Madelyn Hsiao-Rei Hicks

Casualties in civilians and coalition soldiers from suicide bombings in Iraq, 2003–10: a descriptive study

BACKGROUND Suicide bombs in Iraq are a major public health problem. We aimed to describe documented casualties from suicide bombs in Iraq during 2003-10 in Iraqi civilians and coalition soldiers. METHODS In this descriptive study, we analysed and compared suicide bomb casualties in Iraq that were documented in two datasets covering March 20, 2003, to Dec 31, 2010--one reporting coalition-soldier deaths from suicide bombs, the other reporting deaths and injuries of Iraqi civilians from armed violence. We analysed deaths and injuries over time, by bomb subtype and victim demographics. FINDINGS In 2003-10, 1003 documented suicide bomb events caused 19% (42,928 of 225,789) of all Iraqi civilian casualties in our dataset, 26% (30,644 of 117,165) of injured civilians, and 11% (12,284 of 108,624) of civilian deaths. The injured-to-killed ratio for civilians was 2·5 people injured to one person killed from suicide bombs. Suicide bombers on foot caused 43% (5314 of 12,284) of documented suicide bomb deaths. Suicide bombers who used cars caused 40% (12,224 of 30,644) of civilian injuries. Of 3963 demographically identifiable suicide bomb fatalities, 2981 (75%) were men, 428 (11%) were women, and 554 (14%) were children. Children made up a higher proportion of demographically identifiable deaths from suicide bombings than from general armed violence (9%, 3669 of 40,276 deaths; p<0·0001). The injured-to-killed ratio for all suicide bombings was slightly higher for women than it was for men (p=0·02), but the ratio for children was lower than it was for both women (p<0·0001) and men (p=0·0002). 200 coalition soldiers were killed in 79 suicide bomb events during 2003-10. More Iraqi civilians per lethal event were killed than were coalition soldiers (12 vs 3; p=0·004). INTERPRETATION Suicide bombers in Iraq kill significantly more Iraqi civilians than coalition soldiers. Among civilians, children are more likely to die than adults when injured by suicide bombs. FUNDING None.

Decision-Making within the Social Course of Dementia: Accounts by Chinese-American Caregivers

The goal of this retrospective pilot study was to provide a naturalistic description of the decision-making process regarding dementia, a chronic illness. The hypothesis was that in-depth descriptions by caregivers in a community setting would provide a more comprehensive and realistic representation of decision-making in the case of chronic illness than has been provided by most models. Data were gathered from in-depth, qualitative interviews with seven Chinese-American families living in the Boston area and caring for an elderly family member with dementia. These were supplemented with interviews with medical professionals and ethnography done in the community regarding the care of elders with dementia. Based on the findings, this paper proposes a dynamic, more comprehensive model for the social process of decision-making which is particularly applicable to clinical and life situations of decision-making in the case of chronic illness. The model describes: 1) the decision-maker constellation, including multiple family members, professionals and service systems; 2) relationships between decision-makers as “allies” or “competitors” 3) variations in the nature of the decision-making process; and 4) the interaction of decision-making with larger social, economic and cultural forces. Decision-making in the case of dementia is placed within the conceptual framework of the “social course” of chronic illness.

Perceived causes of suicide attempts by U.K. South Asian women.

Perceived causes of suicide attempts were examined in 180 ethnic South Asian women living in the London area. The 3 factors endorsed most frequently and strongly as causes of suicide attempts in South Asian women were violence by the husband, being trapped in an unhappy family situation, and depression.

The Prevalence and Characteristics of Intimate Partner Violence in a Community Study of Chinese American Women

A community probability-sampled survey was done of 181 Chinese American women to investigate the prevalence and nature of intimate partner violence (IPV) in Chinese Americans. Of participants, 42% knew a Chinese woman who had experienced IPV. Also, 14% had experienced IPV themselves in their lifetime (8% severe and 6% minor), 3% in the previous year, and 2% currently. In Chinese American women who were ever married, the lifetime prevalence of IPV was 17%. IPV resulted in physical injuries for 31% of women and affected their work and education. Exploratory analysis suggests that relationship problems and partners alcohol use may be risk factors for IPV in this group.

Violent Deaths of Iraqi Civilians, 2003–2008: Analysis by Perpetrator, Weapon, Time, and Location

Madelyn Hsiao-Rei Hicks and colleagues provide a detailed analysis of Iraqi civilian violent deaths during 2003-2008 of the Iraq war and show that of 92,614 deaths, unknown perpetrators caused 74% of deaths, Coalition forces 12%, and Anti-Coalition forces 11%.

Partner violence and major depression in women: a community study of Chinese Americans.

This cross-sectional, retrospective study used epidemiological and anthropological methods toward two aims: 1) to examine associations between partner violence and major depression in a community probability sample of women and 2) to provide new data on partner violence in Chinese Americans. In this study, 181 Chinese American women were interviewed, with 178 completing structured sections on CIDI 2.1 major depression and on partner violence history. Results indicate that a history of partner violence is associated with significantly higher rates of lifetime, 12-month, and current major depression in this community population. This effect is specific and independent of other factors. Partner violence also has a dose-response relationship with the severity of major depression episodes, increasing risk for severe and moderate episodes. The strength and specificity of this association, its dose-response effect, and its commonality across different populations suggest a possible causal role for partner violence needing further investigation in research on major depression in women.

The Weapons That Kill Civilians — Deaths of Children and Noncombatants in Iraq, 2003–2008

Dr. Madelyn Hicks and colleagues used the Iraq Body Count database to determine the nature and effects of various weapons on civilians in Iraq. They are now convinced that documenting the particular causes of violent civilian deaths during armed conflict is essential, both to prevent civilian harm and to monitor compliance with international humanitarian law.

Civilian deaths from weapons used in the Syrian conflict

The ongoing Syrian conflict is one of the largest humanitarian crises of the 21st century so far. Debarati Guha-Sapir and colleagues analyse the impact of weapons on civilian deaths, with a focus on women and children

Validity of the CIDI Probe Flow Chart for Depression in Chinese American Women

This article presents observations on the function and validity of the Composite International Diagnostic Interview (CIDI) 2.1 in a study of major depression in Chinese American women. CIDI symptom items for depression had good apparent validity and acceptability. However, CIDI probe flow chart (PFC) ‘clinical significance’ criteria appeared to underidentify cases of major depression if they occurred in China, or in deprived conditions within the U.S. and other developed countries. Validity of the CIDI PFC was affected by social, political and cultural factors. Patterns of bias are discussed and related to assumptions underlying the PFC regarding resource availability, help-seeking and the expression of distress.

Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors

BackgroundA bill to legalize physician-assisted suicide in the UK recently made significant progress in the British House of Lords and will be reintroduced in the future. Until now there has been little discussion of the clinical implications of physician-assisted suicide for the UK. This paper describes problematical issues that became apparent from a review of the medical and psychiatric literature as to the potential effects of legalized physician-assisted suicide.DiscussionMost deaths by physician-assisted suicide are likely to occur for the illness of cancer and in the elderly. GPs will deal with most requests for assisted suicide. The UK is likely to have proportionately more PAS deaths than Oregon due to the bills wider application to individuals with more severe physical disabilities. Evidence from other countries has shown that coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide. Depression influences requests for hastened death in terminally ill patients, but is often under-recognized or dismissed by doctors, some of whom proceed with assisted death anyway. Psychiatric evaluations, though helpful, do not solve these problems. Safeguards that are incorporated into physician-assisted suicide criteria probably decrease but do not prevent its misapplication.SummaryThe UK is likely to face significant clinical problems arising from physician-assisted suicide if it is legalized. Terminally ill patients with mental illness, especially depression, are particularly vulnerable to the misapplication of physician-assisted suicide despite guidelines and safeguards.