Comparisons of Prisoners Who Make or Do Not Make Suicide Attempts and Further Who Make One or Multiple Attempts

Suicidal behavior among prisoners is a major problem. The objective of this study was to compare prisoners who have made an attempt at suicide vs non-attempters and further to compare single vs multiple suicide attempts. Among 1,537 prisoners, 200 (13%) had a lifetime history of attempting suicide and 92 (6%) had made multiple attempts. Those who had made multiple or single attempts were compared on socio-demographic, developmental, personality, forensic, and psychiatric variables. In a re-analysis we also compared non-attempters with attempters in this larger sample. The comparison showed that prisoners who had made multiple attempts had experienced significantly more childhood trauma, were more introverted, less resilient, had a history of self-mutilation, and had more suicidal ideation. Anger and hostility scores and criminal and violence histories significantly differentiated prisoners who had attempted from those who had never attempted but they did not differentiate multiple from single attempters. Having a history of multiple attempts may be indicative of more severe psychopathology in prisoners, as found in other populations. These findings may be helpful in predicting which prisoner is at increased risk of exhibiting suicidal behavior while incarcerated and after release.     

Hospital and community-based care for patients with chronic schizophrenia in Hong Kong

Background: There have been few studies on the impact of de-institutionalization on psychiatric patients' lives in Chinese culture. The objectives of the present study were: (1) to compare quality of life (QOL) of Chinese patients with schizophrenia living in three different treatment settings (hospital, long-stay care home and half-way house) in Hong Kong, and (2) to identify factors associated with patients' subjective well-being. Method: A matched-group design was used. Subjects (n = 204) living in the three treatment settings were matched according to age, sex, educational level, marital status, length of psychiatric illness and number of previous psychiatric admissions. Multiple measures for the evaluation of QOL included the Satisfaction With Life Scale (SWLS), WHO Quality of Life Measure-Abbreviated version-Hong Kong (WHOQOL-BREF-HK), Life Event List (LEL) and the Global Assessment Scale (GAS). Psychiatric symptoms were evaluated with the Brief Psychiatric Rating Scale (BPRS). Results: Significant differences in objective QOL indices (global level of functioning, number of life events and income) between subjects staying in hospital and community-based residential services were found in favour of the less restrictive community settings. However, with respect to global life satisfaction, subjects preferred the more secure settings despite their restrictiveness. Predictors of subjective well-being were educational level, negative life events and the BPRS items of somatic concern, anxiety and guilt feelings. The impact of negative life events on subjective well-being decreased over time. Conclusion: In a cohort of Chinese patients with chronic schizophrenia, community-based treatment settings had a positive impact on objective QOL indices but not on subjective well-being. Negative life events, education level, and the BPRS items of somatic concern, anxiety and guilt feelings were predictors of subjective well-being which seemed to adapt to external circumstances over time. Accepted: 1 October 2002 Correspondence to Dr. G. S. Ungvari     

Correspondence of perceptions about centenarians’ mental health

Objectives: The goals of this study were to uncover the criteria by which centenarians, proxy/caregivers, and interviewers rated centenarians’ mental health. Often proxy and interviewer reports are obtained in studies of the oldest-old and become a primary source of information.

Methods: Data were from a population-based sample of mentally competent US centenarians in northern Georgia. The dependent variables were based on alternative reports for the centenarians’ mental or emotional health. Regression analysis was used to predict each source's rating of mental health separately with the same set of variables. These variables included information obtained from the centenarians and proxies about their distal experiences, demographics, and proximal resources including Mini-Mental Status Examination (MMSE), health, personality, socioeconomic resources, and coping behaviors.

Results: Examination of mean-level differences between sources revealed similarity across mental health ratings. For centenarians and proxies, perceived economic status was a very important predictor of mental health. For centenarians and interviewers, personality (neuroticism and extraversion) was an important common predictor. The interviewer and proxy mental health ratings were strongly associated with MMSE, but that was not the case for centenarians.

Conclusion: Mean-level findings and the comparative regression results provide corroborating evidence that centenarians’ self-reports of mental health are similar based on average ratings and presence of common associations with other raters (i.e., perceived economic status and personality). Implications of differences across rater pairs are discussed as guidance about the comparative value of substitution of proxies as informants for addressing specific influences on mental health.     

Transplantationsmedizin

Zusammenfassung Die Organtransplantation wird als wirksame Therapie für die Behandlung der meisten Formen des Organversagens angesehen. Meilensteine prägten ihre Geschichte. Ständig weiterentwickelte Immunsuppressiva aber auch die verbesserte Organkonservierung, chirurgische Techniken sowie das peri- und postoperative Management konnten die Ergebnisse der klinischen Organtransplantation bis Ende des 20. Jahrhunderts in allen Bereichen deutlich verbessern. Bis dahin waren weltweit mehr als eine halbe Millionen Menschen transplantiert worden. Dabei überwiegen zahlenmäßig die Transplantationen im Bereich der abdominellen Organe, insbesondere von Niere, Leber und Pankreas. An thorakalen Organen sind international mehr als 50 000 Herzen und mehr als 10 000 Lungen transplantiert worden. Die Ergebnisse vereinzelt durchgeführter xenogener Organtransplantationen in der letzten Hälfte des vergangenen Jahrhunderts waren hingegen ernüchternd. So wird sich die Zukunft der klinischen Xenotransplantation an den Verbesserungen der genetischen Modifikation der Transplantate entscheiden. Allerdings können weder die zunehmende Lebendorganspende von Niere und Leber noch die Weiterentwicklung technischer Möglichkeiten bzw. extrakorporaler Organersatzverfahren dem steigenden Bedarf an Transplantaten und Geweben gerecht werden. Deshalb sind vermehrte Anstrengungen vor allem in der Organspende notwendig, um das Defizit an transplantierbaren Organen langfristig besser ausgleichen zu können.     

A Paper About a Piece of Paper

The only constant is change. Heraclitus 1 ¹ See Geoffrey Stephen Kirk et al., The Presocratic Philosophers: A Critical History with a Selection of Texts 186–87 (1957).

It strikes me that the questions brought on by medical technology have come upon us in a relatively short time, and that society is at the beginning of even grasping their dimension and complexity, let alone coming up with satisfactory answers.

William H. Colby 2 ² William H. Colby, Unplugged: Reclaiming Our Right to Die in America 95 (2006). Colby was the attorney for the family of Nancy Cruzan, whose end-of-life decision-making case was the first one heard in the United States Supreme Court. Cruzan v. Dir., Mo. Dep't of Health, 497 U.S. 261 (1990).