A Comparison of Child-sex-abuse-related and Mental-disorder-related Suicide in a Six-year Cohort of Regional Suicides: The Importance of the Child Protection-Psychiatric Interface

Correspondence to: Professor Colin Pritchard, Department of Mental Health, School of Medicine, Southampton University, Royal South Hants Hospital, Southampton SO14 0YG, UK. E-mail: cp1{at}soton.ac.uk Summary The study compares Mental-Disorder-Related (MDR) suicide rateswith Child-Sex-Abuse-Related (CSAR) suicide of ‘Victims’and ‘Perpetrators’ of child sex abuse, based uponan examination of all Coroners’ inquest files over a six-yearperiod (n = 1,017). Census data, psychiatric case register andpolice records were used to calculate the potential MDR andCSAR populations. There were five main findings: (i) male andfemale CSAR victim suicide rates were 2.2. and 2.5 times theGeneral Population Suicide Rate (GPSR), respectively; (ii) everyfemale, and 80 per cent of male CSAR victim suicides, also hada mental disorder but none of the CSAR perpetrator suicides;(iii) male and female MDR suicide rates were 5 and 6 times theCSAR Victim rates; (iv) the sex abuser perpetrators’ suiciderate was more than 3 times the male MDR rate; (v) the intra-and extra-familial perpetrator suicide rates, were 25 and 78times the GPSR, respectively. Possible explanations for thesesurprising results are briefly discussed. They confirm the overrepresentationof people with mental disorder amongst suicides, and identifyan overrepresentation of CSAR suicides, particularly perpetrators.The results have implications for suicide prevention programmes,whilst highlighting the importance of the child protection-psychiatricinterface, and indicates the futility of simple explanationsin an area of practical and moral complexity.     

Why do People Disclose their HIV Status? Qualitative Evidence from a Group of Activist Women in Khayelitsha

Abstract

This study explores the bio-psychosocial context of HIV/AIDS in which eleven HIV-positive activist women from Khayelitsha negotiated the process of disclosing their HIV-positive status to significant others, specifically biological household members. The study is based on the narratives of a group of HIV-positive peer-educators in Cape Town, South Africa. The results suggest that community perceptions of HIV/AIDS are shaped by a wide variety of factors particular to the socio-cultural and political context of HIV/AIDS in South Africa. The process and outcomes of disclosure to others occurs within this shifting web of meanings, and in turn, reshapes them as people respond to the person who has just disclosed. Eight out of the eleven women disclosed to a close biological household member as these significant-others provided, or had the potential to provide, the appropriate support. Six of the eleven participants disclosed during the symptomatic phases of HIV/AIDS, while five were asymptomatic at the time. Four of the five who disclosed when asymptomatic were diagnosed while pregnant and had never experienced severe opportunistic infections. Additionally, these same four disclosed some time after diagnosis (nine months > t < two years). Of the six who disclosed in a state of ill-health, five disclosed immediately after diagnosis in order to access health-related social support. At this time, concerns regarding health and mortality superseded fears of rejection and discrimination due to AIDS-related stigma. The perceived potential benefits (social and health-related support) outweighed the perceived risks (stigmatisation and discrimination). When participants had never experienced serious illness, they disclosed in order to educate loved-ones, gain emotional support or challenge false popular perceptions of HIV/AIDS.     

The Interpretation of Line of Regard by Prelingually Deaf Children

The ability of 5- to 12-year-old deaf children to utilise and interpret another person's visual line of regard (where the eyes are looking) was studied in four experiments using cartoon faces. The children had little difficulty in determining whether or not a face was looking directly at them. They had more difficulty, however, with more complex tasks requiring them to infer mental states of desire and intention from line of regard and to ignore line of regard when it was inappropriate to attend to this cue. Deaf children raised in a hearing environment appear to have more difficulty with these more complex tasks than hearing children. The results are discussed in terms of the special difficulties facing some deaf children in the development of skills involving utilisation of line of regard and the implications for the development of joint attentional behaviour, theory of mind and dyadic social interaction in deaf and hearing children.     

Bank Loan Officers' Perceptions of Business Owners: The Role of Gender

There is a widely held belief that banks may be discriminating against female business owners. This study was designed to explore the perceptions held by bank loan officers of male and female business owners, using Bourdieu's theory of practice and Kelly's personal construct methodology. The research literature might lead to an expectation that the characteristics of the business owners would be relatively homogenous but that men and women business owners would be construed differently (for example women might be seen to lack drive). However, the results demonstrate heterogeneity in the constructs held by bank loan officers, and a particular concern with the character of the business owner. Significant gender differences were observed in only 20 of the 325 constructs elicited from 35 bank loan officers. Female bank loan officers were as likely as male bank loan officers to draw gender distinctions between business owners. Detailed multivariate analyses confirmed no evidence of systematic gender differences in the constructs held by bank loan officers of business owners.     

PERMUTATION MODELS FOR RELATIONAL DATA

A common problem in sociology, psychology, biology, geography, and management science is the comparison of dyadic relational structures (i.e., graphs). Where these structures are formed on a common set of elements, a natural question that arises is whether there is a tendency for elements that are strongly connected in one set of structures to be more—or less—strongly connected within another set. We may ask, for instance, whether there is a correspondence between golf games and business deals, trade and warfare, or spatial proximity and genetic similarity. In each case, the data for such comparisons may be continuous or discrete, and multiple relations may be involved simultaneously (e.g., when comparing multiple measures of international trade volume with multiple types of political interactions). We propose here an exponential family of permutation models that is suitable for inferring the direction and strength of association among dyadic relational structures. A linear-time algorithm is shown for MCMC simulation of model draws, as is the use of simulated draws for maximum likelihood estimation (MCMC-MLE) and/or estimation of Monte Carlo standard errors. We also provide an easily performed maximum pseudo-likelihood estimation procedure for the permutation model family, which provides a reasonable means of generating seed models for the MCMC-MLE procedure. Use of the modeling framework is demonstrated via an application involving relationships among managers in a high-tech firm.