in England, Section 28 of the Local Government Act (1988), forbidding the promotion of homosexuality, further reinforced negativity towards this group of people. This compounded the negative mental health consequences for those developing a gay sexual orientation in a climate of heterosexism. Current health care policy in England concerns itself with the rising number of suicides among young people but fails to acknowledge the importance of the research findings relating to gay people by integrating them into the development of mental health policy. This paper reviews the literature relating to homosexual people and suicidality, and addresses the seriousness of a policy rhetoric which results from ignoring the evidence while dictating mental health nursing practice.     

Family and community influences on the social and sexual lives of Latino gay men.

The purpose of this study was to explore the effect of family and community on the social and sexual lives of a group of Latino gay men living in a metropolitan area. A secondary analysis of four focus groups with 28 Latino gay men was conducted. Families had a difficult time acknowledging and supporting participants' homosexuality. Participants experienced racism, discrimination, and physical and verbal abuse as a result of their ethnicity and homosexuality. These negative effects contributed to their marginalization and made them vulnerable to depression and suicide. Health care professionals should be aware of the effect of family and culture on the social and sexual lives of Latino gay men so that they can intervene and direct the client to the services needed to manage depression, suicidal ideation, and high-risk sexual behavior.     

"13th-Stepping:" Why Alcoholics Anonymous Is Not Always a Safe Place for Women

"Thirteenth-stepping" is a euphemistic term used among members of Alcoholics Anonymous (AA) to refer to people (particularly men) who target new, more vulnerable members (typically women) for dates or sex. Previous research suggests that women frequently experience sexual harassment in AA meetings and even in chemical dependency treatment settings. The objective of this survey study is to describe the frequency of various 13th-stepping experiences in a sample of women involved in AA.

Fifty-five women, aged 17-72 years, completed an anonymous survey to describe their experiences with 13th-stepping by men in AA. Results showed that at least 50% of the participants had at least occasionally experienced seven of the thirteen 13th-stepping behaviors listed in the survey. Also, compared to women who had never attended a female-only AA group, women who had attended such groups reported more 13th-stepping experiences from their attendance at coed groups. Two of the study participants volunteered that men they met in AA had raped them.

It is important that chemical dependency treatment providers be aware of 13th-stepping in AA, particularly when treating women. Especially vulnerable women, such as those with histories of sexual abuse, should be referred to female-only groups when possible. When women's groups are unavailable, women should be adequately prepared to protect themselves from 13th-stepping.     

Lifetime physical and sexual abuse in chronic pain patients: psychosocial correlates and treatment outcomes

Purpose : This study describes a subgroup of diagnostically heterogeneous chronic pain patients, with a lifetime history of physical and/or sexual abuse, who underwent a pain management programme. A battery of psychosocial and pain measures were assessed, as well as 1-year post-treatment socio economic outcomes.

Method : The prevalence of a history of abuse was assessed via a semi-structured interview of 162 consecutive patients (112 females and 50 males) presenting for 4-8 weeks of treatment in an interdisciplinary, outpatient rehabilitation programme. Treatment outcome data were gathered immediately, 6 months and 1 year following discharge. The chronic pain patients with a history of abuse were compared to those without a history of abuse on several pre-treatment psychosocial variables--pain severity, psychological distress, DSM-IV Axis I comorbidity and health care utilization. Patient groups were matched on age, race, primary pain diagnosis, time in pain prior to treatment and gender.

Results : Results indicated that 61% of patients had a history of lifetime physical and/or sexual abuse. Rates of sexual, and combined sexual and physical, abuse across the lifespan were higher for women than for men. Abused patients had a greater number of psychiatric diagnoses than nonabused patients. Abused patients also reported greater affective distress, less perceived life control, and a greater number of ER visits in the 6 months prior to treatment than their nonabused counterparts. A model consisting of gender (female), a higher number of psychiatric diagnoses, and higher affective distress was found to be a sensitive and relatively accurate predictor of abuse history. Finally, analyses indicated that, despite having greater psychosocial risk factors during the pre-treatment period, chronic pain patients with a history of abuse benefited from treatment and maintained treatment gains to a degree similar to nonabused chronic pain patients.

Conclusions : Chronic patients with an abuse history can successfully complete a rehabilitation programme if the programme is designed to treat their psychosocial distress. Moreover, this also carries over to treatment outcome. A history of abuse does not have to negatively impact long-term treatment outcomes in this population of chronic pain patients.     

Understanding the role of sex differences in work injuries: implications for primary care practice

Purpose. Primary care physicians care for work-injured women and men, yet there is little information on sex differences in outcomes and factors contributing to post-injury outcomes to guide their evaluation and recommendations.

Methods. Two self-administered questionnaires were sent to a large sample of women and men with work injuries reported to the New Hampshire (USA) Department of Labour between November 2000 and March 2002. Factors associated with the work injury and outcomes were assessed.

Results. A total of 3001 persons (1448 women and 1553 men) completed the first questionnaire and 67% completed the second questionnaire. Work-injured women were significantly younger, more educated, more likely to be single, had more pre-injury comorbidities, and worked in less physically demanding occupations as compared to work-injured men. Women's injuries were more often a result of routine job tasks and of gradual onset. Women had worse long-term outcomes including job stability and post-injury income. In multivariate analyses, being female was independently associated with a negative employer response and greater future work concerns.

Conclusions. Women and men differ in terms of work injury circumstances and factors contributing to post-injury outcomes. Primary care providers should consider sex when evaluating and treating work-injured adults.     

Health problems of gay and bisexual men.

Significant mental and physical morbidity occurs among gay and bisexual men because health care providers are often unaware of their actual or potential health concerns. Mental health problems include anxiety, depression, suicide, and both alcohol and substance abuse. Physical health concerns include HIV disease, hepatitis, and other sexually transmitted diseases, as well as an increased risk of heart disease and certain cancers. Health care professionals, who are clinically competent in the care of men who have sex with men, have the opportunity to reduce the risk of disease, while providing unbiased, quality care which recognizes the unique problems of this population of men.     

Unique aspects of women's emotional responses to disability

Purpose. To improve rehabilitation clinicians' awareness of gender differences in emotional responses to disability as a means of enhancing accuracy and sensitivity in diagnosis and treatment of persons in their care.

Method. A prospective survey study using a new grief measure, the Loss Inventory (LI), with a diverse convenience sample of persons undergoing inpatient rehabilitation in the USA. Focused review of the bereavement, depression, and disability literatures related to observed gender differences.

Results. Study participants reported grief symptoms in varying intensities. Consistent with all literature reviewed, significant gender differences were found in kind and intensity of grief and depression symptoms reported. Ethnicity also significantly affected responses to disability by LI study participant responses.

Conclusions. While persons with disabilities as a whole may not necessarily develop depression, gender is a risk factor for onset of mood problems after illness or injury-related losses. As compared with study sample disabled men, disabled women reported more intense and different symptoms of grief and depression. Women with disabilities in the LI sample were twice as likely as disabled men to be depressed. Rehabilitation clinicians may wish to incorporate consideration of these differences in their mental health assessments, diagnoses, and treatment plans.     

Barriers against returning to work--as perceived by disability pensioners with back pain: a focus group based qualitative study

Purpose. The aim of this study was to explore the issue of perceived barriers for returning to work, based on the experiences and beliefs in a group of disability pensioners with back pain.

Method. Focus groups were used to interview 12 women and five men, aged 38 - 56, who participated in a larger project aiming to help disability pensioners back to work.

Results. The barriers appearing were related to earlier negative experiences, poor self-judgement of work ability and low self-esteem, lack of support from social security authorities and unsuitable economic arrangements. The pensioners also suggested alternative solutions for making a possible return to work.

Conclusions. Our study provides insight into the perceived barriers of returning to work and might be useful in future efforts aiming to help disability pensioners back to work.     

Perceptions of lesbian, gay and bisexual people of primary healthcare services

AIM: This paper reports a study exploring people's perceptions of disclosure about lesbian, gay and bisexual identity to their primary healthcare providers. BACKGROUND: Disclosure of sexual identity to healthcare professionals is integral to attending to the health needs of lesbian, gay and bisexual populations, as non-disclosure has been shown to have a negative impact on the health of these people. For example, an increased incidence of suicide, depression and other mental health problems have been reported. METHOD: From April to July 2004, a national survey of lesbian, gay and bisexual persons was carried out in New Zealand. Participants were recruited through mainstream and lesbian, gay and bisexual media and venues, and 2,269 people completed the questionnaire, either electronically or via hard copy. The 133-item instrument included a range of closed-response questions in a variety of domains of interest. RESULTS: In this paper, we report results from the health and well-being domain. More women than men identified that the practitioner's attitude toward their non-heterosexual identity was important when choosing a primary healthcare provider. Statistically significantly more women than men reported that their healthcare provider usually or always presumed that they were heterosexual and in addition more women had disclosed their sexual identity to their healthcare provider. CONCLUSION: Nurses need to reconsider their approach to all users of healthcare services by not assuming everyone is heterosexual, integrating questions about sexual identity into health interviews and ensuring that all other aspects of the assessment process are appropriate and safe for lesbian, gay and bisexual people.     

Program Directors' Views of the Effect of Managed Care on Substance Abuse Programs in Southern California

This article reports the results of semi-structured interviews with substance abuse treatment (SAT) program directors (PDs) regarding the ways SAT is being influenced by managed care (MC), plans for future SAT, and strategies for decreasing costs of care. It compares findings to an earlier survey of 50 SAT PDs.

Interviews were conducted in 20 SAT programs to gather information about treatment delivery since the advent of MC, including PD responsibilities, funding source, treatment intensity, location, duration, and methods of treatment. Open-ended responses were used to gather information about current and future plans in providing SAT, and awareness of new types of treatment being planned by organizations impacted by MC.

PDs reported changes in SAT secondary to MC such as decreased treatment length, limiting of inpatient and outpatient services, and delayed treatment secondary to benefit determination. Political and economic constraints were seen as barriers to providing adequate and effective services. SAT being subsumed by mental health was viewed as problematic along with an emerging split between alcohol abuse and drug treatment. A positive emerging treatment trend was the development of targeted programs for special need groups.

PDs revealed a variety of strategies that have promoted necessary adaptations to economic and political influences within the structure of managed behavioral care. Strategies such as varying treatment length, modality, and subspecialty care reflected necessary adaptations to diverse market needs.

Managed care continues to have a tremendous impact on the delivery of SAT services. While MC has helped to contain costs, negative outcomes are decreased availability of appropriate care and overtaxing of units that have survived MC cut backs. However, special need programs have allowed SAT programs to specialize, expand, and even flourish in today's competitive SAT market. Interviews with PDs reinforced the need for maintaining quality and diversified SAT services in today's MC environment.     

Women's perception of changes in the social network after a spinal cord injury

Purpose. To describe how women with a spinal cord injury (SCI) perceived changes in the social network, and how these changes affected their ability to participate in occupation.

Method. Thirteen women, aged 25 to 61 years, with a SCI were interviewed twice. The interviews focused on their ability to participate in occupation, their relations with individuals within the social network, and changes in the social network following the SCI. The analysis was carried out using qualitative content analysis.

Results. The women described an emotional need for social support after the SCI to participate in occupation. This was a new experience that required time to adapt to. The women also described a need for practical social support from the social network members to manage meaningful occupation. After the SCI, the women had developed new habits through close cooperation with members in the social network. The women felt that they had become more responsible for the development of their relations. Many relations had improved after the SCI, while some had decreased. The women had also developed new relations with other persons with disabilities.

Conclusions. The women perceived substantial changes in the social network following the SCI, which in several ways affected their ability to participate in occupation. To adapt to their new life situation, the women gradually developed different strategies. The results point out the need to identify persons in the social network that women with SCI develop relations with, and integrate them in the rehabilitation process.     

The construction of men who are nurses as gay

AIM: This paper is a report of a study to examine the construction of the stereotype of male nurses as gay, and to describe how this discourse impacts on a group of New Zealand male nurses. BACKGROUND: A discourse stereotyping male nurses as gay is accompanied by one which privileges hegemonic masculinity and marginalizes homosexuality. METHOD: This social constructionist study drew on data collected from existing texts on men, nursing and masculinity and interviews with 18 New Zealand men conducted in 2003-2004. Discourse analysis, informed by masculinity theory and queer theory, was used to analyse the data. FINDINGS: Despite the participants' beliefs that the majority of male nurses are heterosexual, the stereotype persists. A paradox emerged between the 'homosexual' general nurse and the 'heterosexual' psychiatric nurse. The stigma associated with homosexuality exposes male nurses to homophobia in the workplace. The heterosexual men employed strategies to avoid the presumption of homosexuality; these included: avoiding contact with gay colleagues and overt expression of their heterosexuality. CONCLUSION: There is a paradox between widespread calls for men to participate more in caring and discourses which stereotype male nurses as gay and conflate homosexuality and sexual predation. These stigmatizing discourses create a barrier to caring and, aligned with the presence of homophobia in the workplace, deter men's entry into the profession and may be important issues with respect to their retention. Nurse educators must ensure that nurses are able to resist collusion with stigmatizing discourses that marginalize men (and women) in the profession through the perpetration of gender and sexual stereotypes.     

Minority Stress and Attributions for Discriminatory Events Predict Social Anxiety in Gay Men

This study revealed that attributional style can identify gay men at risk for adverse mental health correlates of discrimination, as well as those resilient in the face of frequent discriminatory events. Men identifying as gay (N = 307) completed online self-reports of social anxiety, perceived frequency of discriminatory events, attributions for discriminatory events, and key minority stress constructs: internalized homonegativity and gay identity development. A new measure was constructed to assess different types of attributions regarding discrimination, with factor analyses yielding promising psychometric properties. Global attributions and the importance ascribed to discrimination were associated with increased social anxiety, above and beyond other minority stress constructs related to mental health in gay men. Attribution style also served as a moderator, as perceived discrimination was only associated with increased social anxiety in gay men who attributed high globality/importance to discriminatory events. Attributions may serve as risk or protective factors in the context of discrimination.     

Modeling social reintegration in persons with spinal cord injury

Purpose: This study was undertaken to identify and develop a model of the factors related to social reintegration in persons with spinal cord injury (SCI).

Method: A convenience sample of 145 persons with SCI living in two cities in South Korea anonymously completed a questionnaire that comprised the assessment of social reintegration, a tool developed to measure the degree of adjustment to community living in persons with SCI. Structural equation modeling was used to examine the direct and indirect effects of self-esteem, social barriers, physical function, family support, informational support, perceived stress, emotion-focused coping (EFC), and problem-focused coping (PFC) on social reintegration.

Results: The model explained 65% of the variance in social reintegration in persons with SCI. The results indicated that the social reintegration of persons with SCI was influenced most by EFC. Family support, informational support, perceived stress and social barriers were also significantly related to social reintegration.

Conclusions: These findings suggest implications for developing the interventions at various levels including family and community and specific to individual coping strategies to enhance social reintegration in persons with SCI.     

To regain participation in occupations through human encounters--narratives from women with spinal cord injury

Purpose. To gain an understanding of how women with spinal cord injury (SCI) experienced human encounters in occupations and how these influenced their participation.

Method. The data were collected through two or three in-depth interviews with 13 women (age 25 - 61 years) with SCI. Data analysis was carried out by using a paradigmatic analysis of narrative data, followed by an interpretation based on a narrative theory.

Results. The results showed a complexity where the women's experiences and acting in human encounters changed over time. In these human encounters the women struggled with conflicts, supported other persons that were insecure and revaluated their apprehension about persons in their social network. These multidimensional human encounters thereby enabled them to regain participation in occupations.

Conclusions. This shows that human encounters are important for persons with disabilities so they can restructure their occupational identity and their needs for participation in occupations. The study also showed that the use of narratives as a tool within rehabilitation could lead to an increased understanding of the subjective changes that occur over time for a person with a disability.     

The adoption of tobacco dependence treatment by rehabilitation clinicians

Purpose: Individuals with disabilities tend to smoke at rates that surpass those of the general population. The Public Health Service Guideline on the treatment of tobacco dependence suggests that all smokers be screened at every health care visit and counselled regarding how best to quit smoking. We review the literature on the adoption of tobacco dependence treatment by rehabilitation clinicians working with disabled individuals. Despite the deleterious health effects of smoking on individuals with disabilities, the limited data suggests that rehabilitation clinicians rarely encourage their clients who smoke to quit.

Method: Studies were collected using various computerized databases from 1980 to the present. Because of the paucity of literature on tobacco dependence treatment utilization among rehabilitation clinicians, we also examine research on the use of tobacco dependence treatment by health care providers in the general population and in substance abuse treatment settings.

Results: Despite the efficacy of tobacco dependence treatment in smokers with disabilities, tobacco dependence treatment appears to be underutilized by rehabilitation clinicians.

Conclusions: Interventions that have successfully increased adoption by the two other clinician groups should be utilized to increase tobacco dependence treatment provision by rehabilitation clinicians. Additional research is warranted to determine how to overcome obstacles to adoption.     

Psychological factors after traumatic amputation in landmine survivors: The bridge between physical healing and full recovery

Purpose: Limb loss due to a landmine injury is sudden and devastating. The resulting disability makes life challenging in a world where physical ability is the 'norm'. In order to better understand the psychological adjustments individuals make in their recovery from a landmine injury, the Landmine Survivors Network conducted an exploratory qualitative study to determine factors that contribute to an individual's recovery. The study examined psychosocial aspects, coping strategies, and resilience characteristics of limb loss survivors across differing cultural, societal and economic backgrounds.

Method: Eighty-five participants (68 persons of limb loss, 10 family members, seven service providers) were interviewed using a semi-structured protocol in the USA and an open-ended format in six landmine affected countries. Data analysis was completed using grounded theory analytic strategies.

Results: Data indicated that the survivors' acceptance of limb loss and their state of psychological recovery were greatly influenced by the individual's resilience characteristics, social support, medical care, economic situation and societal attitudes toward people with disabilities.

Conclusion: Recovery from traumatic amputation in landmine survivors needs to be comprehensive and coordinated, and requires addressing the individual's physical, psychological, economic and social needs within the context of family, community, and the socio-cultural environment in which they live.