Recent trends in suicide and homicide among blacks

The black community contends daily with the phenomena of suicide and homicide. However, it is the killing of black males that constitutes the heaviest burden for the group. Black suicide rates, on the other hand, continue to be lower than white suicide rates. Nevertheless, it is the black male group between the ages of 25 and 34 years that bears the brunt of both suicide and homicide. This article reviews the major theories advanced to explain the existence of these serious public health problems in the black community, suggests ways of attacking these problems, and also delineates significant areas for future research.     

International and interstate comparisons of homicide among young males

The homicide rate for males 15 through 24 years of age in the United States was compared with the rates in 21 other developed countries. The US homicide rate, 21.9 per 100,000, was more than four times higher than the next highest rate in Scotland (5.0). Most countries had rates that were between 1 and 3 per 100,000. The lowest rates were in Japan and Austria, each with rates below 0.6 per 100,000 males 15 through 24 years of age. Three quarters of the homicides in the United States resulted from the use of firearms contrasted with less than a quarter of all homicides in the comparison countries. The US homicide rate for black males 15 through 24 years of age (85.6) was more than seven times the rate for white males (11.2). In 1987 there were only four states that had homicide rates among white males that were as low as the rates among males in the comparison countries. The lowest state rate among young black males was still seven times the highest rate abroad. There are about 4000 homicides per year among young males in the United States. If the US homicide rate could be reduced to that in the country with the next highest rate, more than 3000 lives would be saved.     

Radiological evidence of a modern 'martyr's crown': suicide by multiple self-inflicted nail gun shots

A man attempted suicide by shooting seven nails into his head with a nail gun; five in the right temporal region and two in the left. He subsequently presented at the emergency department with complaints of headache. He was found to be oriented in space and time, with no focal neurological deficits. The patient handed the nail gun to the doctors and informed them that he had earlier attempted suicide. Radiological studies showed the presence of nails arranged like a 'martyr's crown'. The man died six days after the surgical removal of the nails. Autopsy was refused by Italian authorities. We conclude that imaging techniques are an adjuvant to forensic medical diagnosis and forensic autopsies.     

Effect of a ban on carrying firearms on homicide rates in 2 Colombian cities

Andrés Villaveces, MD, MPH; Peter Cummings, MD, MPH; Victoria E. Espitia, MSc; Thomas D. Koepsell, MD, MPH; Barbara McKnight, PhD; Arthur L. Kellermann, MD, MPH

JAMA. 2000;283:1205-1209.

Context  Homicide is a leading cause of death in Colombia, with much of the fatal interpersonal violence concentrated in the country's largest cities. Firearms are involved in as much as 80% of homicides in Colombia.

Objective  To evaluate the effect of an intermittent police-enforced ban on carrying firearms on the incidence of homicide in urban Colombia.

Design  Interrupted time-series study with multiple replications.

Setting  Cali, Colombia, during 1993 and 1994 and Bogotá, Colombia, from 1995 through August 1997.

Participants  The populations of Cali and Bogotá.

Intervention  Carrying of firearms was banned on weekends after paydays, on holidays, and on election days. Enforcement included establishment of police checkpoints and searching of individuals during traffic stops and other routine law enforcement activity.

Main Outcome Measure  Homicide rates during intervention days were compared with rates during similar days without the intervention; estimates were based on comparisons within the same month, day of week, and time of day.

Results  There were 4078 homicides in Cali during 1993 and 1994 (114.6 per 100,000 person-years). In Bogotá, 9106 homicides occurred from 1995 through August 1997 (61 per 100,000 person-years). The incidence of homicide was lower during periods when the firearm-carrying ban was in effect compared with other periods (multivariate-adjusted rate ratio, 0.86 [95% confidence interval {CI}, 0.76-0.97] for Cali, and 0.87 [95% CI, 0.77-0.98] for Bogotá).

Conclusion  An intermittent citywide ban on the carrying of firearms in 2 Colombian cities was associated with a reduction in homicide rates for both cities.

     

社区环境与自杀行为的关联性研究

目的探索社区环境对社区居民自杀的影响程度,为提出自杀预防措施提供理论依据。方法从山东、辽宁、湖南三省采用完全随机方法抽取16个县（市）,收集了392例15～34岁自杀死亡者和416例对照进行研究。采用心理解剖方法收集自杀死亡者信息;采用同样结构式访谈工具获取同社区对照2名信息人信息。利用WHOSUPRE—MISS社区压力和问题调查量表测量居民的社区环境。结果研究结果表明社区环境因子得分与自杀呈正相关关系,社区环境不良为个体自杀的主要危险因素（Waldx2=10．036,P〈0．05,OR=1．323）。社区存在的问题如家庭不和、交通不便、缺乏医疗保健、就业保障、酗酒、迷信现象可以明显提高中国农村自杀率。同时显示相对贫穷、患有精神疾病（OR=32．346）是自杀的主要危险因素;受较好教育、已婚、健康身体状况是自杀的主要保护因素。结论政府需要进一步完善社会救助系统,解决社区现存的一些问题,营造和创建良好的社区环境,减轻其生活压力;同时应加强心理障碍筛检,对高危人群积极实施社区心理健康干预,提高人的应激能力,以此有效降低中国农村社区居民自杀率。     

Firearm homicide among black teenage males in metropolitan counties. Comparison of death rates in two periods, 1983 through 1985 and 1987 through 1989.

OBJECTIVE--To identify US counties (1) that had either significantly high or significantly low firearm homicide rates among black males 15 through 19 years of age in 1983 through 1985 and in 1987 through 1989, and/or (2) that experienced a significant increase in the firearm homicide rate between 1983 through 1985 and 1987 through 1989. DESIGN--Using the Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md, county-level firearm homicide rates are analyzed. SETTING--Eighty counties with a population of at least 10,000 black males 15 through 19 years of age in 1987 through 1989. SUBJECTS--Black males 15 through 19 years of age whose underlying cause of death was classified as firearm homicide (E965.0 through E965.4, or E970) in the ICD-9 (International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision). MAIN OUTCOME MEASURE--County-specific firearm homicide rate. RESULTS--In 1983 through 1985 and in 1987 through 1989, seven and 13 counties, respectively, were identified that had significantly high firearm homicide rates. Firearm homicide rates were significantly high in both time periods in the following counties: Los Angeles, California; Wayne, Michigan; Kings, New York; St Louis City, Missouri; and Baltimore City, Maryland. Firearm homicide rates increased significantly between 1983 through 1985 and 1987 through 1989 in 34 of the 80 counties. Twenty counties had significantly low rates in both time periods. Several counties with low rates in 1983 through 1985 experienced significant increases and by 1987 through 1989 were among those with high rates. CONCLUSIONS--Surveillance of firearm homicide rates at the county levels in counties with high and with low rates is a necessary first step in the development of successful violence prevention programs. Those counties where rates are high and increasing are the counties that are in greatest need for intervention strategies. Knowledge of the incidence of nonfatal firearm injuries is also needed.