School environment as a risk and protective factor for self-harm and suicidality: Insights from the Longitudinal Study of Indigenous Children

BackgroundImproving the wellbeing of Indigenous populations is an international priority. Robust research conducted with Aboriginal and Torres Strait Islander peoples is key to developing programs and policies to improve health and wellbeing. This paper aims to quantify the extent of participation in a national longitudinal study of Aboriginal and Torres Strait Islander (Indigenous Australian) children, and to understand the reasons why caregivers participate in the study.MethodsThis mixed methods study uses data from Wave 6 of Footprints in Time, the Longitudinal Study of Indigenous Children. We conducted descriptive analysis of quantitative variables to characterise the sample and retention rates. We applied conventional content analysis to 160 caregivers’ open-ended responses to the question, ‘Why do you stay in the study?’, identifying themes and overarching meta-themes.ResultsThe study has maintained a high retention rate, with 70.4% (n = 1239/1671) of the baseline sample participating in the study’s 6th wave. We identified seven themes related to why participants stay in the study: telling our story, community benefit, satisfaction, tracking Study Child’s progress, study processes, receiving study gifts, and valuing what the study stands for. These related to two meta-themes: reciprocity, and trust and connection. Caregivers reported that participation was associated with benefits for their family and community as well as for the study. They identified specific features of the Footprints in Time study design that built and maintained trust and connection between participants and the study.ConclusionsOur findings support the assertion that Aboriginal and Torres Strait Islander people want to be involved in research when it is done ‘the right way’. Footprints in Time has successfully recruited and retained the current-largest cohort of Aboriginal and Torres Strait Islander children in Australia through the use of participatory research methodologies, suggesting effective study implementation and processes. Participants indicated ongoing commitment to the study resulting from perceptions of reciprocity and development of trust in the study. Footprints in Time can serve as a successful model of Aboriginal and Torres Strait Islander health research, to promote good research practice and provides lessons for research with other Indigenous populations.

This study examined patterns of rearrest in a sample of Australian Aboriginal and/or Torres Strait Islander and non-Indigenous youth who have sexually harmed, and the association between these patterns and personal and environmental characteristics present at the first (i.e., onset) sexual offence. Participants included 111 (n = 67 non-Indigenous; n = 44 Aboriginal and/or Torres Strait Islander) youth who were reviewed at five fixed-time intervals over a 10-year period. Bivariate analyses (i.e., Chi-square and t-tests) and Analysis of Variance indicated that generally, a higher proportion of Aboriginal and/or Torres Strait Islander youth were rearrested for violent and non-sexual/non-violent offences. No differences were found for sexual offences. Overall, those who were rearrested for sexual/violent offences scored higher on personal behavioural controls at onset; whereas, non-sexual/non-violent rearrests were associated with environmental vulnerabilities (i.e., adverse social conditions, population stressors). The findings are discussed in regards to the interplay between youth and the broader ecological environment in which onset and persistence of offending occur.

Footprints in Time: The Longitudinal Study of Indigenous Children (LSIC) is a national study of 1759 Australian Aboriginal and Torres Strait Islander children living across urban, regional and remote areas of Australia. The study is in its 11th wave of annual data collection, having collected extensive data on topics including birth and early life influences, parental health and well-being, identity, cultural engagement, language use, housing, racism, school engagement and academic achievement, and social and emotional well-being. The current paper reviews a selection of major findings from Footprints in Time relating to the developmental origins of health and disease for Australian Aboriginal and Torres Strait Islander peoples. Opportunities for new researchers to conduct further research utilizing the LSIC data set are also presented.

Fuelled by the tobacco industry, commercial tobacco use is a major cause of preventable morbidity and mortality among Aboriginal and Torres Strait Islander peoples. Preventing adolescent smoking initiation is critical to reducing uptake. Understanding individual, social, and environmental factors that are protective against smoking can inform prevention strategies. We analysed data from adolescents 12-15 years and their caregivers from Wave 11 (2018) of the Longitudinal Study of Indigenous Children (LSIC). Poisson regression was used to calculate adjusted prevalence ratios (PR) of never smoking in relation to individual, social, and environmental factors adjusted for age and remoteness. Never smoking was reported by 81.3% of adolescents. Half (51.3%) of those who had ever-smoked had smoked in the last year. Never smoking was significantly associated with peer never smoking, no substance use (including e-cigarettes), positive family and school environments, no boredom, no trouble with police, and no family experiences of racism. Never smoking prevalence was twofold among adolescents who had never (versus ever) tried e-cigarettes (PR = 2.10; 95%CI: 1.41, 3.14). Fostering positive social relationships, discouraging substance use, and eliminating racism and discrimination are important in preventing adolescent smoking, offering some protection against the exploitative practices of the tobacco industry. Culturally safe structural supports and comprehensive approaches to individual, social, and environmental wellbeing are required to prevent smoking and promote wellbeing.

ObjectivesAboriginal and Torres Strait Islander children and adolescents are at higher risk of overweight and obesity, highlighting an inequitable public health concern. The aim of this study was to estimate transition probabilities and validate a model predicting the epidemiologic trajectory of overweight and obesity in Australian Aboriginal and Torres Strait Islander children.MethodsAn individual-level state-transition Markov model was developed to model transitions between healthy weight, overweight, and obesity for Aboriginal and Torres Strait Islander children aged between 2 and 14 y. Age-specific annual transition probabilities were derived from semi-parametric survival analyses using the Longitudinal Study of Indigenous Children. The model used annual cycles over a 12-y time horizon, and the epidemiological predictions of the model were validated using both internal and external data, according to best practice guidelines. The starting age of the model was 2 to 4 y and 4 to 5 y for the internal and external validation, respectively. Aboriginal and Torres Strait Islander children from the Longitudinal Study of Australian Children were used as the external validation cohort.ResultsA total of 1,643 children with 11,514 complete anthropometric measurements were used to estimate transition probabilities. The model predictions showed both good internal and external validity, with most predictions falling within the 95% confidence intervals of measured data. The model was able to reliably capture the epidemiology of overweight and obesity prevalence in early childhood.ConclusionsOur model predictions showed good internal and external validity, ensuring our model is fit for purpose to use to evaluate Aboriginal and Torres Strait Islander-led programs to achieve a healthy weight.HighlightsAboriginal and Torres Strait Islander children experience high rates of overweight and obesity; hence, there is a need for high-quality evidence on both effectiveness and cost-effectiveness of Aboriginal and Torres Strait Islander-led childhood obesity prevention programs to ensure they offer value for money.This is the first study to develop and validate a predictive model using anthropometric data from Aboriginal and Torres Strait Islander children to inform decision making on childhood obesity programs.Our model predictions showed good internal and external validity, ensuring our model is fit for purpose to use to evaluate Aboriginal and Torres Strait Islander-led programs to achieve a healthy weight.The model provides a framework to assist policy makers in identifying when best to intervene in childhood as well as the most effective approaches for maintaining a healthy weight for Aboriginal and Torres Strait Islander children.

The National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing identifies building a strong Aboriginal and Torres Strait Islander led evidence-base to inform care as a key priority. Aboriginal and/or Torres Strait Islander adolescents in contact with the criminal justice system are a highly vulnerable group of Australians, with substantial unmet needs. There is limited evidence to inform culturally appropriate models of care that meet the social and emotional wellbeing needs of justice-involved Aboriginal and/or Torres Strait Islander adolescents. This project aims to develop, implement and evaluate an in-reach and community transitional model of social and emotional wellbeing care for Aboriginal and/or Torres Strait Islander adolescents (10–17 years old) who experience detention through close engagement with Aboriginal and/or Torres Strait Islander youth, Elders, researchers, practitioners and community members, and by drawing on culturally informed practice and knowledge systems. The project is based on a multi-level mixed methods design, with a strong focus on ongoing project evaluation (based on the Ngaa-bi-nya framework) and co-design. Co-design is facilitated through culturally safe and trauma informed participatory processes based on development of strong partnerships from project initiative, design, implementation and evaluation. Application of the landscape domain of the Ngaa-bi-nya framework for Aboriginal and Torres Strait Islander program evaluation will be explored in Phase one. Aboriginal and Torres Strait Islander adolescents with experience in detention will be engaged through one-on-one interviews with data collection through the Growth and Empowerment Measure (GEM) Youth (which will be adapted from the adult version and validated as part of this study), the Kessler Psychological Distress Scale (K-10), questions around alcohol and drug use, and narrative interviews exploring experience. Qualitative data will be analyzed using an inductive thematic approach, structured within the framework of the Ngaa-bi-nya landscape prompts. Quantitative data will be analyzed using descriptive statistics to provide a profile of the cohort. Findings from Phase one will be used to inform the development of a model of social and emotional wellbeing care that will be implemented and evaluated in Phase two.

Issue AddressedLittle is currently known about the relationships between body composition and the social determinants of health among Aboriginal and Torres Strait Islander youth in Australia, which could help inform policy responses to address health inequities.MethodsThis study aimed to explore the relationship between various social factors and healthy body mass index (BMI) and waist/height ratio (WHtR) among Aboriginal and Torres Strait Islander youth aged 16–24 years. Baseline survey data from 531 participants of the ‘Next Generation: Youth Well‐being study’ were used. Robust Poisson regression quantified associations between healthy body composition and self‐reported individual social factors (education, employment and income, government income support, food insecurity, home environment, relationship status, racism), family factors (caregiver education and employment) and area‐level factors (remoteness, socioeconomic status).ResultsHealthy body composition was less common among those living in a crowded home (healthy WHtR aPR 0.67 [0.47–0.96]) and those receiving government income support (healthy BMI aPR 0.74 [0.57–0.95]). It was more common among those with tertiary educated caregivers (healthy BMI aPR 1.84 [1.30–2.61]; healthy WHtR aPR 1.41 [1.05–1.91]) and those in a serious relationship (healthy BMI aPR 1.33 [1.02–1.75]).ConclusionsSocial factors at the individual and family level are associated with healthy body composition among Aboriginal and Torres Strait Islander youth.So What?The findings of this study highlight the potential for health benefits for youth from policies and programs that address social inequities experienced by Aboriginal and Torres Strait Islander people in Australia.

Internationally, cultural renewal and language revitalisation are occurring among Indigenous people whose lands were colonised by foreign nations. In Australia, the Aboriginal and Torres Strait Islander people are striving for the re-voicing of their mother tongue and the re-practicing of their mother culture to achieve cultural renewal in the wake of over 250 years of colonisation (Williams in Recover, re-voice, re-practise. Sydney, NSW AECG Incorporated, 2013).While 120 Indigenous languages are still spoken in Australia today, little has been documented regarding the extent to which languages are learned and maintained by young Aboriginal and Torres Strait Islander children. The current paper offers a unique insight by drawing upon a large-scale dataset, Footprints in Time: the Longitudinal Study of Indigenous Children (LSIC), to describe patterns of language use and maintenance among young Aboriginal and Torres Strait Islander children. Of the 580 children followed longitudinally from the first wave of the baby cohort of LSIC (aged 0–1 years) until wave 4 (aged 3–5 years), approximately one in five (19.3 %) were reported to speak an Indigenous language. Children in the study were learning up to six languages simultaneously, including English (both Standard Australian English and Aboriginal Australian English), Indigenous languages, creoles, foreign languages (other than English) and sign languages. Social and environmental factors such as primary caregivers’ use of an Indigenous language and level of relative isolation were found to be associated with higher rates of Indigenous language maintenance. These findings have important implications for identifying ways of supporting Aboriginal and Torres Strait Islander children to learn and maintain Indigenous languages during early childhood, especially for children who may not have the opportunity to learn an Indigenous language in the home environment and for children living in urban areas.

Parent wellbeing, family screen time and socioeconomic status during early childhood predict physical activity of Aboriginal and Torres Strait Islander children at ages 8-13.

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessLong-Term Study Backs Link Between Smoking, SuicidalityJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:15 Apr 2005https://doi.org/10.1176/pn.40.8.00400052While Americans worry about whether cigarette smoking will cause lung cancer, perhaps they should also pay attention to a lesser-known risk factor for the habit—suicide. Epidemiological studies going back at least a quarter century have linked cigarette smoking with suicide. And now another large epidemiological study does as well.This latest investigation was headed by Naomi Breslau, Ph.D., a professor of epidemiology at Michigan State University. Results appeared in the March Archives of General Psychiatry.In 1988, Breslau and her colleagues selected some 1,000 young adults to participate in their study. All were members of a health maintenance organization in the Detroit area. All were interviewed at baseline and at three, five, and 10 years after the study started. During each interview, their psychiatric health, smoking habits, and occurrence of suicidal thoughts and of suicidal attempts since the last interview were ascertained.As it turned out, subjects reported only 19 suicide attempts during the 10-year study period. Since 19 suicide attempts were not enough for a meaningful statistical analysis, Breslau and her team decided to lump suicidal attempts and suicidal thoughts together. Combining these gave 17 suicide attempts with the reporting of suicidal thoughts; two suicide attempts without the reporting of suicidal thoughts; and 130 suicidal thoughts without suicide attempts, for a total 132 suicidal thoughts and/or attempts.Breslau and her colleagues then attempted to see whether smoking at baseline, at the three-year assessment, and at the five-year assessment could be statistically linked with the combined number of suicidal thoughts or attempts during the subsequent study periods.The answer was yes. Compared with subjects who had never smoked, current smokers (those who had smoked during the past 12 months) were at a statistically significant increased risk of suicidal thoughts or attempts. In contrast, past daily smokers were not at increased risk for subsequent occurrence of suicidal thoughts or attempts.Moreover, this link between current cigarette smoking and suicidal thoughts or attempts held even when potentially confounding factors—prior suicidal thoughts or attempts, current or past major depression, and current or past substance abuse—were taken into consideration.And even though the study results did not find current cigarette smoking to be as grave a risk factor for suicidal thoughts or attempts as prior suicidal thoughts or attempts, or current or past major depression, they do suggest some practical implications.“Clinical psychiatrists should always be concerned and inquire about suicidality, self-destructive thoughts, et cetera,” Glenn Davis, M.D., a professor of psychiatry at Michigan State University and one of the study authors, said in an interview. “But with added knowledge that there is a connection between smoking and risk for suicidal behavior, they should be particularly sensitive to smoking history in their evaluation of patients.”“By highlighting current smoking, [this study further reinforces] the benefits of smoking cessation,” Donald Klein, M.D., a professor of psychiatry at Columbia University, pointed out to Psychiatric News.How current cigarette smoking might trigger suicidal thoughts or attempts is not known. Yet if it does play a causal role, Breslau and her team suspect that it may do so via an intermediary culprit—the enzyme monoamine oxidase (MAO), which is found in the liver and the central nervous system. It is crucial to the functions of the neurotransmitter serotonin. Low levels of MAO have been found in blood cells of current cigarette smokers, but not in those of ex-smokers, and low blood-cell levels of MAO in turn have been linked with violence and suicide.This investigation has several advantages over past ones on the subject. It took major depression, a well-established risk factor for suicide, into consideration, and it was quite sophisticated in design. Klein explained that it “incorporated major methodological advances by using prospective multiwave longitudinal psychiatric diagnoses in estimating whether smoking independently increases suicide-related behaviors.”The study had a weakness, however, which Breslau and her group acknowledged in their report: The researchers did not gather data about subjects' completed suicides, only about their suicidal thoughts and attempts.The study was funded by the National Institute of Mental Health.An abstract of “Smoking and the Risk of Suicidal Behavior” is posted online at<http://archpsyc.ama-assn.org/cgi/content/abstract/62/3/328>.▪ Arch Gen Psychiatry 2005 62 328 ISSUES NewArchived

This article draws upon data from the Longitudinal Study of Indigenous Children to explore whether Aboriginal and Torres Strait Islander youth (n = 472) feel adequately supported within their cultural identity at school, and what they believe could enhance their sense of support. The confidence of Indigenous youth in their Indigeneity within educational environments has been reported as crucial for fostering positive self-esteem, and contributes to favourable school retention and success, positive relationships with peers and staff, alongside one’s overall health and well being. Our findings indicate that a majority of the sampled Indigenous students do not report having received sufficient support from their schools towards their cultural identity. Participant-identified areas of improvement from schools in this regard include more classes and in-school activities, increased presence and recognition of culture, and greater encouragement and support. These insights are useful for informing educators, schools, and policymakers in developing educational settings that are received as valuing and nourishing Indigenous students and their cultural identity.

Ed Shneidman reports on his 1971 analysis of the suicides that had occurred in the Terman Gifted Children Study. Begun in the 1920s at Stanford University, Professor Lewis Terman identified 1,528 high-IQ California students and, over the years, they have been continuously followed. Today, the remaining subjects (about 100) have a mean age of 93. In his uniquely Shneiderian manner, Ed relates how, in 1971, he utilized a psychological autopsy approach to accurately predict the suicides of a small subsample of the 20 suicides that had occurred to date among the 857 male participants. Almost 35 years later, he shares with us his slightly revised view of those factors that he believes play significant predictable roles in the eventuality of suicide. Jeremy Kisch et al. report on analyses from the Spring 2000 National College Health Assessment Survey (NCHA), sponsored by the American College Health Association. This is the largest and most comprehensive survey to date (15,977 college students) that provides a replication of the CDC's 1995 National College Health Risk Behavior Survey (NCHRBS). This study investigates the relationship between suicidal behavior and depressed mood, as well as other risk factors which increase vulnerability to suicidal behavior. Of particular note is that less than 20% of college students reporting suicidal ideation or attempts were receiving treatment (psychotherapy and/or medications). Adolescent suicide continues to be a major focus of much research as evidenced by the number and range of studies published in SLTB over the years. Researchers have appropriately focused on identifying critical risk factors associated with suicidal behaviors. Thompson et al. explored the roles of anxiety, depression, and hopelessness as mediators between known risk factors and suicidal behaviors among 1,287 potential high school dropouts. As a step toward theory development, a model was tested that posited the relationships among these variables and their effects on suicidal behaviors. The results showed direct effects of depression and hopelessness on suicidal behaviors for males, and direct effects of hopelessness, but not depression, for females. For both males and females, anxiety was directly linked to depression and hopelessness; drug involvement had both direct and indirect effects on suicidal behavior. Lack of family support showed indirect influences on suicidal behaviors through anxiety for both males and females as hypothesized. As the authors point out, for mental health professionals, school personnel, and prevention scientists working with at-risk or suicidal youth, the findings make evident the need to address multiple co-occurring problem behaviors such as drug involvement, emotional distress, and suicidal behaviors. Over the years, SLTB has published data emanating from the CDC's Youth Risk Behavior Survey (YRBS), which is conducted biannually. (see SLTB 30: 304–312; 32: 321–323). The four questions that measure suicidal ideation and attempts are ordered along an implicit continuum of development and severity from seriously considering suicide, to planning, to actually attempting suicide, and, finally, to requiring medical attention for a suicide attempt. As presented by Victor Perez, this process assumes a straightforward sequence of suicidal thought and action and is the underpinning of the content and order of the YRBS questions. However, the assumed ordinal properties of the four questions had never been empirically tested. Brener, Krug, and Simon (SLTB 30: 304–312) found discrepancies in the trends of responses to the questions measuring suicidal activity in their analysis of the YRBS from 1991–1997. Specifically, they showed that although the percentage of students who reported having seriously considered or attempted suicide in the past 12 months had declined steadily since 1991, the percentage of students requiring medical attention for an injurious suicide attempt had increased. They concluded that injurious suicide attempts might not be linked to seriously considering or planning a suicide attempt. Perez examines the assumed ordinal relationship in the 1999 Youth Risk Behavior Survey by constructing a trajectory that identifies all possible response patterns among the four questions measuring suicidal activity. Significant differences between means of dependent variables at each level of the normative trajectory supported the hypothesis that frequency of risk behaviors increases monotonically with successive suicidal thought and behavior. Research on the relationship between schizophrenia and suicidal behaviors has languished until recently (see SLTB 30: 34–49; 34: 66–76; 34: 76–86; 34: 311–319). Camilla Haw et al. identify the risk factors for deliberate self-harm (DSH) in schizophrenia. They provide an explanation and reference to their use of the broader (European) term DSH, rather than attempted suicide. Although there are several published review articles on risk factors for suicide and suicidal behavior in schizophrenia, there are few reviews which make any mention of risk factors for DSH, and there is an assumption that the risk factors for DSH and suicide are the same. Haw et al. examined cohort and case-control studies of patients with schizophrenia or related diagnoses that reported DSH as an outcome. Five variables (past or recent suicidal ideation, previous DSH, past depressive episode, drug abuse or dependence, and higher mean number of psychiatric admissions) were associated with an increased risk of DSH, while one (unemployment) was associated with a reduced risk. In a continuing series of studies (see SLTB 27: 153–163), Eric Blaauw et al. focus on the prevention of suicide in jails and prisons. This current study aims to identify combinations of characteristics (demographic, psychiatric, and criminal) that are capable of identifying potential suicide victims. Characteristics of 95 suicide victims in the Dutch prison system were compared with those of a random sample of 247 inmates in ten jails. Combinations of indicators for suicide risk were also tested for their capability of identifying 209 suicides in U.S. jails and 279 prison suicides in England and Wales. A combination of two demographic characteristics (age over 40, homelessness), two criminal characteristics (one prior incarceration, violent offense), and two indicators of psychiatric problems (history of psychiatric care, history of hard drug abuse) proved capable of identifying 82 percent of the suicide victims in the Netherlands at a specificity of .82 in the general inmate population. Less powerful combinations correctly classified 53% of the U.S. suicides and 47% of the U.K. suicides. Blaauw and colleagues conclude that a small set of demographic and criminal characteristics and indicators of psychiatric problems is useful for the identification of suicide risk in jails and prisons. They point out that the characteristics can easily be incorporated in a screening device that can be administered during the intake process for new inmates. Some risk factors for suicidal behavior are similar to those often studied in the field of criminology. The link between suicide and crime is most apparent when there is a homicide followed by suicide. People who kill others rarely kill themselves afterward. When they do, they are more likely to have killed someone with whom they are intimately involved—an intimate partner or a child. A review of the literature on this phenomenon in Australia, Canada, and the United States showed that, in all three countries, the majority of those who commit suicide after a homicide are male partners or ex-partners of female victims. Using data on over 700 intimate femicides, Myrna Dawson examined the role of premeditation in cases of intimate femicide-suicide compared to killings that do not culminate in a suicide. Her results show that premeditation is more likely to occur in cases involving the offenders' suicide, but that evidence of premeditation varies depending on the type of suicidal killer. Michel Préville et al. present the results of a psychological autopsy investigation of 101 adults aged 60 years and older who died by suicide in Quebec in 1998–1999. The study looks at a number of variables from proxy survivor interview data, including health- and mental health-related behaviors, mental health diagnoses, and social and demographic variables. In this study, 42.6% of the suicide cases presented with mental disorders at the time of their death (mainly depression), and nearly 44% of the suicide cases had no current or pre-existing psychiatric condition. Only 27.7% of the cases did not express any idea of death during the 6-month period preceding their suicidal death. Interestingly, 53.5% of the suicide cases consulted a general practitioner or specialist during the 2-week period preceding their death. The authors suggest that family members and friends could play an important role in preventing elderly suicide attempts by encouraging their parents to discuss their suicidal thoughts with their general practitioner. The results show some similar and some disparate results compared to other studies of elderly suicides, indicating the need for research that examines the complex causal nature of the relationship between mental disorders and suicide among the elderly. Adding to his studies of homeless veterans who abuse substances (SLTB 33:430–432), Brent Benda studied 315 male and 310 female homeless military veterans in a V.A. inpatient program designed to treat substance abusers, many of whom also suffer psychiatric disorders. The study examined gender differences in factors associated with the odds of having suicidal thoughts, and of attempting suicide, in comparison to being nonsuicidal. Childhood and current sexual and physical abuses, depression, fearfulness, relationship problems, limited social support, and low self-esteem were more strongly associated with suicidal thoughts and attempts for women than for men veterans. Extent of alcohol and other drug abuse, aggression, resilience, self-efficacy, combat exposure, combat-related PTSD, and work problems were more strongly associated with suicidal thoughts and attempts for men than for women. While anticipating the release of the CDC's final 2002 national suicide death numbers and rates, there have been different explanations offered for the apparent slow, but steady decline in national suicide rates over the last years. In 1996 the rate was 11.52/100,000; 11.23 in 1997; 11.13 in 1998; 10.47 in 1999; 10.43 in 2000, and 10.69 in 2001. By the time you receive this issue, we will know whether the trend is heading downward or beginning to climb back up. Recently, my attention was drawn to an Editorial originally published on July 30, 1904, in the Journal of the American Medical Association, entitled, “The Increase in Suicide.” I have excerpted portions as follows: The increase of suicide has come to be such a marked feature of social statistics in this country that physicians must be made to realize the possibilities there may be of bringing about a decrease in this unfortunate matter by more care and prevision. Suicides are somewhat more than twice as frequent now as they were ten years ago. … Carefully collected statistics show that there was a constant increase from 3,531 suicides in 1891 to 6,600 in 1897, then a drop in 1898 to 5,920, and in 1899 to 5,340. In 1900 there were 6,755 suicides, an increase of over 150 above the figures for 1897, the highest previous number, and there has been a constant increase since, in 1903 the number of suicides being very close to 8,600. During the last thirteen years—that is, since 1891, there have been altogether 77,617 cases of suicide reported in the newspapers of this country. The decrease in the number of suicides during 1898 and 1899 is not surprising, if we remember the conditions that prevailed in the commercial world at that time. After a period of hard times there was the wave of prosperity and a decided reaction in men's feelings that made the future look bright enough for everyone. Curiously enough, the statistics, however, do not show that city life is so much harder on the people than country life. During the last ten years, the suicide rate in fifty cities of this country has about doubled. That is, however, only in proportion to the suicide rate throughout all the rest of the country and does not especially condemn the high pressure of large city life as a disturbing factor of mentality. The most serious thing about the statistics is the fact that, though suicides are more common among men than women in all countries, the difference is gradually growing less, and in recent years, this has been quite marked. (43: 333–334) The 1890 census data from some states was partially destroyed by a fire in 1921; however, the federal records indicate an 1890 U.S. census of 62,116,811. Using this number, the rates are as follows: 5.68/100,000 in 1891, 10.63 in 1897, 9.53 in 1898, and 8.60 in 1899. The official U.S. census in 1900 was 74,607,225. In 1900, there were 6,755 suicides, yielding a rate of 9.05/100,000. In 1903, there was a significant increase in the number of suicides to approximately 8,600. Using the 1900 census, the suicide rate rose to 11.53/100,000. During the 13-year period between 1891–1903 there were 77,617 suicides, or approximately 5,971/year. This yields a roughly estimated rate of 9.61/100,000 for this 13-year period. Taken as a whole for the years surrounding the turn of the 20th century, the rate hovered around 9–10/100,000. One hundred years later, we continue to grapple with similar rates and similar risk factors.

Increasing awareness of sexually transmitted infections (STI) testing and addressing stigma may improve STI testing in Aboriginal and Torres Strait Islander youth: Evidence from the Next Generation Youth Wellbeing Study

BackgroundSuicide is one of the leading causes of death among children and adolescents. Most studies about the burden and risk factors for suicide have been conducted in high-income countries. However, there is a dearth in the literature about the burden and risk factors for suicide among children and adolescents in low- and middle-income countries including within Sub-Saharan Africa (SSA). There is need to summarise the available literature about the burden and risk factors for suicide among children and adolescents in SSA. In this review, we will (a) determine the overall prevalence of suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA; (b) describe the methods (such as hanging, firearms, overdose, poisoning, drowning and burning) used for suicidal attempt, and completed suicide among children and adolescents in SSA; and (c) document the risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA.MethodsThe review will be conducted and reported in accordance to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. We will include journal articles that have documented the prevalence and risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents aged 5–19 years in SSA. We will also include accessible grey literature about the topic. Qualitative studies will be excluded from the study since they are limited in estimating prevalence. We will search different search engines including PUBMED, EMBASE, Psych-INFO, Cochrane Library, Africa wide-information and global health using suicide, adolescents and children, SSA as the keywords. We will use a meta-analysis, should we find that there is no heterogeneity between included studies.DiscussionThis protocol describes a systematic review of observational studies reporting completed suicide, suicidal ideation and suicidal attempt among children and adolescents in sub-Saharan Africa. We anticipate that once this review is complete and published, our findings will be of interest to adolescents with suicidal behaviour, their families and caregivers, clinicians and other healthcare professionals, scientists and policy makers.Systematic review registrationPROSPERO International prospective register of systematic reviews: CRD42016048610.

Social exclusion social inclusion are useful concepts for making sense of the deeply embedded socio-economic disadvantaged position of Aboriginal and Torres Islander people in Australian. The concepts not only describe exclusion from social and economic participation; but seek to understand the dynamic processes behind their creation and reproduction. Yet few Australian studies go beyond describing Aboriginal over-representation on social exclusion indicators. Neither do they address the translatability of the concepts from non-Indigenous to Indigenous contexts despite mainstream studies finding the pattern of social exclusion (and therefore what social inclusion might look like) differs for Aboriginal and Torres Strait Islander people to that of other disadvantaged groups. This paper uses data from the Longitudinal Study of Indigenous children to explore patterns of social exclusion across social, economic, well-being and community dimensions for urban Aboriginal and Torres Strait families. The paper then develops a contextual understanding of the processes and patterns that create and sustain social exclusion and the opportunities and challenges of moving to greater social inclusion for urban Aboriginal and Torres Strait Islander people/s.