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1.  Are There Still Too Few Suicides to Generate Public Outrage? 
JAMA psychiatry  2016;73(10):1003-1004.
doi:10.1001/jamapsychiatry.2016.1736
PMCID: PMC5082695  PMID: 27706486
2.  Self-injury Mortality in the United States in the Early 21st Century 
JAMA psychiatry  2016;73(10):1072-1081.
IMPORTANCE
Fatal self-injury in the United States associated with deliberate behaviors is seriously underestimated owing to misclassification of poisoning suicides and mischaracterization of most drug poisoning deaths as “accidents” on death certificates.
OBJECTIVE
To compare national trends and patterns of self-injury mortality (SIM) with mortality from 3 proximally ranked top 10 causes of death: diabetes, influenza and pneumonia, and kidney disease.
DATA, SETTING, AND PARTICIPANTS
Underlying cause-of-death data from 1999 to 2014 were extracted for this observational study from death certificate data in the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research online databases. Linear time trends were compared by negative binomial regression with a log link function. Self-injury mortality was defined as a composite of suicides by any method and estimated deaths from drug self-intoxication whose manner was an “accident” or was undetermined.
MAIN OUTCOMES AND MEASURES
Mortality rates and ratios, cumulative mortality in individuals younger than 55 years, and years of life lost in 2014.
RESULTS
There were an estimated 40 289 self-injury deaths in 1999 and 76 227 in 2014. Females comprised 8923 (22.1%) of the deaths in 1999 and 21 950 (28.8%) of the 76 227 deaths in 2014. The estimated crude rate for SIM increased 65%between 1999 and 2014, from 14.4 to 23.9 deaths per 100 000 persons (rate ratio, 1.03; 95%CI, 1.03–1.04; P < .001). The SIM rate continuously exceeded the kidney disease mortality rate and surpassed the influenza and pneumonia mortality rate by 2006. By 2014, the SIM rate converged with the diabetes mortality rate. Additionally, the SIM rate was 1.8-fold higher than the suicide rate in 2014 vs 1.4-fold higher in 1999. The male-to-female ratio for SIM decreased from 3.7 in 1999 to 2.6 in 2014 (male by year: rate ratio, 0.98; 95%CI, 0.97–0.98; P < .001). By 2014, SIM accounted for 32.2 and 36.6 years of life lost for male and female decedents, respectively, compared with 15.8 and 17.3 years from diabetes, 15.0 and 16.6 years from influenza and pneumonia, and 14.5 and 16.2 years from kidney disease.
CONCLUSIONS AND RELEVANCE
The burgeoning SIM rate has converged with the mortality rate for diabetes, but there is a 6-fold differential in the proportion of SIM vs diabetes deaths involving people younger than 55 years and SIM is increasingly affecting women relative to men. Accurately characterizing, measuring, and monitoring this major clinical and public health challenge will be essential for developing a comprehensive etiologic understanding and evaluating preventive and therapeutic interventions
doi:10.1001/jamapsychiatry.2016.1870
PMCID: PMC5482223  PMID: 27556270
3.  The Prevalence of Distress and Depression among Women in Rural Sichuan Province 
PLoS ONE  2016;11(8):e0161097.
Background
In this paper, we report findings regarding the prevalence of expressed distress and depressive conditions among women living in a rural region of Sichuan Province. As well, we know of no data among women in rural China that examine whether “depression,” as categorically defined in classifications such as the DSM, adequately captures the expressed distress and symptomatic complaints of women in rural China.
Methods
A multistage sampling method was employed to recruit the target population. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure distress symptoms, and MINI International Neuropsychiatric Interview (MINI) was employed to determine the prevalence of diagnosable depression and other disorders.
Results
Among 1898 rural women, 12.4% (236) scored ≥16 on the CES-D, indicative of distress, and a subset of 7.7% (146) had scores ≥21, highly suggestive of a clinically significant disorder. We found that 49.8% women with ≥16 CES-D score were identified as showing features consistent with a current major depressive episode (MDE) vs. 1.9% in a sample of randomly selected women with <16 CES-D score. Among respondents, 30 of 84 (35.7%) scoring 16–20 and 83 of 143 (58.0%) scoring ≥21 reported symptoms consistent with MDE. 25.1% of women with a positive CES-D score did not describe symptoms consistent with any DSM-IV disorder.
Conclusions
We found a higher portion of women reporting significant distress than previously described. Among them, there was a clear gradient, such that 41.7% of women with moderate distress did not have a psychiatric diagnosis, and even among those with more severe symptoms, 15.4% did not manifest a DSM-specific psychiatric condition.
doi:10.1371/journal.pone.0161097
PMCID: PMC4985145  PMID: 27526182
4.  A Test of Core Psychopathic Traits as a Moderator of the Efficacy of a Brief Motivational Intervention for Substance Using Offenders 
Objective
In a randomized controlled trial we studied a Brief Motivational Intervention (BMI) for substance use, examining core psychopathic traits as a moderator of treatment efficacy.
Method
Participants were 105 males and females who were 18 years of age and older and in a pretrial jail diversion program. The sample was approximately 52% black and other minorities and 48% white. Outcome variables at a six-month follow-up were frequency of substance use (assessed with the Timeline Follow-back Interview and objective toxicology screens), substance use consequences (Short Inventory of Problems-Alcohol and Drug Version), and self-reported participation in non-study mental health and/or substance use treatment. Psychopathy was assessed using the Psychopathy Checklist-Revised (PCL-R).
Results
BMI interacted with core psychopathic traits to account for 7% of the variance in substance use at follow-up. Treatment was associated with greater use among individuals with high levels of core psychopathic traits. Toxicology screening results were consistent with self-report data. The treatment and standard care groups did not differ on substance use consequences or non-study treatment participation at follow-up and no moderation was found with these outcomes. An exploratory analysis indicated that low levels of affective traits of psychopathy were associated with benefit from the BMI in terms of decreased substance use.
Discussion
Findings suggest that caution is warranted when applying BMIs among offenders; individuals with high levels of core psychopathic traits may not benefit and may be hindered in recovery. Conversely, they indicate that a low-psychopathy subgroup of offenders benefits from these brief and efficient treatments for substance use.
Public Health Significance
This study of an intervention that is widely used in criminal justice systems provides information regarding for whom the treatment works and for whom it may be unhelpful.
doi:10.1037/ccp0000065
PMCID: PMC4760863  PMID: 26727409
5.  Mood-, Anxiety-, and Substance Use Disorders and Suicide Risk in a Military Population Cohort 
There are meager prospective data from nonclinical samples on the link between anxiety disorders and suicide or the extent to which the association varies over time. We examined these issues in a cohort of 309,861 United States Air Force service members, with 227 suicides over follow-up. Mental disorder diagnoses including anxiety, mood, and substance use disorders (SUD) were based on treatment encounters. Risk for suicide associated with anxiety disorders were lower compared to mood disorders and similar to SUD. Moreover, the associations between mood and anxiety disorders with suicide were greatest within a year of treatment presentation.
doi:10.1111/j.1943-278X.2012.00125.x
PMCID: PMC4863230  PMID: 23094649
suicide; mental disorder; risk factor; military; cohort
6.  Self-Reported Childhood Physical Abuse and Perpetration of Intimate Partner Violence: The Moderating Role of Psychopathic Traits 
Criminal justice and behavior  2012;39(7):910-922.
Whereas considerable evidence links childhood physical abuse with later perpetration of intimate partner violence (IPV), research to identify moderators of this relationship will increase our understanding of which victims of childhood abuse are at risk for later IPV. The present study examined dimensions of psychopathy as moderators of the relationship between physical abuse in childhood and perpetration of IPV in a sample of criminal offenders. Results indicated that, among individuals with higher levels of impulsive-irresponsible (i.e., Lifestyle) traits of psychopathy, childhood physical abuse was associated with later perpetration of IPV. Findings have implications for the propensity toward IPV perpetration among individuals who have experienced childhood physical abuse.
doi:10.1177/0093854812438160
PMCID: PMC3439214  PMID: 22984318
child abuse; psychopathy; intimate partner violence; aggression; antisocial behavior
7.  Lay health supporters aided by a mobile phone messaging system to improve care of villagers with schizophrenia in Liuyang, China: protocol for a randomised control trial 
BMJ Open  2016;6(1):e010120.
Introduction
Schizophrenia is a severe, chronic and disabling mental illness. Non-adherence to medication and relapse may lead to poorer patient function. This randomised controlled study, under the acronym LEAN (Lay health supporter, e-platform, award, and iNtegration), is designed to improve medication adherence and high relapse among people with schizophrenia in resource poor settings.
Methods/analysis
The community-based LEAN has four parts: (1) Lay health supporters (LHSs), mostly family members who will help supervise patient medication, monitor relapse and side effects, and facilitate access to care, (2) an E-platform to support two-way mobile text and voice messaging to remind patients to take medication; and alert LHSs when patients are non-adherent, (3) an Award system to motivate patients and strengthen LHS support, and (4) iNtegration of the efforts of patients and LHSs with those of village doctors, township mental health administrators and psychiatrists via the e-platform. A random sample of 258 villagers with schizophrenia will be drawn from the schizophrenic ‘686’ Program registry for the 9 Xiang dialect towns of the Liuyang municipality in China. The sample will be further randomised into a control group and a treatment group of equal sizes, and each group will be followed for 6 months after launch of the intervention. The primary outcome will be medication adherence as measured by pill counts and supplemented by pharmacy records. Other outcomes include symptoms and level of function. Outcomes will be assessed primarily when patients present for medication refill visits scheduled every 2 months over the 6-month follow-up period. Data from the study will be analysed using analysis of covariance for the programme effect and an intent-to-treat approach.
Ethics and dissemination
University of Washington: 49464 G; Central South University: CTXY-150002-6. Results will be published in peer-reviewed journals with deidentified data made available on FigShare.
Trial registration number
ChiCTR-ICR-15006053; Pre-results.
doi:10.1136/bmjopen-2015-010120
PMCID: PMC4735204  PMID: 26792221
schizophrenia; medication adherence; mHealth; lay health worker; implementation science; “686” program
8.  Changes in South Korean urbanicity and suicide rates, 1992 to 2012 
BMJ Open  2015;5(12):e009451.
Objectives
Studies have highlighted the association between the degree of urbanicity and spatial disparities in suicide, but few have evaluated its changes across time. We explored the geospatial trends of suicide in South Korea from 1992 to 2012, and their relationship to the nation's evolving urbanicity.
Setting
South Korea.
Primary outcome measures
Age-sex-specific suicide rate.
Results
Suicide rates increased in all regions of South Korea during the study period. Controlling the effects of age and sex, there was an overall inverse relationship between the degree of urbanicity and regional suicide rates. These associations were, however, attenuated across the periods, as there were smaller increases in suicide rates in mid-sized urban regions as compared to larger cities and to rural areas. Increases over time in the suicide rates among youth and working-age adults were greater in large urban centres and in rural regions. For elders, the increase was far greater in rural regions.
Conclusions
The association of urbanicity and the geospatial pattern of suicide in South Korea was a dynamic process and varied by age groups across the course of two decades. Internal migration and related social processes most likely contributed to these changes.
doi:10.1136/bmjopen-2015-009451
PMCID: PMC4691784  PMID: 26700283
EPIDEMIOLOGY; MENTAL HEALTH; PUBLIC HEALTH
11.  Variable Classification of Drug-Intoxication Suicides across US States: A Partial Artifact of Forensics? 
PLoS ONE  2015;10(8):e0135296.
Background
The 21st-century epidemic of pharmaceutical and other drug-intoxication deaths in the United States (US) has likely precipitated an increase in misclassified, undercounted suicides. Drug-intoxication suicides are highly prone to be misclassified as accident or undetermined. Misclassification adversely impacts suicide and other injury mortality surveillance, etiologic understanding, prevention, and hence clinical and public health policy formation and practice.
Objective
To evaluate whether observed variation in the relative magnitude of drug-intoxication suicides across US states is a partial artifact of the scope and quality of toxicological testing and type of medicolegal death investigation system.
Methods
This was a national, state-based, ecological study of 111,583 drug-intoxication fatalities, whose manner of death was suicide, accident, or undetermined. The proportion of (nonhomicide) drug-intoxication deaths classified by medical examiners and coroners as suicide was analyzed relative to the proportion of death certificates citing one or more specific drugs and two types of state death investigation systems. Our model incorporated five sociodemographic covariates. Data covered the period 2008–2010, and derived from NCHS’s Multiple Cause-of-Death public use files.
Results
Across states, the proportion of drug-intoxication suicides ranged from 0.058 in Louisiana to 0.286 in South Dakota and the rate from 1 per 100,000 population in North Dakota to 4 in New Mexico. There was a low correlation between combined accident and undetermined drug-intoxication death rates and corresponding suicide rates (Spearman’s rho = 0.38; p<0.01). Citation of 1 or more specific drugs on the death certificate was positively associated with the relative odds of a state classifying a nonhomicide drug-intoxication death as suicide rather than accident or undetermined, adjusting for region and type of state death investigation system (odds ratio, 1.062; 95% CI,1.016–1.110). Region, too, was a significant predictor. Relative to the South, a 10% increase in drug citation was associated with 43% (95% CI,11%-83%), 41% (95% CI,7%-85%), and 33% (95% CI,1%-76%) higher odds of a suicide classification in the West, Midwest, and Northeast, respectively.
Conclusion
Large interstate variation in the relative magnitude of nonhomicide drug-intoxication deaths classified as suicide by medical examiners and coroners in the US appears partially an artifact of geographic region and degree of toxicological assessment in the case ascertainment process. Etiologic understanding and prevention of drug-induced suicides and other drug-intoxication deaths first require rigorous standardization involving accurate concepts, definitions, and case ascertainment.
doi:10.1371/journal.pone.0135296
PMCID: PMC4546666  PMID: 26295155
12.  Prevalence of suicidal ideation and suicide attempts in the general population of China: A meta-Analysis 
Objective
The objective of this meta-analysis is to estimate the pooled prevalence of suicidal ideation and suicide attempts in the general population of Mainland China.
Methods
A systematic literature search was conducted via the following databases: PubMed, PsycINFO, MEDLINE, China Journals Full-Text Databases, Chongqing VIP database for Chinese Technical Periodicals and Wan Fang Data. Statistical analysis used the Comprehensive Meta-Analysis program.
Results
Eight studies met the inclusion criteria for the analysis; five reported on the prevalence of suicidal ideation and seven on that of suicide attempts. The estimated lifetime prevalence figures of suicidal ideation and suicide attempts were 3.9% (95% Confidence interval [CI]: 2.5%–6.0%) and 0.8% (95% CI: 0.7%–0.9%), respectively. The estimated female-male ratio for lifetime prevalence of suicidal ideation and suicide attempts was 1.7 and 2.2, respectively. Only the difference of suicide attempts between the two genders was statistically significant.
Conclusion
This was the first meta-analysis of the prevalence of suicidal ideation and suicide attempts in the general population of Mainland China. The pooled lifetime prevalence of both suicidal ideation and suicide attempts are relatively low; however, caution is required when assessing these self-report data. Women had a modestly higher prevalence for suicide attempts than men. The frequency for suicidal ideation and suicide attempts in urban regions was similar to those in rural areas.
doi:10.1177/0091217415589306
PMCID: PMC4536918  PMID: 26060259
Suicide attempts; suicidal ideation; prevalence; meta-analysis; China
13.  Internal migration, mental health, and suicidal behaviors in young rural Chinese 
Purpose
There is a dearth of data on the association of internal migration with mental health in young rural Chinese. This study aims to explore the associations between migrant status, mental health, and suicidal behaviors in young rural Chinese.
Methods
We recruited 1,646 rural subjects aged 16–34 years, of whom 756 were migrant workers and 890 non-migrants, from ten representative villages in rural Sichuan Province, the southwestern part of China. To assess subject's depressive symptoms and general psychological quality of life (psycho-QOL), the study protocol included the Centre for Epidemiological Studies Depression Scale, and psycho-QOL subscale of the World Health Organization's QOL Questionnaire-Brief Version, in addition to structured questions regarding one-year suicidal thoughts and behaviors (serious ideation, plan, and attempt), socio-demographic, social support, and physical health information.
Results
After adjustment for confounders, migrant workers had relative to non-migrant rural residents a decreased risk for depression (OR = 0.69, P = 0.026), but comparable risk for poor psycho-QOL (OR = 0.91, P = 0.557) and one-year suicidal behaviors (OR = 0.59–1.10, P = 0.19–0.90). Migrant status only accounted for 0.5, 2.8, 4.7, 9.8, and 12.6 % of the total explainable variance for suicide attempt, poor psycho-QOL, suicide plan, depression and serious suicide ideation, respectively.
Conclusion
Our findings suggested that among young rural Chinese there were no significant associations involving migrant status and poor psycho-QOL or one-year suicidal behaviors, while migrant status significantly correlated with a decreased risk of depression. The unique contribution of migrant status to mental health among young rural Chinese participants in this study was very small.
doi:10.1007/s00127-014-0985-y
PMCID: PMC4536925  PMID: 25403568
Internal migration; Mental health; Suicidal behavior; Chinese; Young
14.  The Impact of Improving Suicide Death Classification in South Korea: A Comparison with Japan and Hong Kong 
PLoS ONE  2015;10(5):e0125730.
Introduction
The suicide rate of South Korea has increased dramatically during the past decades, as opposed to steadily decreasing trends in Japan and Hong Kong. Although the recent increase of suicide in South Korea may be related to changing socioeconomic conditions and other contextual factors, it may also reflect, in part, a reduction of misidentified suicide cases due to improving classification of manner of death.
Method
We compared the annual proportional change of suicide, undetermined death, and accidental death from South Korea with those of Japan and Hong Kong from 1992 to 2011; a greater proportional change of the manner-of-death categories during the period is indicative of a relatively less stable registration and hence a greater potential for misclassification bias on reported suicide trends. Subgroup analyses stratifying the deaths by methods were also conducted. To estimate the impact, the age-standardized rates of these three death categories in each site were calculated.
Results
We found that, during the 20-year observation period, the proportional change of suicide, undetermined death, and accidental death in South Korea was significantly greater than Japan and Hong Kong. Similar observations were made in subgroup analyses. While death rates of the three manners in Japan and Hong Kong generally moved in a parallel fashion, the increase of suicide in South Korea occurred concomitantly with a significant reduction of its accidental death rate. 43% of the increase in suicides could be attributed to the decrease in accidental deaths, while 57% of the increase could be due to fundamental causes.
Conclusion
Our data suggest that, during the mid-1990s and after, the increasing burden of suicide in South Korea initially was masked, in part, by misclassification. Thus, the later apparently rapid increase of suicides reflected steadily improving classification of manner of death, as well as a more fundamental increase in the suicide rate.
doi:10.1371/journal.pone.0125730
PMCID: PMC4439106  PMID: 25992879
15.  Depression, social support and associated factors among women living in rural China: a cross-sectional study 
BMC Women's Health  2015;15:28.
Background
Few studies have focused on depression and social support in Eastern populations, especially women in rural China. Our research investigated depression among women in rural China, and studied the relationships between social support and depression.
Methods
We recruited women ages 16 years and older from north Sichuan. Participants completed socio-demographic measures, the Center for Epidemiologic Studies Depression Scale, and the Duke Social Support Index. The analysis method included descriptive statistics and logistic regression.
Results
The final sample included 1,898 participants with a mean age of 48.6 years, and the prevalence of significant depressive symptoms was 12.4%. Results suggest being unemployed, having poorer perceived health/economic status, and lower social support were positively associated with depression. Younger age and greater social support were negatively associated with depression.
Conclusions
This study provides insights on the psychological health of women in rural China and potential directions for future research. These issues are especially pertinent during this time of rapid economic transformation and outmigration in rural China.
doi:10.1186/s12905-015-0180-7
PMCID: PMC4392745  PMID: 25879808
Depressive mood; Social support; Females in rural China; Mental health
16.  Suicide Contagion: A Systematic Review of Definitions and Research Utility 
PLoS ONE  2014;9(9):e108724.
Objectives
Despite the common use of contagion to analogize the spread of suicide, there is a lack of rigorous assessment of the underlying concept or theory supporting the use of this term. The present study aims to examine the varied definitions and potential utility of the term contagion in suicide-related research.
Methods
100 initial records and 240 reference records in English were identified as relevant with our research objectives, through systematic literature screening. We then conducted narrative syntheses of various definitions and assessed their potential value for generating new research.
Results
20.3% of the 340 records used contagion as equivalent to clustering (contagion-as-cluster); 68.5% used it to refer to various, often related mechanisms underlying the clustering phenomenon (contagion-as-mechanism); and 11.2% without clear definition. Under the category of contagion-as-mechanism, four mechanisms have been proposed to explain how suicide clusters occurred: transmission (contagion-as-transmission), imitation (contagion-as-imitation), contextual influence (contagion-as-context), and affiliation (contagion-as-affiliation). Contagion-as-cluster both confounds and constrains inquiry into suicide clustering by blending proposed mechanism with the phenomenon to be studied. Contagion-as-transmission is, in essence, a double or internally redundant metaphor. Contagion-as-affiliation and contagion-as-context involve mechanisms that are common mechanisms that often occur independently of apparent contagion, or may serve as a facilitating background. When used indiscriminately, these terms may create research blind spots. Contagion-as-imitation combines perspectives from psychology, sociology, and public health research and provides the greatest heuristic utility for examining whether and how suicide and suicidal behaviors may spread among persons at both individual and population levels.
Conclusion
Clarifying the concept of “suicide contagion” is an essential step for more thoroughly investigating its mechanisms. Developing a clearer understanding of the apparent spread of suicide-promoting influences can, in turn, offer insights necessary to build the scientific foundation for prevention and intervention strategies that can be applied at both individual and community levels.
doi:10.1371/journal.pone.0108724
PMCID: PMC4178222  PMID: 25259604
17.  Conducting Community Research in Rural China –Addressing the Methodological Challenges of Recruiting Participants in Rapidly Changing Social Environments 
Background
The paper addressed a unique challenge for public health and community research in rural China, i.e., the very large percentage of young adults that comprises a highly mobile working population that has been an essential component of the country’s economic transformation. Fluid local demographic patterns potentially have a substantial impact on sample representativeness and data validity.
Methods
This report is based upon a cross sectional survey with face-to-face interviews of residents aged 16–34 years in rural communities of Mianyang, Sichuan Province, China. Two waves of fieldwork and other strategies were adopted in response to recruitment challenges.
Results
1654 of 3008 potential participants took part in the study; this constituted 98% of those individuals approached and 55% of the persons enumerated in the local household registration system (hukou). Analyses revealed substantial differences among those who were interviewed during September and October 2005, versus those seen during the Chinese Lunar New Year of 2006 when many migrant workers and students returned to their homes. Both groups together differed from those who were unavailable during either recruiting episode.
Discussion and Conclusions
We discuss potential responses to associated methodological challenges, including, (1) permanent hukou mismatches; (2) temporary hukou mismatches; (3) difficulties faced by potential participants to fully understand the purpose of research, the informed consent process, and specific research questions; and (4) appreciation of the importance of local social networks, as they pertain in particular to rural China. These findings underscore that there may be a need to make “on-the-ground” adjustments to varying local conditions to maximize sample representativeness and data validity.
doi:10.1111/j.1758-5872.2012.00182.x
PMCID: PMC3363287  PMID: 22662022
Epidemiology; Rural Community; China; Methodology; Recruitment
18.  Changing the focus of suicide research in China from rural to urban communities 
Shanghai Archives of Psychiatry  2013;25(3):174-175.
doi:10.3969/j.issn.1002-0829.2013.03.007
PMCID: PMC4054551  PMID: 24991153
19.  Does Practice Make Perfect? A Randomized Control Trial of Behavioral Rehearsal on Suicide Prevention Gatekeeper Skills 
The journal of primary prevention  2011;32(3-4):195-211.
Suicide is the third leading cause of death among 10–24-year-olds and the target of school-based prevention efforts. Gatekeeper training, a broadly disseminated prevention strategy, has been found to enhance participant knowledge and attitudes about intervening with distressed youth. Although the goal of training is the development of gatekeeper skills to intervene with at-risk youth, the impact on skills and use of training is less known. Brief gatekeeper training programs are largely educational and do not employ active learning strategies such as behavioral rehearsal through role play practice to assist skill development. In this study, we compare gatekeeper training as usual with training plus brief behavioral rehearsal (i.e., role play practice) on a variety of learning outcomes after training and at follow-up for 91 school staff and 56 parents in a school community. We found few differences between school staff and parent participants. Both training conditions resulted in enhanced knowledge and attitudes, and almost all participants spread gatekeeper training information to others in their network. Rigorous standardized patient and observational methods showed behavioral rehearsal with role play practice resulted in higher total gatekeeper skill scores immediately after training and at follow-up. Both conditions, however, showed decrements at follow-up. Strategies to strengthen and maintain gatekeeper skills over time are discussed.
doi:10.1007/s10935-011-0250-z
PMCID: PMC3249637  PMID: 21814869
Suicide prevention; School-based gatekeeper training; Behavioral rehearsal; Observational methods; Standardized patient
20.  Suicide in Older Adults 
doi:10.1016/j.psc.2011.02.002
PMCID: PMC3107573  PMID: 21536168
Suicide; older adult; aged; prevention
23.  Health status and suicide in the second half of life 
Objective
To examine the associations of suicide in the second half of life with medical and psychiatric illness, functional limitations, and reported use of inpatient, ambulatory, and home health care services.
Method
A retrospective case-control design was used to compare 86 people over age 50 years who died by suicide with a comparison group of 86 living community participants that were individually matched on age, gender, race, and county of residence.
Results
Suicide decedents had more Axis I diagnoses, including current mood and anxiety disorders, worse physical health status, and greater impairment in functional capacity. They were more likely to have required psychiatric treatment, medical, or surgical hospitalization in the last year, and visiting nurse or home health aide services. In a multivariate model, the presence of any active Axis I disorder and any impairment in instrumental activities of daily living (IADL) made independent contributions to suicide risk.
Conclusions
Mental illness, physical illness, and associated functional impairments represent domains of risk for suicide in this age group. In addition to individuals with psychiatric illness, those with severe or comorbid physical illness and functional disability who require inpatient and home care services should be targeted for screening and preventive interventions.
doi:10.1002/gps.2348
PMCID: PMC2864785  PMID: 19582758
suicide; primary care; functional impairment; service utilization; aged
24.  Epidemiology of Alcohol Abuse and Dependence in Rural Chinese Men 
Background
Several national and regional epidemiological studies in China have reported increases in the prevalence of alcohol use disorders over the past three decades.
Methods
This cross-sectional study conducted in 2007 identified 11,884 male subjects aged 18 to 60 years using multi-stage randomized cluster sampling methods in two rural communities in China and interviewed 9,866 of them. Current and lifetime alcohol use disorders were assessed with a semi-structured diagnostic interview.
Results
The age-standardized prevalence of current (lifetime) alcohol abuse and alcohol dependence in Hunan were 1.8% (4.8%) and 4.7% (8.6%) respectively, and those in Henan were 7.6% (11.8%) and 8.7% (10.8%). Higher age (55–60) and lower education were risk factors for alcohol dependence in Hunan while middle age (35–44), currently married, and higher education and higher income were risk factors in Henan.
Conclusions
Alcohol abuse and dependence are no longer uncommon disorders among rural men in China. Unlike most western reports, alcohol dependence shows higher prevalence than abuse. There are significant differences in the prevalence of alcohol use disorders and the socio-demographic profile of affected individuals in the two different regions of the country.
doi:10.1111/j.1530-0277.2009.01014.x
PMCID: PMC2950277  PMID: 19572979
alcohol abuse; alcohol dependence; epidemiology; risk factors

Results 1-25 (29)