Norman Kreitman

Mean cell volume and gamma-glutamyl-transpeptidase as markers of drinking in working men.

The usefulness of serum-gamma-glutamyl-transpeptidase (gamma-GT) and mean cell volume (MCV) as markers of alcohol consumption was assessed in men in employment (266 company directors and 222 manual workers in alcohol-production firms) and in 34 male alcoholic patients. The correlations of admitted consumption with gamma-GT were 0.307 (directors) and 0.418 (manual workers) and with MCV 0.439 (directors) and 0.360 (manual workers). A man with an MCV of over 98 fl and a gamma-GT level above 50 i.u./l had a 62% chance of admitting to drinking over 450 g alcohol per week. Although the probability of being a heavy drinker increases progressively with elevation in both these tests, as screening tests they lack power, though false positives may be explained in party by inaccurate self-reports by both survey subjects and patients. For clinical purposes, however, the tests have a use in supplementing self-report and in following problem drinkers in outpatient treatment.

Trends in parasuicide and unemployment among men in Edinburgh, 1968-82.

Between 1968 and 1982 annual unemployment and annual incidence of parasuicide among men in Edinburgh were positively and highly significantly correlated (r = 0.77). Similarly, they were found to be correlated across the city wards in 1971 (r = 0.76) and, even more strongly, 1981 (r = 0.95). Throughout the period the incidence of parasuicide among the unemployed was nearly always more than 10 times higher than among the employed. Men unemployed for more than a year were at much higher risk than those out of work for shorter periods. These findings were considered to be consistent with the view that unemployment, especially if long term, increases the incidence of parasuicide. The official prediction of an increase in long term unemployment has important implications.

Parasuicide and unemployment among men in Edinburgh 1968-82.

The ecological association between unemployment and parasuicide rates among males in Edinburgh over the period 1968-82 was positive and highly significant (r = 0.77). Similarly, the two rates were found to be correlated across the city wards in 1971 (r = 0.76) and even more strongly in 1981 (r = 0.95). Throughout the period the parasuicide rate among the unemployed was nearly always more than 10 times higher than that among the employed. The long-term unemployed were at much higher risk than those out of work for lesser periods, although the impact of recent job loss was marked. Population attributable risk has shown a tendency to rise in line with the upward trend in the unemployment rate, despite the decline in relative risk over the period. The findings were considered consistent with the view that unemployment increases the parasuicide rate.

Age and parasuicide ('attempted suicide').

A one-year cohort of parasuicide patients (n = 882) was divided into three age groups, subdivided by sex where indicated. Systematic comparisons of the groups were made, and significant discrepancies validated using a second cohort of patients. A number of social, demographic and clinical differences were found, as well as some unexpected similarities. The rates for subsequent (completed) suicide were conspicuously different in the six age-sex subgroups.

Long term trends in parasuicide and unemployment in Edinburgh, 1968-87

SummaryAggregate- and individual-level trends in parasuicide and unemployment among men and women resident in Edinburgh during the years 1968–87 are reported. During the first half of the period unemployment and parasuicide rates increasedin parallel (r=0.91,P<0.001 among men;r=0.82,P<0.01 among women). However, while unemployment continued to rise after 1977, parasuicide rates tended to fall (r=−0.83,P<0.001 among men;r=−0.38, NS among women). It could be shown that the reversed relationship between parasuicide and unemployment after 1976 was not due to changes over time in the validity of the local unemployment rate as a marker of economic conditions. Suggested explanations for the falling parasuicide rate in Edinburgh include the possibility of a “threshold” effect and the influence of other (non-economic) factors. The rate of parasuicideamong the unemployed fell, especially after 1973, while the rate among the employed rose until 1976–7, thereafter tending to fall. The relative risk (rate among the unemployed/rate among the employed) declined until 1979, since when it has fluctuated at about 10. The highest rate of parasuicide was consistently found among the long-term unemployed.

Social construction or causal ascription: Distinguishing suicide from undetermined deaths

SummaryThis study reports findings of the first Scottish comparison between suicide and undetermined deaths on a number of sociodemographic and psychiatric variables, and also in relation to the method of death. Logistic regression analysis confirmed that method was the most powerful and significant discriminator (88% of ‘active’ deaths were labelled suicide compared to only 54% of drowning) and also pointed to an interaction between gender and age. The two types of death could not be differentiated by marital status, previous psychiatric contact or social class. Time interval between psychiatric contact and death was not significantly associated with classification of death. The authors conclude that evidence concerning the aetiological significance of prior parasuicide and psychiatric illness in suicide remains valid. The alternative social construction hypothesis, namely that these are criteria used by officials to label an ambiguous death as suicide, finds no support.