The study comprises 149 refugees from various countries, reporting exposure to severe traumata, who were referred for psychiatric diagnosis and assessment of suicide risk. The stressors reported comprised both personal experience of and/or forced witnessing of combat atrocities (including explosions or missile impacts in urban areas), imprisonment (including isolation), torture and inflicted pain, sexual violence, witnessing others' suicide, and of summary and/or mock executions. Posttraumatic stress disorder (PTSD) was diagnosed in 79% of all cases, other psychiatric illness in 16% and no mental pathology in 5%. The prevalence of suicidal behavior was significantly greater among refugees with principal PTSD diagnoses than among the remainder. PTSD patients with depression comorbidity reported higher frequency of suicidal thoughts; PTSD nondepressive patients manifested increased frequency of suicide attempts.

A ten-year series of 142 homicidal fatalities caused by sharp force injury was studied with the aim to systematize information inherent in the characteristics of the victim and the pattern of injuries. The population of victims consisted of 112 males (79%) and 30 females (21%); among perpetrators, 125 (88%) were males. Among victims as well as among perpetrators, persons of non-Swedish origin were overrepresented in relation to their share of the nonselected population. In 82 cases (58%), one or two wounds had been inflicted; in 23 cases (16%), ten or more wounds. In the latter group, eleven victims but no perpetrators were female. In the majority of cases victim and perpetrator were known to each other, and in instances of multiple wounding, a close relationship between the two was clearly more common than in the group of one- to two-wound fatalities. Tests for blood alcohol were positive in 86 of 116 victims (74%), the majority being in elimination phase. Furthermore, 96 of 120 perpetrators (80%) had positive tests or were known to be drunk at the time of the killing. In multiple wound fatalities, alcohol inebriation was less common both among victims and perpetrators. In these cases, the two persons involved were usually closely related or intimately known to each other, and in the absence of psychiatric disorder in the assailant, the motive was of a passionate type.

A total of 89 cases of sharp force suicide that had been committed in the Stockholm area in Sweden from 1972 through 1984 were investigated. The series showed a male preponderance, sex ratio 3.3, and among males a shift towards the age group 40 to 49 years of age. An impact of cultural/ethnic factors was indicated by the overrepresentation of Finnish and Hungarian immigrants. A psychiatric diagnosis had been ascribed in 22 cases, and addiction to drugs or alcohol in 23. Previous attempts at self-destruction were recorded in 11 cases, only 1 of which was by sharp force. Classical indicators of suicidal intent, for example, suicide notes and the presence of hesitation injuries, were found in 28 and 80%, respectively. A preference for certain anatomical locations (throat, precordium, epigastrium, wrists) was confirmed as was the tendency to expose the skin before inflicting suicidal wounds. As compared to homicidal precordial stabs whose entrance wounds usually run vertically, horizontal or upwards/left-slanting stabs are strongly suggestive of suicide. Although cases were encountered where several “rules of thumb” concerning homicidal versus suicidal patterns were violated, our series contained no case of injuries to the backside of the trunk and no case of more than one wound piercing the left ventricle of the heart. Multiple chest wounds transecting costal or sternal bone were however not uncommon, and, along with the use of bizarre tools and objects like wood chisels or pieces of glass, illustrated the determination of suicidal intent. Toxicological analysis was positive for drugs in 22 and for alcohol in 27 cases. Blood alcohol levels were roughly similar to those found in victims of homicidal sharp force, whereas drug levels tended to be lower or higher in suicides.

The aims of this study, which was part of a survey on adolescent sexual behaviour, were to investigate adolescents' experience of child sexual abuse and to present possible abuse-related problems. Representative samples of 2% of Sweden's 17-y-old male and female students and school non-attenders were selected in a two-step procedure. In all, 1943 students and 210 school non-attenders answered a self-administered anonymous questionnaire, distributed by school nurses. Six out of 170 questions dealt with personal experiences of child sexual abuse, i.e. age at onset, frequency of abuse and relationship to the offender. Peer abuse was excluded by the definitions used. The overall response rate was 92.2% for students and 44.2% for school dropouts. Among male and female students, 3.1% and 11.2%, respectively, acknowledged sexual abuse, 2.3% and 7.1%, respectively, when exhibitionism was excluded. Mean age at onset was 9.1 y (SD 4.3) for boys and 9.0 y (SD 3.9) for girls; 1.2% of the boys and 3.1% of the girls reported abusive oral, vaginal and/or anal intercourse. Suicide attempts or other acts of self-harm were reported by 33.3% of the male students reporting abuse and by 5.1% (p < 0.001) of those who had not been abused, and by 30.4% of the abused student girls compared to 9.1% of the non-abused (p < 0.001). Sleep and eating disorders, use of alcohol at an early age and/or experimentation with illicit drugs and consensual coitarche before age 15 y was reported significantly more often by abused than non-abused girls (p < 0.001, differences not found among the student boys). Of school non-attenders, 4% of the boys and 28% of the girls reported sexual abuse. Of the abused girls, 49% reported abusive vaginal intercourse and 64% reported self-destructive behaviour or suicide attempts. No abused boys and few abused girls had confided in a teacher, health professional or social worker. Results from the student sample should be interpreted as markers of "minimum prevalence", as female school non-attenders report significantly higher prevalence of sexual abuse. Potential high-risk groups are better included in prevalence investigations of child sexual abuse. The fact that so few adolescents confided in "professionals" about the abuse, despite having severe symptoms and signs of distress, underlines the need to address sexual abuse when recording the social, medical and psychiatric histories of adolescents.

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The study reports on 65 refugees with diagnoses of posttraumatic stress disorder (PTSD) and manifest suicidal behavior (40% had suicide attempts; 29% detailed suicide plan; 31% recurrent suicidal thoughts). Our hypothesis was that the predominant kind of stressful experience in PTSD patients might be reflected in their choice of method when pondering or attempting suicide. Relationships were found to exist between the main stressors and the respective subjects' preference for suicide method. Particularly among PTSD patients with a history of torture, an association was found between the torture methods that the victim had been exposed to, and the suicide method used in ideation or attempts. Blunt force applied to the head and body was associated with jumping from a height or in front of trains, water torture with drowning, or sharp force torture with methods involving self-inflicted stabbing or cutting. Relationships between main stressors and content of suicidal ideation are discussed.

Cases seen at SAC are strongly selected. The late cohort seems more representative of the commonly occurring assaults; young victims, known assailants. Even late presenters are in need of a multidisciplinary approach.

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