The hypothesis of a negative association between rates of suicide and number of children in marriage was investigated in a prospective study of 989,949 women followed up for 15 years (1970 through 1985) with 1190 deaths from suicide. Women who had never married exhibited higher relative risks for suicide than married parous and married nonparous women for all age groups younger than 65 years at the start of follow-up. Among the married, the parous women had lower relative risks than nonparous women for all ages. For both premenopausal and postmenopausal women, a strong linear decrease in relative risk for suicide with increasing number of children in marriage was found. The effect of number of children was independent of social class measured as years of completed schooling. The findings provide the first empirical support for theories of parenthood and suicide advanced by Durkheim almost 100 years ago.
Several studies suggest that the patient's experience of being coerced, during the admission process to mental hospitals, does not necessarily correspond with their legal status. Rather, perceived coercion appears to be associated with having experienced force and/or threats (negative pressures), as well as feeling that their views were not taken into consideration in the admission process (process exclusion). We investigated perceived coercion, among patients admitted both voluntarily and involuntarily, to acute wards in Norway. We used a visual analogue scale (the Coercion Ladder, CL) and the MacArthur Perceived Coercion Scale (MPCS), a five-item questionnaire, to measure perceived coercion. Two hundred and twenty-three consecutively admitted patients to four acute wards were included and interviewed within 5 days of admission. Many patients reported high levels of perceived coercion in the admission process, with the involuntary group experiencing significantly higher levels than the voluntary group. However, 32% of voluntarily admitted patients perceived high levels, and 41% of involuntarily admitted patients perceived low levels of coercion. Legal status did not significantly predict perceived coercion on either the MPCS or the CL after taking negative pressures and process exclusion into account. Applying a visual analogue scale (CL) seems to provide a useful measure of patients' perception of coercion and one that largely parallels the MPCS.
The use of coercion on people with mental illness is a serious intervention, and a reduction in its use is a declared goal in mental health care. Yet many countries have introduced expanded powers of coercion in recent years, including outpatient commitment (OC). However, the evidence of the effectiveness of OC is inconclusive, and little is known about how patients experience OC schemes. The objective of this qualitative study was to explore (1) patients' experiences with OC, and (2) how routines in care and health services affect patients' everyday living. The data was collected in 2011-2012 and included 11 qualitative in-depth interviews with patients subject to OC. The study used a narrative approach to interviews, and a thematic narrative analysis. Participants generally complied with the OC requirements because of the clear and secure framework of OC, but also because they believed the alternative would be involuntary hospitalisation. No one reported physical force, but the coercion was experienced as limitation of freedom of action through excessive control and little patient influence or participation in their own treatment. Factors affecting patients' freedom of action under OC should be taken into account when the imposition of an OC order is considered.
This paper explores some of the controversies in the debate regarding the justification of civil commitment. The sometimes conflicting values reflected in the mental health legislation, human rights principles, moral philosophy and psychiatric professional standards are discussed. In spite of the often substantial use of civil commitment in many countries, there are almost no scientifically sound studies addressing the outcome of coercive treatment. The paper establishes that the traditional arguments in favour of civil commitment, like lack of insight and competence as well as the effectiveness of civil commitment, are poorly founded. The paper concludes that there seems to be a general agreement that civil commitment of patients who are dangerous to themselves or others should be the responsibility of the mental health care system, while civil commitment for treatment purposes is more controversial and hard to justify.
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