Janice L. Hastrup

Stress and suicide in the Nurses' Health Study.

Study objectives: Although stress is thought to be a risk factor for suicide, most research has been retrospective or has focused on attempted suicides or suicide ideation. This study examined prospectively the associations between self perceived stress, diazepam use, and death from suicide among adult women. Design: A cohort study was conducted with 14 years of follow up. Stress at home and at work were assessed by questionnaire and scored on a four point scale: minimal, light, moderate, or severe. Setting: Eleven states within the United States. Participants: Female nurses (n=94 110) who were 36 to 61 years of age when they answered questions on stress and diazepam use in 1982. Results: During 1 272 000 person years of observation 73 suicides were identified. After adjustment for age, smoking, coffee consumption, alcohol intake, and marital status, the relation between self reported stress and suicide remained U shaped. Compared with the light home and work stress categories, which had the lowest incidences of suicide, risks were increased among women reporting either severe (relative risk (RR) = 3.7, 95% confidence intervals (CI) 1.7 to 8.3) or minimal (RR=2.1, 95% CI 1.0 to 4.5) home stress and either severe (RR=1.9, 95% CI 0.8 to 4.7) or minimal (RR=2.4, 95% CI 0.9 to 6.1) work stress. When responses to home and work stress were combined, there was an almost fivefold increase in risk of suicide among women in the high stress category. Risk of suicide was over eightfold among women reporting high stress or diazepam use compared with those reporting low stress and no diazepam use. Conclusions: The relation between self reported stress and suicide seems to be U shaped among adult women. The excess risk for those reporting minimal stress may reflect denial or undiagnosed depression or an association with some other unmeasured risk factor for suicide.

Fear of Cancer in a Rural Appalachian Community Following Notification of an Environmental Hazard

In this chapter we explore some of the intriguing questions raised by contaminated communities. Is there a connection between exposure to environmental hazards and psychological distress? If yes, how best can it be measured? What kinds of psychological problems are aggravated by this kind of life stress? How do we know that victims are truly experiencing increased problems such as anxiety, depression and fears about their health?