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Correlates of age in a sample of suicide attempters known to an agency Kiani, Aquila 1982

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CORRELATES OF AGE IN A SAMPLE OF SUICIDE ATTEMPTERS KNOWN TO AN AGENCY by ^AQUILA KIANI B.A., B.T., Agra University, India, 1943-1944 M.A. Ed., University of London, England, 1949 M.A., Sociology, Columbia University, U.S.A., 1953 Ph. D., F l o r i d a State University, U.S.A., 1955 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK in THE FACULTY OF GRADUATE STUDIES SCHOOL OF SOCIAL WORK We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA December 1982 (c) Aquila Kiani I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h C o l u m b i a , I agree t h a t t h e L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y purposes may be g r a n t e d by t h e head o f my department o r by h i s o r h e r r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Department o f S o c i a l Work The U n i v e r s i t y o f B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date F e b r u a r y 23, 1 9 8 3 DE-6 (3/81) ABSTRACT Canada's s u i c i d e r a t e has al m o s t d o u b l e d d u r i n g a q u a r t e r o f t h e c e n t u r y , i . e . , from 1951-1977. The s u i c i d e r a t e f o r B r i t i s h Columbia i s h i g h e r t h a n t h e n a t i o n a l average Canadian a g e - s p e c i f i c s u i c i d e r a t e s a r e a l s o h i g h among t h e e l d e r l y . I n t h e Vancouver downtown d i s t r i c t , s u i c i d e r a t e has r e a c h e d a l a r m i n g p r o p o r t i o n s . S.A.F.E.R., as p a r t o f i t s program f o r p r e v e n t i o n o f S u i c i d e A t t e m p t s , F o l l o w - u p , E d u c a t i o n and R e s e a r c h , had an on- g o i n g d a t a - c o l l e c t i o n p r o j e c t from mid 1977 t o t h e end o f 1981. D u r i n g t h e 4 1/2 y e a r s , i n f o r m a t i o n on 5,358 ca s e s o f a t t e m p t e d s u i c i d e was c o l l e c t e d by S.A.F.E.R. Workers f o r c l i n i c a l and programmatic p u r p o s e s . The p r e s e n t s t u d y has a n a l y z e d t h e d a t a c o l l e c t e d and s t o r e d i n S.A.F.E.R. Tape F i l e s . The main o b j e c t i v e o f t h e p r e s e n t s t u d y has been t o con-s t r u c t r e c o g n i z a b l y d i f f e r e n t p r o f i l e s f o r S.A.F.E.R. C l i e n t s by c l a s s i f y i n g them i n t o v a r i o u s age-groups. I n c r e a s e d aware-ness o f age as a f a c t o r may appear r e l e v a n t t o the p l a n n i n g and o n - g o i n g e v a l u a t i o n o f s u i c i d e p r e v e n t i o n programs. The assumed r e l a t i o n s h i p o f age w i t h t h e v a r i a b l e s o f t h e s t u d y was f o r m u l a t e d i n s e p a r a t e h y p o t h e s e s . T e s t s o f s i g n i f i c a n c e were a p p l i e d t o f i n d t h e s i g n i f i c a n c e o f a s s o c i a -t i o n between t h e v a r i a b l e s as w e l l as t o see t h e s t r e n g t h o f a s s o c i a t i o n between age and o t h e r v a r i a b l e s . S t a t i s t i c a l l y s i g n i f i c a n t relationships were found betwee age and most of the variables tested. Tests of association, however, showed consistently weak relationships; most were i n the neighbourhood of zero. Since the sample was large enough in most analyses to y i e l d s t a t i s t i c a l l y s i g n i f i c a n t findings even when actual differences were small, interpretations of the findings were based primarily on the strength of associa-t i o n rather than on s t a t i s t i c a l s i g n i f i c a n c e . No s i g n i f i c a n t differences were found between the 'young' and the 'old' e l d e r l y i n patterning of suicide attempts or i n the u t i l i z a t i o n of S.A.F.E.R. services. Highlights of recommendations include: a more r e s t r i c -t i v e p o l i c y on the monitoring and sale of drugs mostly used i n suicide attempts, i d e n t i f i c a t i o n of high-risk suicide attemp-t e r s , including the e l d e r l y through vigorous out-reach e f f o r t s , use of volunteers, special focus on working with the family of attempters, d i s p e l l i n g negative images and stereotyping against the e l d e r l y through education and t r a i n i n g programs for professionals and volunteers, integration of suicide pre-vention education with the school c u r r i c u l a as focus on pre-vention of high incidence of suicide among the teen-agers, evaluation of suicide prevention services, developing a sound data base to achieve r e l i a b i l i t y i n research and recognizing and strengthening the many roles of s o c i a l workers i n suicide prevention. i v TABLE OF CONTENTS Page ABSTRACT i i TABLE OF CONTENTS i v LIST OF TABLES v i LIST OF CHARTS v i i LIST OF DIAGRAMS v i i ACKNOWLEDGEMENTS v i i i DEDICATION X CHAPTER I. INTRODUCTION 1 Statement of the Problem. . . 1 Rationale for the Study 13 I I . REVIEW OF BACKGROUND LITERATURE 17 The History of Suicide 17 The S c i e n t i f i c Perspective 19 The Theoretical Orientation 21 Relation of Completed and Attempted Suicide . . 31 Findings of Related Studies . 31 Sui c i d a l Behavior Among the Elde r l y 44 II I . STRUCTURE OF THE INQUIRY 5 7 Objectives of the Study 57 Sp e c i f i c Hypotheses 59 Significance of the Study 62 IV.- METHODOLOGY 64 Type of Study 64 The Sample 65 Data C o l l e c t i o n 66 V a l i d i t y and R e l i a b i l i t y of Data 68 Selection of Variables 70 De f i n i t i o n of Key Concepts 73 Explanation of Terms Used i n Hypotheses . . . . 74 Abbreviations Used i n S t a t i s t i c a l Analysis. . . 75 V CHAPTER Page V. ANALYSIS OF DATA AND ITS INTERPRETATION 76 Basic P r o f i l e of Suicide Attempters 77 Testing of Hypotheses 88 Comparative Analysis of Young and Old El d e r l y Suicide Attempters 109 VI. SUMMARY OF FINDINGS, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS 112 Summary of Findings 112 Conclusions 113 Limitations of the Study 116 Recommendations 119 Implications for Social Work 128 Suggestions for Further Research 129 REFERENCES AND BIBLIOGRAPHY 131 APPENDICES A - l S.A.F.E.R. Information Summary Sheet (SIS) . . . . 148 A-2 SIS Variable Codes 149 B Recodes for Variables 152 C Cross Tabulations of Age by Correlated Variables 155 D Cross Tabulations of Age (65 & over) by Correlated Variables 188 v i LIST OF TABLES TABLE Page 1-A L i f e Expectancy i n More Developed Countries. . . 2 I- B L i f e Expectancy i n Less Developed Countries. . . 3 2 Rate of Suicide in More Developed and Less Developed Countries 3 3 Standardized Suicide Rate, by Sex, Selected Years, Canada 4 4 Crude Suicide Rate by Sex, Canada and Regions. . 5 5 Standardized Suicide Rate for the Population Aged 15 and Over by Sex and Selected Years, Canada 6 6 Standardized Suicide Rate by Sex and Selected Years, Canada 7 7 Suicides and Ratios for Local Areas, 1970-72, By Provinces 11 8 Tests of Hypotheses, Age by Correlated Variabes . 92- 97 9 t-tests on 14 Selected Correlates of Age . . . . 98-101 10 Tests of ANOVA on 8 Selected Correlates of Age 102-103 I I - A Multivariate Analysis of Age by PrioContype by Contype (No Service) ' 105 11-B Multivariate Analysis of Age by PrioContype by Contype (Some Service) 106 12 Tests of Association by Age (65+) and Correlated Variables 110 v i i LIST OF CHARTS Chart Page I Crude Suicide Rate for the Population Aged 65 and Over by Sex, Canada 9 II Growth Rate by Age Groups, 1950-2000 16 III Bar Chart Showing Frequency of Suicide Attempts by Year 78 IV Bar Chart Showing Frequency of Suicide Attempts by Month 79 V Bar Chart Showing Frequency of Suicide Attempts by Day of Week 85 VI Bar Chart Showing Frequency of Suicide Attempts by Hour of Day 86 LIST OF DIAGRAMS I Hypothetical Model i n Fatal and Non-Fatal Suicide Attempts. . . . . 45 II P r o f i l e of Attempted Suicide as Gleaned From a Review of Background Literature 4 6 III High-Risk P r o f i l e of E l d e r l y Suicides and Attempted Suicides 56 V i l l A C K N O W L E D G E M E N T S T h i s study has been accomplished through the h e l p , support and i n t e r e s t o f s e v e r a l people t o whom I wish to express my g r a t i t u d e i n d i v i d u a l l y . To begin w i t h , I would l i k e t o express my h e a r t f e l t thanks to Dr. R i c h a r d Nann, whose prompt a t t e n t i o n and i n i t i a l e f f o r t s i n s e c u r i n g the necessary p e r m i s s i o n from S.A.F.E.R., made the undertaking of t h i s study p o s s i b l e . To Dr. John Crane, s p e c i a l thanks are due. His constant guidance i n the data a n a l y s i s and i n the o r g a n i z a t i o n of m a t e r i a l has been most h e l p f u l . I am f u r t h e r g r a t e f u l t o him f o r p r o v i d i n g generous a s s i s t a n c e i n the use of computer res o u r c e s f o r s t a t i s t i c a l a n a l y s i s and f o r other output which made the study appear i n a more s u b s t a n t i a l form. To Mrs. Mary H i l l , I extend my g r a t e f u l a p p r e c i a t i o n . Her c r i t i c a l comments i n rev i e w i n g some of the chapters of the t h e s i s brought v a l u a b l e i n s i g h t s and breadth of v i s i o n . Her a s s i s t a n c e i n d i r e c t i n g me t o a p p r o p r i a t e sources of r e f e r e n c e helped f i l l up the gaps which might have otherwise o c c u r r e d . Dr. Glen Cooper, S t a t i s t i c a l C o n s u l t a n t , Computer Centre, U n i v e r s i t y of B r i t i s h Columbia, deserves s p e c i a l t r i b u t e f o r i x d e v o t i n g many hours from h i s otherwise busy schedule i n a s s i s t -i n g me w i t h the programming and running o f the data f o r t h i s study. I am t h a n k f u l to Dr. Li n d a Rosenfeld, c o o r d i n a t o r of the S.A.F.E.R. program, f o r f i n d i n g time to answer some of the q u e s t i o n s i n connec t i o n with the r e s e a r c h problem and f o r p r o v i d i n g the f a c i l i t y to c o n s u l t r e l e v a n t m a t e r i a l i n her o f f i c e . I am indebted, indeed, to Ron P e t e r s , r e s e a r c h o f f i c e r o f the Gr e a t e r Vancouver Mental H e a l t h S e r v i c e , f o r h i s a s s i s -tance i n a number o f ways. He has shared u n h e s i t a t i n g l y h i s knowledge and experience and made a v a i l a b l e r e a d i n g m a t e r i a l from h i s o f f i c e as the study progressed. His c o n t r i b u t i o n i n p r e p a r i n g 'An I n t r o d u c t i o n t o the S.A.F.E.R. Data Base' and h i s r o l e as a ' l i a i s o n ' between the School of S o c i a l Work, U n i v e r s i t y o f B r i t i s h Columbia, and S.A.F.E.R. i s s p e c i a l l y acknowledged. L a s t , but not the l e a s t , my g r a t i t u d e goes to my c h i l d r e n whose i n s p i r a t i o n and support enabled me to accomplish t h i s r e s e a r c h . X DEDICATED To Khalid, Sohail and Lina Who volunteer to help save l i v e s in despair & in c r i s i s 1 CHAPTER I INTRODUCTION Statement of the Problem Man's innate drive for self-preservation has been affirmed as the most predominant factor i n running the course of human existence. The process of survival records man's struggle against odds and his continuing search for evolving and innovat-ing safer and more improved ways of l i v i n g . In fact, the growth and development of human cultures and the progress of c i v i l i z a -tions have been primarily motivated by the drive to make l i f e more secure and at i t s best on-going. Nevertheless, there have been counter-forces throughout the course of human history caus-ing some people to be predisposed to or to d r i f t toward s e l f -destruction. Denys deCatanzaro (1981:X), i n his Preface to 'Suicide and s e l f destructive behavior' remarks "self-preserva-t i o n i s r e a d i l y explained through b i o l o g i c a l concepts, but s e l f -destruction i s quite anomalous." The act of self-destruction or suicide i s considered a threat to society, but to the individuals who attempt or complete suicide, i t i s said to be the only way to avoid the problem of pain, f a i l u r e , unhappiness and the l i k e . Such ambivalence has both puzzled and fascinated the inquiring minds. Sigmund Freud commented on the mystery of suicide as to how i t becomes possible for the extraordinary powerful l i f e i n -s t i n c t to be overcome by deliberate acts of s e l f - a n n i h i l a t i o n . He suspended his judgement on the issue for many years. A highly paradoxical s i t u a t i o n i n general confronts the more developed* countries which have attained higher l i f e expectancy, yet have increasing rates of suicide.- S c i e n t i f i c and technological advancement has made i t possible for them to gain control over diseases, to have access to better health measures, to l i f e - s a v i n g drugs, improved n u t r i t i o n and to have more adequate housing and other amenities of l i f e . In addition an adequate income d i s t r i b u t i o n has made i t possible for everyone to a v a i l of the advantages and benefits, which the more aff l u e n t nations can provide for t h e i r people. A l l these factors may account for the longevity of l i f e i n those countries. Canada i s included among such countries with higher l i f e expectancy, which yet has a higher suicide rate. Tables 1 A, B and 2 provide figures to substantiate the statement. TABLE 1 - A L i f e Expectancy i n More Developed Countries Country Male Female Year Austria 68.54 75.60 1977 Canada 69. 34 76.46 1977 Sweden 72.23 78.14 1974-78 U.K. 69.62 75.82 1974-76 U.S.A. 68.7 76.5 1975 *The More Developed Countries are also characterized by greater i n d u s t r i a l i z a t i o n and urbanization. TABLE 1 - B L i f e Expectancy i n Less Developed Countries Country Male Female Year Angola 37.0 40.1 1970-75 Chile 60.43 66.01 1969-70 Mexico 62.76 66.57 1975 P h i l l i p i n e s 56.9 60.0 1970-75 Saudi Arabia 44.2 46.5 1970-75 Source: Demographic Year Book 1978. United Nations, 1979, TABLE 2 Rate of Suicide i n More Developed and Less Developed Countries, (per 100,000 Living Population) A l l Ages. Country Rate Year Austria 22.7 1976 Canada 12.5 ' 1976 Sweden 20.8 1975 U.S.A. 12.2 1976 West Germany 21.7 1976 Angola* 1.0 1972 Chile* 5.4 1976 Egypt* 0.1 1975 Mexico* 0.7 1975 P h i l l i p i n e s * 1.1 1974 Source: Ibid. United Nations, 1979. Denotes Less Developed Countries 4 In Canada, the rate of suicide has almost doubled i n twenty six years. According to calculations by Health and Welfare Canada, based on V i t a l S t a t i s t i c s , the o v e r a l l suicide rate i n 1951 was 7.8 per 100,000 inhabitants. In 1977, i t swung up to 14.3. There were three times as many males as females who committed suicide as seen from Table 3. TABLE 3 Standardized* Suicide Rate, by Sex and Selected Years, Canada (per 100,000 inhabitants) Year Male Female Total 1951 11. 3 3.9 7.8 1961 12.9 3.3 8 . 2 1966 14.1 5.0 9.6 1971 18.3 6.8 12.5 1973 18.7 7.4 13.1 1975 18.2 7.0 12.6 1977 21.2 7.3 14.3 Source: Rates calculated by Health and Welfare, Canada based on S t a t i s t i c s Canada, V i t a l S t a t i s t i c s , 1951-77, S t a t i s t i c s Canada Revised Annual Estimates of population by sex and age, 1951-77 and Estimates of population by sex and age, 1977. (Lepine, Lorraine, 1982:41) *Standardized to Canadian Population (male and female separately) 1 Standardized Rate takes into account variations i n d i f f e r e n t population groups by adjusting the structure of the population group to some corresponding population group. (Lepine, 1982:4) 5 Among the causes of death i n 1977, suicide ranked fourth i n terms of the Potential Years of L i f e Lost (PYLL) between 0 - 7 0 years. (Ibid.:1) Of a l l the provinces of Canada, B r i t i s h Columbia had the second highest rate for male suicides i n 1977, which was 25.5 per 100,000 male inhabitants. The rate for females appeared highest of a l l the provinces at 9.6 per 100,000 female inhabitants. The suicide rate for B r i t i s h Columbia stood higher (17.5) than the national average, as seen i n Table 4. TABLE 4 Crude suicide rate by Sex, Canada and Regions, 1977 (per 100,000 inhabitants) Canada & Male Female Total Regions 2 1 > 2 ? > 3 ^ A t l a n t i c 14.7 3.2 9.0 Quebec 18.3 6.5 12.3 Ontario 20.8 8.3 14.5 P r a i r i e s 27.1 7.4 17.3 B r i t i s h Columbia 25.5 9.6 17.5 Source: Rates calculated by Health and Welfare, Canada, based on S t a t i s t i c s Canada V i t a l S t a t i s t i c s , 1977 and Estimates of population for the same year. (Ibid.:39) 6 In suicide, s t a t i s t i c s for the adult population aged 15 and over are regarded as more accurate as suicide i s usually not recorded before age 15. "Prior to t h i s age, regardless of findings the act i s usually deemed as accident". (Ibid.:16) Based on calculations of the suicide rate for the population aged 15 and over, the o v e r a l l rate for Canada changes from 14.3 to 18.8 for the adult population. The figures for the male rate r i s e to 28.3 per 100,000 males i n the t o t a l population and for females to 9.6. Table 5 represents the suicide rate by sex and selected years for Canada for the population aged 15 years and over. TABLE 5 Standardized* suicide rate for the population aged 15 and over, by sex and selected years, Canada (per 100,000 inhabitants) Year Male Female Total 1951 15. 3 5.1 10.3 1961 17.2 4.3 10.9 1966 18.9 6.5 12.7 1971 24.4 8.9 16.6 1973 25.0 9.8 17.3 1975 24.3 9.1 16. 6 1977 28. 3 9.6 18.8 Source: Rates c a l c u l a t e d by Health and Welfare Canada, based on S t a t i s t i c s Canada V i t a l S t a t i s t i c s , 1951-75. S t a t i s t i c s Canada Revised Annual Estimates of p o p u l a t i o n by Sex and Age. 1977. (Ibid.:42) *S tandardized to 1977 Canadian p o p u l a t i o n (male and female s e p a r a t e l y ) . 7 I f the s u i c i d e r a t e s are c a l c u l a t e d f o r the a d u l t p o p u l a t i o n 15 - 64 o n l y , the r a t e i n 1977 r i s e s t o 19.1. T h i s i s shown i n Table 6. The Age S p e c i f i c Rates i n Canada r e c o r d h i g h percentage r a t e s among the o l d . .-"In 1.977.suicide-::Ea,feelfor".-those;.'65o.y.ears;. and- .-older:?for Canada as a whole was c a l c u l a t e d to be 26.9 f o r males and 7.8 f o r females per 100,000 male and.female i n h a b i t a n t s r e s p e c t i v e l y . Table 6 p r o v i d e s comparative s u i c i d e r a t e s of the p o p u l a t i o n aged 65 and over, w i t h the a d u l t p o p u l a t i o n 15 - 64 y e a r s . TABLE 6 Stand a r d i z e d S u i c i d e Rate by sex and s e l e c t e d y e a r s , Canada (per 100,000 i n h a b i t a n t s ) A d u l t Population" 1' P o p u l a t i o n Aged 65+2 aged 15-64 Year Male Female T o t a l Male Female T o t a l 1966 18.2 6.8 12.6 24.9 4.2 13.6 1969 21.7 9.1 15.4 27.4 6.5 16. 0 1971 24.4 9.1 16.1 24.7 7.2 15.1 1973 24.9 9.8 17. 3 26.1 9.6 16.2 1975 24.2 9.3 16.8 25.0 7.8 15. 3 1977 28.4 9.8 19.1 26.9 7.8 16.2 Sources 1 & 2: Rates c a l c u l a t e d by Hea l t h and Welfare Canada, based on S t a t i s t i c s Canada V i t a l S t a t i s t i c s , 1977, S t a t i s t i c s Canada Revised Annual Estimates of P o p u l a t i o n by Sex and Age, 1966-75, and Estimates of P o p u l a t i o n by Sex and Age, 1977 (Ibid.:44-45). 8 The Standardized Suicide rate for males aged 65 and over was higher than the standardized rates for the adult male population from 1966 to 1975. In 1977, the suicide rate for el d e r l y males dropped s l i g h t l y . The Standardized rate of suicide for women 65 years and over increased from 1966 to 1977, although i t remained s l i g h t l y below the female adult population (aged 15 - 64). The increase within the two age groups was higher by .6 for the elder l y female group 65 and over. A comparison of suicide rates by regions puts B r i t i s h Columbia among the provinces with the highest suicide rate among both males and females 65 years and older. Chart 1 on the next page depicts the highest rates among the el d e r l y males i n B r i t i s h Columbia, i . e . 65 years and older. For the el d e r l y females the rate i n B r i t i s h Columbia ranks t h i r d a f t e r the Ontario and P r a i r i e s Regions respectively. CHART I 9 Rate 35 •• 30 -• 25 20 --15 " 10 •-5 •-0 -Crude Suicide Rate for the Population Aged 65 and Over, by Sex, Canada and Regions, 1977 (per 100,000 inhabitants) Males Females C'-Vcvi /MX/" /W7i /I N:Nl FA Canada A t l a n t i c Quebec O n t a r i o P r a i r i e s B.C. Region Rate -• 35 --30 -- 25 — 20 -- 15 -- 10 5 0 Source: Rates calculated by Health and Welfare Canada, based on S t a t i s t i c s Canada V i t a l S t a t i s t i c s , 1977, and on S t a t i s t i c s Canada Estimates o f Population by Sex and Age, 1977. 10 An examination of Canadian suicides by l o c a l areas and urban centers revealed as early as 1970-72 a s i g n i f i c a n t l y high r a t i o , both for males and for females i n the Greater Vancouver • i Area..ri)lfee-^Eh^^Bquar;e^...Variaes;;ji for males stood at 11.20 and for females at 52.64. For the Vancouver City, the value of Chi-Square was calculated as 41.90 for males and as 63.59 for females with 99% p r o b a b i l i t y . Table 7 on the next page provides a comparison of r a t i o s for l o c a l and urban areas. In summary, the National, regional (Provincial) and the l o c a l rates on suicide lead one to conclude that: (1) there are sex and age differences i n the suicide rate for the t o t a l Canadian population, (2) the rate i n B r i t i s h Columbia i s higher than most provinces and regions, both for males as well as for females, (3) the high rate of suicide among the e l d e r l y i . e . those 65 years and above places them i n the category of high r i s k groups, (4) the s i t u a t i o n i n the Vancouver area, p a r t i c u l a r l y i n the downtown d i s t r i c t has reached too alarming proportions of suicide. More recently attention has been directed toward prevention of incidence of suicide by finding e f f e c t i v e ways of treatment and aftercare of suicide attempters. Those who k i l l e d themselves were mostly found to have a history of p r i o r attempts. S i m i l a r l y findings of several research studies have indicated that one i n three suicide attempters eventually k i l l themselves. (Roberts, 1975:23). Cutter and Pokorney 1s (Roberts, Ibid.:26) Follow-up Study of 618 s u i c i d a l patients disclosed that, "the greater the number and period of time for s u i c i d a l attempts i n the history of TABLE 7 Suicides and r a t i o s f or l o c a l areas, 1970-72, by Provinces 11 X 2 Values between 3.84 & 6.65 are marked with one a s t e r i s k X Values over 6.65 are marked with two a s t e r i s k s . Provinces Actual Suicides Expected Suicides S i g n i f i c a n t l y High |Signif i c a n t l y Low standard M o r t a l i t y Rate Census Population M Newfoundland 49 10 136 51 ** 56.63 33 ** .41 36.16 19.75 266,107 255,997 Prince Edward Island 29 11 29 11 ** .10 101.29 9.12 56,226 55,415 Nova S c o t i a 198 37 202 78 ** 6.94 5.23 22 * * .08 98.06 47.66 396,467 392,493 New Brunswick 100 30 163 62 ** 24.89 17 ** .28 61.47 48.12 319,422 315,135 Quebec 1,261 433 1,225 600 ** 63.27 63 ** ,95 82.69 72. 33 2,994,547 3,033,217 Ontario 2,062 973 1,956 764 ** 8.90 ** 89.11 105.41 127.35 3,840,906 3,862,200 Manitoba 292 92 252 98 * * 6.69 115.92 94.21 494,610 493,637 Saskatchewan 262 65 240 90 ** 7.31 110.96 72.13 470,724 455,518 A l b e r t a 477 132 422 158 ** 7.89 4.71 4.71 113.15 83.40 827,785 800,089 B.C. Local Areas Greater Vancouver Vancouver C i t y 489 248 374 143 11-28 41.90 85.55 52-§4 63.59 L30.89 L24.86 Source; Canadian Suicide Ratio by Local Areas and by Urban Centers, 1970-72 S t a t i s t i c s Canada, Catalogue No. 84-530 (occasional) 173.44 185. 62 1,100,375 1,084,246 12 the victim, the greater i s the l i k e l i h o o d of his death during the course of a s e l f - i n j u r i o u s act or i t s consequences". It i s apparent from such findings that the increased 'recidivism' among suicide attempters can be prevented through improvement i n after-care programs. Experience with cases of suicide attempters and research findings has brought about a growing r e a l i z a t i o n among administrators of hospitals, medical p r a c t i t i o n e r s , p s y c h i a t r i c workers and professionals i n service programs that the after-care programs for suicide attempters needed c a r e f u l review i n planning and management of cases to prevent t h e i r p r e c i p i t a t i n g into completed suicides. It i s recognized that the lack of follow-up after t h e i r discharge from the emergency wards of hospitals or after some treatment and long i n t e r v a l s between therapeutic sessions lead to an increase i n recidivism of further attempts. Assuming attempters to be l i k e l y high r i s k groups, continuity of care through follow-up services at short i n t e r v a l s through out-reach programs i s beginning to be regarded as a more e f f e c t i v e approach for prevention of further attempts. Shneidman (1957:3) i n his experimental study: 'Clues to Suicide 1 aptly remarks, "Professional, p s y c h i a t r i c , psychologic and s o c i a l services might save many p o t e n t i a l l y s u i c i d a l persons i f the dangers were anticipated". 13 R a t i o n a l e f o r the Study The need f o r community-based support s e r v i c e s f o r s u i c i d e attempters has been p e r c e i v e d by S.A.F.E.R. As an acronym, S.A.F.E.R. stands f o r S u i c i d a l Attempts, Follow-up, Educa t i o n and Research. As e a r l y as February 1972, i t e s t a b l i s h e d a p i l o t project.. Being an autonomous o r g a n i z a t i o n u n t i l A p r i l 1981, S.A.F.E.R. c o l l a b o r a t e d with the Greater Vancouver Mental Health S e r v i c e s i n c e November 1979 i n p r o v i d i n g c l i n i c a l s e r v i c e s f o r s u i c i d e attempters. Since A p r i l 1981, S.A.F.E.R. Program f u n c t i o n s as p a r t of the support s e r v i c e components of the Greater Vancouver Health S e r v i c e . .(G. V .'H'.SV,:.: 1982 :2).'. In pursuance of i t s r e s e a r c h o b j e c t i v e s , S.A.F.E.R. launched a r e s e a r c h p r o j e c t i n the summer of 1977. The two r e s e a r c h e r s , namely, Ron P e t e r s and Mi c h a e l Rand developed a s e t of forms f o r the proposed p r o j e c t . The purpose was to c o l l e c t i n f o r m a t i o n on the i n c i d e n c e and p a t t e r n i n g of s u i c i d e i n the Vancouver area. The r e p o r t of the P r o j e c t was completed i n September, 197 7. I t i s e n t i t l e d " S u i c i d e and Attempted S u i c i d e i n Vancouver Area". The s e t of forms on which i n f o r m a t i o n was c o l l e c t e d are r e f e r r e d t o as the S.A.F.E.R. Information Sheet (SIS). Some minor m o d i f i c a t i o n s were made i n the SIS d u r i n g the data c o l l e c t i o n phase. The m o d i f i c a t i o n s kept i n view the enhanced u t i l i t y of the data f o r c l i n i c a l work and s e r v i c e programs. S.A.F.E.R. has continued i t s r e s e a r c h f u n c t i o n u s i n g the SIS as data base from mid 1977 up to the end of 1981. (G.V.M.H.S., 1982:4) 14 The present study i s designed with a view to analysing the data for the period which i s stored i n the S.A.F.E.R. Tape F i l e s . Being the l e g a l property of the S.A.F.E.R. Program, formal permission has been obtained by the School of Social Work, University of B r i t i s h Columbia, for f u l f i l l i n g the p a r t i c u l a r objective of the study. The data c o l l e c t e d by the S.A.F.E.R. workers over an extended period of time (4-1/2 years) i s impressive i n i t s scope as well as i n i t s content. I t affords an excellent opportunity for t h i s study as well as for any subsequent analyses by other researchers to develop empirical frameworks i n order to acquire deeper insights into the c l i n i c a l and programmatic aspects of suicide attempts. El d e r l y as High-Risk Group One important area of concern for t h i s study are the cases of those 65 years and older. I t i s intended to see the extent to which the e l d e r l y u t i l i z e or respond to programs and services offered for suicide attempters i n the community. The focus on the el d e r l y as a special group i s suggested for two main reasons. F i r s t , because the suicide rate among aged 65 and over i s high i n Canada i n r e l a t i o n to t h e i r percentage i n the t o t a l population, but accounted for 10% of a l l reported suicides i n Canada. Second, according to demographic calculations, the el d e r l y 15 population i s growing faster than i n young age groups. As seen in. Chart II, the growth rate of the age-group 70 years and over was the highest i n 1970-80 (Stone & Fletcher, 1981). As estimated, by 2031 the aged w i l l represent 20% of the population and t h e i r suicide rate i s calculated to be 21 percent (Lepine, 1982:18). Growth Rate o f Pop u l a t i o n " , 1950 - 2000 16 S o u r c e : S t o n e , L.O. and F l e t c h e r , S. 1981 A s p e c t s o f p o p u l a t i o n A g i n g i n Canada 17 CHAPTER II REVIEW OF LITERATURE 2.1 The History of Suicide S u i c i d a l behavior i s as old as humanity i t s e l f . Since recorded history, i t has been found to occur throughout the world. Many of the early writings were concerned with the ethics of suicide. The f i r s t known document dealing with s u i -cide i s an Egyptian writing known as 'dispute over suicide.' A man t i r e d of a series of misfortunes debates whether to hold onto l i f e or to end i t . The misery of s o c i a l i s o l a t i o n and loneliness leads to his self-destruction (Choron, 1972). In the Greek and Roman Literature, suicide i s mentioned with admiration and was encouraged by the Cynics, the Cyrenaics, the Stoics and the Epicureans (Dublin and Bunzel, 1963: 183). Suicide has been denounced i n the Jewish, the Christian and Islamic r e l i g i o n s which fostered a fe e l i n g of indignation against those who committed suicide. The Brahmanic and Buddhist r e l i g i o n s viewed suicide favor-ably and i n s t i t u t i o n a l i z e d i t , e.g., 'sutte', the practice of a Hindu wife to die with her husband. I t i s quoted by Dublin (1963: 154) that the Rig-Veda, the oldest and most sacred book of the Brahmins does not however commend i t . In China and Japan 18 also the acts of suicide i n cert a i n circumstances were r i t u a l i z e d , e.g. death i n insolvency or defeat i n a b a t t l e i n China or Hara-K i r i i n Japan, (a compulsory form of punishment for those of noble rank) were r i t u a l i z e d (Iga & Tatai : 1975). A review of the 19th century anthropological data by Steinmetz (1894: 53) contains several instances of suicide among the primitive cultures. I t includes the Polar People, the North American Indians, South American Indians, Bedouins, People of the Caucasus, Native Races of B r i t i s h India, Melanesians, Micronesians, Polynesians and Indonesians. He adds that suicide was unknown among the Australian Aborigines and the "wilder South American peoples" might be based on incomplete evidence. The 2 0th century studies on primitive people have also confirmed the existence of s u i c i d a l propensity among them. The more notable among such studies are those conducted by Devereux, 1962; Elwin, 1943;.Firth, 1961; Leighton and Hughes, 1955; Malinowski, 1962; Ramussen, 1931 and Westermarck, 1908. The studies on the whole contain information on the causes and methods of suicide among the primitives. It was generally found that: (1) male suicides were more common than female suicides. (2) The causes of suicide were d i f f i c u l t i e s with members of the opposite sex, i n s u l t s , accusations, fear of being conquered, old age or when a person reached some int o l e r a b l e and inescapable s i t u a t i o n . (3) There are ethnic, r a c i a l and c u l t u r a l differences i n attitudes toward suicide although the motives of suicide seem to be commonly held. 19 Dublin (1963) observes that s u i c i d a l rates d i f f e r with r e l i g i o s i t y and taboos against suicide. Despite p o s i t i v e or negative attitudes toward the act of suicide, i t appears to have occurred at s i g n i f i c a n t frequencies i n most cultures. It i s low i n Muslim countries, i n I s r a e l and i n the Catholic countries i n general, except Austria, Hungary and France. High rates of suicide characterize Protestant countries where the c h r i s t i a n attitudes toward the act are more relaxed. The comments of deCatenzaro (1981: 140-141) are worth nothing i n t h i s context. He observes: "Organized r e l i g i o n s may provide conceptual framework and s o c i a l structure that give r e l i e f to the f i t n e s s d i f f i c u l t i e s of many ind i v i d u a l s . . . perhaps more importantly, i t provides s o c i a l contact for the s o c i a l l y i s o l a t e d , hence r e l i e v i n g some of the major factors known to be antecedents of suicide." Based on the above comments, deCatanzaro concludes (1981: 38): "The order of causation i n any c o r r e l a t i o n of suicide rate and p r e v a i l i n g s o c i a l attitudes toward suicide i s unclear." 2.2 The S c i e n t i f i c Perspective Suicide has been viewed i n early history mainly from philosophical, moral and r e l i g i o u s points of view. Its s c i e n t i f i c perspective i s more recent. Dublin (1963: 211-227) writing on the modern view point of suicide has mentioned that during the fourteenth, f i f t e e n t h aad sixteenth centuries, new currents of thought quite opposed to scholasticism led the way to an e n t i r e l y new philosophy of l i f e i n the West. It was the outcome of a 20 number of factors including geographical, demographic, p o l i t i c a l and s o c i a l . Of a l l the factors, the assertion of the p r i n c i p l e s of human freedom and the development of the c r i t i c a l s p i r i t began to be manifest i n the writings of the thinkers of the 18th century. This i s referred to as the "Age of Enlightenment" i n which the c r i t i c i s m of ex i s t i n g i n s t i t u t i o n s reached i t s height. Thinkers of t h i s century l i k e David Hume (Essay on Suicide) i n England, Montaigne, Montesquieu, V o l t a i r e , Rousseau, Kant, Goethe and Shopenhauer i n Europe, devoted themselves to answering the question why one should not v o l u n t a r i l y give up l i f e ? Dublin (1963: 226) observes that just before the middle of the 19th century, the s p i r i t of investigation r a d i c a l l y changed. Abstract e t h i c a l disputations gave way to greater i n t e r e s t i n factual data. The quantitative and medical aspects of suicide began to receive more attention. The two d i s t i n c t i v e s c i e n t i f i c studies of the l a s t century on suicide were the works of physicians. In 1838, Esquirol, the French a l i e n i s t , wrote an epoch-making book under the t i t l e 'Mental Maladies: A Treatise on Insanity'. It was the f i r s t systematic s c i e n t i f i c study on mental diseases with an extensive coverage on suicide, i t s treatment and prevention. In 1840, Dr. Forbes Winslow, a member of the Royal College of Surgeons i n London, England, published the 'Anatomy of Suicide'. It contained medical discussion on suicide and s t a t i s t i c a l and case material. Just af t e r the middle of the 19th century, several works on the medical, s t a t i s t i c a l , p hysiological and leg a l aspects of 21 s u i c i d e were p u b l i s h e d . Some of the not a b l e authors of the p e r i o d i n c l u d e d E. L e s l i e (1856), L o u i s B e r t r a n d (1865) and A. P i e r r e de Boismont i n the same p e r i o d . T h e i r w r i t i n g s c o n t a i n e d e l a b o r a t e s t a t i s t i c s , as w e l l as a d i s c u s s i o n of causes and of morbid, p h y s i o l o g i c a l and l e g a l q u e s t i o n s at i s s u e (Dublin', bp^; c i t . : 228). The most i n f l u e n t i a l t r e a t i s e s on the s u b j e c t of s u i c i d e appeared i n the l a s t q u a r t e r of the 19th century. The important i n v e s t i g a t i o n s of the p e r i o d i n c l u d e d the works of Legoyt, 1881; M o r s e l l i , 1882; O'Dea, 1882, i n the Un i t e d S t a t e s ; and Strahan, 1893, i n Europe. About t h i s time, Durkheim (1897) i n France p e r c e i v e d the causes of s u i c i d e i n the c o n d i t i o n s t h a t a f f e c t s o c i e t y as a whole and s p e c i a l l y those t h a t i n f l u e n c e the death r a t e of the group. His t h e o r e t i c a l c o n s t r u c t on the s u b j e c t has wielded a marked i n f l u e n c e upon s o c i a l thought s i n c e then. For the purpose of t h i s study, i t i s proposed t o pr e s e n t : (1) the t h e o r e t i c a l o r i e n t a t i o n on the s u b j e c t of s u i c i d e ; (2) the f i n d i n g s o f r e s e a r c h r e l a t e d t o : (a) attempted s u i c i d e and (b) e l d e r l y s u i c i d a l b e havior. 2.3 The T h e o r e t i c a l O r i e n t a t i o n T h e o r e t i c a l L i t e r a t u r e on s u i c i d e has developed from two separate f i e l d s . In one, the s o c i o - c u l t u r a l f a c t o r s are emphasized and i n the oth e r , the i n d i v i d u a l and psychodynamic determinants form the f o c a l p o i n t . The psychodynamic f o r m u l a t i o n s are f u r t h e r c l a s s i f i e d i n t o : (a) P s y c h o a n a l y t i c T h e o r i e s , (b) Non-psycho-a n a l y t i c T h e o r i e s and (c) The o r i e s on motives of suicide;. 22 2.3.1 Socio-Cultural Theories Among the so c i o - c u l t u r a l Theories of Suicide, the most important formulation was developed by Durkheim (1897). He stated that as a general rule, the suicide p o t e n t i a l of a given society varied inversely to the degree of cohesion e x i s t i n g within that society. He i s o l a t e d three e t i o l o g i c a l types of suicides. Although in a footnote to his book Le Suicide (p. 276), he mentioned a fourth one. They are described below. a. Anomic Suicide r e s u l t s when the equilibrium of a society i s severely disturbed. For instance, i n times of business c r i s i s , such a suicide may occur due to the f a i l u r e of the "nouveau riche" to adjust to new change. b. E g o t i s t i c Suicide r e s u l t s from lack of integration of the in d i v i d u a l with other members of his society. c. A l t r u i s t i c Suicide occurs when the in d i v i d u a l i s strongly i d e n t i f i e d with the t r a d i t i o n and mores of his s o c i a l group. d. F a t a l i s t i c Suicide i s a reaction to hyperregulation. For example, when someone i s sold i n slavery or married very young, suicide provides an escape from unbearable sit u a t i o n s . 23 Sorokin (1936: 12) elucidating Durkheim's theory points out the following facts i n r e l a t i o n to each of the above. (1) The factor of s o c i o - c u l t u r a l cohesion and psycho-social i s o l a t i o n explain why i n a given society the divorced exhibit a higher rate of suicide than the married; why c h i l d l e s s families show a higher rate than families with children and why the greater the number of children, the lower the rate of suicide. A cause of higher rate among the divorced can be attributed to the divorced being ostracized (2) I n d i v i d u a l i s t i c occupational groups show a higher rate than the more integrated. Those without occupation and with no permanent t i e s have a higher rate of suicide. (3) Suicide rate tends to be lower i n countries with f a m i l i s t i c type of organizations than i n highly urbanized countries even though the l a t t e r may be economically better off than the former. Durkheim's Theory has provided a model for much subsequent research. The most s i g n i f i c a n t work following Durkheim was of his student Halbwachs." His s t a t i s t i c a l investigations substantiated Durkheim's empirical generalizations with few exceptions (Giddens, 1971: 97). The s t a t i s t i c a l works of Dublin and Bunzel (1933) and the r e s u l t s of various ecological studies of suicide i n urban areas also b a s i c a l l y support Durkheim's general p o s i t i o n . More notable among such works are those of Cavan, 1928; F a r i s , 1955; Henry & Short, 1951 and 1957; Ogburn, 1942; Sainsbury i n London, 1955 and Thomas, 1927. The works of Thomas, Ogburn, Dublin and Bunzel and Henry have s p e c i a l l y demonstrated the existence of high negative rel a t i o n s h i p between suicide and the business cycle i n the United States, England and Wales. That i s to say that suicide rate increases with economic depression and decreases during business prosperity (Shneidman, 1957: 66). Gibbs and Martin (1964) provided considerable data i n t h e i r study on the r e l a t i o n s h i p between the degree to which personal i n i t i a t i v e and i n d i v i d u a l freedom i n role obligations are i n s t i t u t i o n a l i z e d and the suicide rate (Giddens, 1971: 99). Their status-integration theory predicts an inverse r e l a t i o n s h i p between the suicide rate and status integration. Henry and Short (1954: 56) examined the hypothesis that "the acts of both suicide and homicide are undifferentiated responses to extreme f r u s t r a t i o n a r i s i n g from extreme loss of position i n the status hierarchy r e l a t i v e to the status position of others i n the same status reference system". The authors added another variable they c a l l e d " i n t e r n a l r e s t r a i n t " to Durkheim's "external r e s t r a i n t with high suicide rates". Henry and Short took the position that s u i c i d a l behavior was determined by both external and i n t e r n a l forces operating j o i n t l y . These explanations suggest that the f r u s t r a t i o n l y i n g within the s e l f arouses aggression against the s e l f , and r e s u l t s i n suicide. Frustration i s perceived as being the f a u l t of the s e l f . Those persons who occupy high status or are i s o l a t e d from meaningful relationships are most l i k e l y to blame themselves and commit suicide. Sainsbury's study ( 1 9 5 5 : 8 0 ) among the aged i n London showed t h a t s o c i a l i s o l a t i o n , l o n e l i n e s s and l a c k of o c c u p a t i o n were more of a problem than p o v e r t y . He examined the d i f f e r e n c e s i n s u i c i d e r a t e among the c i t y wards and e nunciated the concept of s o c i a l i s o l a t i o n , s o c i a l m o b i l i t y and s o c i a l d i s o r g a n i z a t i o n . Warren Breed ( 1 9 6 7 : 1 9 5 ) e x p l o r e d the phenomena of l o s s i n r e l a t i o n to s u i c i d e , i . e . , l o s s of a person, of a p o s i t i o n , and of m u t u a l i t y of s o c i a l r e l a t i o n s h i p s and found weakening of i n t e r r e l a t i o n s h i p s b e i n g the cause of s u i c i d e . Durkheim's typology of s u i c i d e as Giddens ( 1 9 6 3 : 1 0 0 ) puts i t , " provides a v i a b l e b a s i s f o r the a n a l y s i s of macro-s o c i a l c o n d i t i o n s r e l e v a n t to the a e t i o l o g y of s u i c i d e i n modern s o c i e t i e s and i t has r e c e i v e d a c e r t a i n amount of e m p i r i c a l v e r i f i c a t i o n i n subsequent r e s e a r c h . But the p s y c h o l o g i c a l ideas t h a t Durkheim attempted to l i n k up w i t h i t are found fragmentary and inadequate. T h e r e f o r e , f o r t h e o r e t i c a l i n s i g h t s i n t o the psychology of s u i c i d e we must look else-where." 2 . 3 . 2 The P s y c h o - a n a l y t i c T h e o r i e s The p s y c h o a n a l y t i c t h e o r i e s of s u i c i d e d e r i v e t h e i r source from Freud's Theory of Depression (Freud: 1 9 1 7 ) . A f t e r d e l i b e r a t i n g f o r many years on the q u e s t i o n how i t becomes p o s s i b l e f o r the e x t r a o r d i n a r y powerful l i f e i n s t i n c t to be overcome, he sought the e x p l a n a t i o n of s e l f - d e s t r u c t i v e a c t s i n the 'death i n s t i n c t ' . He r e f e r r e d to i t as "Thanatos". Freud p o s t u l a t e d t h a t an i n t i m a t e and c o n s t a n t i n t e r a c t i o n e x i s t e d between the two b a s i c i n s t i n c t u a l d r i v e s , 'Eros' (the l i f e i n s t i n c t ) and 'Thanatos' (the death i n s t i n c t ) . The p s y c h i c energy f p r s u i c i d e had i t s o r i g i n i n the 26 death wish directed against someone else who was loved and l o s t , but turned against oneself. Freud explained that "the ego i t s e l f deserted by the superego l e t s i t s e l f die". The ego has a number of "subselves". The super-ego i s made up of i n t r o j e c t s which present incorporated love objects. Suicide involves the murder of the o r i g i n a l object whose incorporation helped to create the superego. The Psychoanalytic theories stress the importance of l i b i d i n a l impulses, p a r t i c u l a r l y dynamic aggressive impulses directed against an introjected object. The ideas elaborated by Freud involve the concepts of i n t r o j e c t i o n , incorporation, i d e n t i f i c a t i o n , e g o - s p l i t t i n g and regression. In states of emotional c r i s i s , the ego tends to s p l i t up or fragments and i s referred to as e g o - s p l i t t i n g . Menninger, the chief exponent of Freud's Theory of Suicide, i n his book 'Man against Himself (1938: Part II) brings out three components i n the s u i c i d a l act: (1) the Wish to K i l l ; (2) the Wish to be K i l l e d and (3) the Wish to Die. These three elements are r e f l e c t e d i n conscious hate, g u i l t and hopelessness respectively. In other words, i t i s an aggression turned against oneself. He concludes that the s u i c i d a l act i s the winning out of the destructive tendencies over the constructive tendencies. He observed that the wish to k i l l and be k i l l e d decreased with age, but the wish to die increased as aggressiveness weakened i n old age. I t has been further argued that a person who expresses a wish to l i v e a f t e r being saved from suicide would be lacking i n the t h i r d element, namely the 'wish to die'. Zilboorg (1936) adds that suicide i s a way of thwarting outside forces that make l i v i n g impossible. In his studies he found every p o t e n t i a l case with strong unconscious h o s t i l i t y and an unusual incapacity to love others. Another aspect was the paradoxical e f f e c t of l i v i n g by k i l l i n g oneself, a method of gaining immortality and fame by destroying oneself. O'Connor (1948: 222-228) also stresses the immortality aspect. He states that the suicide of the depressed patient i s a kind of return to power-narcissism, wherein the person achieves omnipotence. He warns that when a depressive patient shows sudden improvement, suicide may be even more of a p o s s i b i l i t y because of the change i n attitudes. Jackson (1957: 11-20) i n reviewing the Psychoanalytic Theories i n 'Clues to Suicide' edited by Shneidman has also included to Psychoanalytic thought the contributions of- Bender and." Schidler, 19 37; Bergler, 1936; Garma, 1944; Jamieson, 1936; Palmer,1941. Bergler makes a d i s t i n c t i o n between types of suicide, c l a s s i f y i n g them into three types: (1) the Introjection Type, i n which the patient has g u i l t feelings against which pseudo-aggression i s mobilized; (2) the Hysteric Type, which i s an unconscious dramatization of how one does not want to be treated accompanied by a c h i l d i s h misconception of death lacking f i n a l i t y ; (3) the Miscellaneous Type, made up of other forms, l i k e paranoid schizophrenics, who project t h e i r super-egos outwardly and hear voices commanding them to k i l l themselves. 28 He d i f f e r e d i n his views with others i n that the aggression did not lead to inner g u i l t as the basic p r i n c i p l e . He believed that "inner p a s s i v i t y masochistically tinged was the decisive element in k i l l i n g oneself". According to some psychoanalysts every suicide i s a psychotic act, representing a breakthrough of the death i n s t i n c t . 2.3.3 The Non-Psychoanalytic Theories There are widely divergent explanations given of the causes of suicide by several writers which do not f i t i n the psycho-analytic or the s o c i o - c u l t u r a l theories. For example, Clark (1922: 254-263) states that at the bottom of a l l suicides one almost invariably finds an onanistic, an incest or an inversion motive. This r e s u l t s i n the disturbance i n the normal balance of the w i l l to l i v e . Crichton-Miller (1931: 339-341) view suicide due to f a i l u r e of adaptation and a regression from r e a l i t y . Lewis (1933: 241-273 & 1934: 146-153) approached the probe to suicide from the psychobiological viewpoint. Davidson (1934: 24-28) states that when a person reaches the l i m i t of his resources and has l o s t his goal, an "organic depression" r e s u l t s and the higher centers cannot control the incoming impulses to choose an action. He ceases to w i l l and i s unable to rej e c t what i s unhealthy. Other writers l i k e M i l l s (1934: 669-677) recognize-" weather as one of many contributing factors, but feels i t i s a major one. He thinks those who are unable to cope with the stresses of l i f e are more affected by weather. Williams (1936: 260-265) f e l t that the 29 dominant cause of suicide was the r i g i d personality which prohibited easy adaptation. Bender and Schidler (1937: 225-234) and Pessin (1941: 13-19) found strong e r o t i c trends i n those with se l f - d e s t r u c t i v e tendencies. Goitein (1942: 225-247) believed that s u i c i d a l impulses occurred as compensations for homicidal impulses against members of the immediate family. After a review of several viewpoints on suicide, one explanation focusses on attempted suicides by Teicher (1947: 283-298). He found the explanation of attempted s u i c i d e s ' i n developed aggressive patterns of reaction to insecurity-provoking s i t u a t i o n s . The aggression i s then inwardly turned because of the i n s e c u r i t i e s . Teicher asserts: "The ins e c u r i t y i s so great i n the case of attempters that they are unable to complete the aggressive act even against themselves. It remains an i n f a n t i l e e x h i b i t i o n i s t i c protest and an act of h o s t i l i t y against a harsh r e s t r a i n i n g figure." 2.3.4 The Theories on Motivation 6f Suicide A way of c l a s s i f y i n g theories of suicide i s i n terms of the various emphases given to the underlying motives of the s u i c i d a l act. The categories proposed by Jackson below, i n a review of 'Theories on Suicide' (Shneidman, 1957: 15), represent i n f a c t , an extension of the psychoanalytic theories. a. S e l f - d i r e c t e d aggression: I t includes p a r t i a l suicide, such as proneness to accidents and other acts of s e l f - i n j u r y 30 including s e l f - m u t i l a t i o n . Zilboorg and others (1936: 270-291) refer to i t as unchannelled aggression. b. Rebirth and Restitution: The idea to make new beginning by destroying the old (bad) s e l f predominates. The motive of suicide i s the joy of finding someone or reuniting with someone who r e a l l y cared. c. Despair, loss of self-esteem and other losses: The despair arises from loss of something that precedes a suicide attempt. Such losses include loss of health, f i n a n c i a l disaster due to business cycle fluctuation (resulting i n suicide of the r i c h f i n a n c i e r s ) , death of a mate and separation or divorce. Jackson (1957: 16) i n his review of the psychoanalytic and non-psychoanalytic theories sums up the phenomena of suicide as a "concactenation of psychic forces and environmental factors". In other words, suicide can be viewed as a combination of the individual's inner emotional make-up and the external stresses or extreme s o c i a l pressure. He refers to suicide as a "symptomatic act, not a discrete e n t i t y " . Despite the c r i t i c i s m s of Durkheim's and Freud's theories, the s o c i o l o g i c a l and psychological explanations of suicide have, for the most part, been incorporated i n the c l i n i c a l , medical and s o c i a l frames of reference for i d e n t i f i c a t i o n , intervention and treatment of s u i c i d a l behavior. 31 2.4 Relation of Completed and Attempted Suicide According to the researchers on suicide, the attempted s u i c i -dal behavior and suicide can be considered independently, but the two overlap to some extent. The overlapping i s stated to be due to the fact that many cases of suicide have a recorded history of previous attempted suicide/suicides. Maris (1981: 264) points out: "almost every investigator of suicide has con-cluded that p r i o r suicide attempts are important predictors of eventual death by suicide." He, however, suggests caution against the danger i n overemphasizing t h e i r s i m i l a r i t i e s in as much as one sees them, 'everyone i s s e l f - d e s t r u c t i v e 1 . Maris (19 81: 2 64) asserts that those who commit suicide are found to be very d i f f e r e n t from those who 'merely' attempt suicide. This view substantiates the findings of Durkheim, 1897; Katsching, 1979; Labovitz, 1968; and Rushing, 1968. A conservative estimate of the r a t i o of attempted suicide to completed suicide i s 8 to 1 (WHO, 1968: 9). Peters & Rand (1977) found the r a t i o of S.A.F.E.R. c l i e n t s to be approximately 9:1. Some of the variations i n s u i c i d a l behavior are age, sex, marital status and race. Durkheim found s i g n i f i c a n t differences in the s u i c i d a l rate by these variables as well as by s o c i a l c l a s s . He did not, however, consider race as a s o c i a l factor. Nevertheless, subsequent studies by so c i o l o g i s t s have included race as a s o c i a l factor. In reviewing research results of previous studies, the 32 purpose here i s mainly to focus on the findings of studies on attempted suicide, but due to overlapping of behavior in com-pleted and attempted suicide, as mentioned before, i t i s found relevant to include the results of some studies on suicide where s u f f i c i e n t evidence i s not found on attempted suicide i n r e l a -t i o n to the variables reviewed here. 2.5 Findings of Related Studies An attempt i s made here to discuss the findings of those studies which have been related to: (1) Attempted Suicide and (2) S u i c i d a l Behavior among the El d e r l y . 2.5.1 Age as a Variable a. Incidence of suicide i s said to increase with increas-ing age, but the rate of attempted suicide decreases as the age increases. In other words, completers of suicide are older attempters (McCullouch-Philip, 1972: 7). b. Peak rates for suicide attempts were found to be i n late teens and early twenties, but were lowest aft e r the age of 55 (Kreitman, 1977: 23; Parkin and Stengel, 1965). That i s to say, there i s a progressive decline i n the rate of attempted suicide with advancing years. A study of attempted suicide in Vancouver City substantiated these findings (Termansen, 1972: 128) . c. Motives of suicide also d i f f e r with age. For example, the young appear to have "less motive to die". The r a t i o of 33 attempted to completed suicide i n t h e i r case i s 50:1 (Mil l e r , 1979: 15). Majority of countries including the U.S.A. represent con-tinuously increasing suicide rates with age, but i n Canada the relat i o n s h i p i s c u r v i - l i n e a r . Middle-aged Canadians have the highest suicide rate. I t tapers o f f both before and after t h i s l i f e stage (Stenback, 82: 638; Peters & Rand, 1977). 2.5.2 Sex as a Variable a. More men k i l l themselves, but more women than men attempt suicide (Kreitman, 1977; Parkin and Stengel, 1965; and Stengel and Cook, 195 8). b. Male suicide exceeds female suicide at a l l ages. But the rate of attempted suicide i s exactly the opposite of the completed suicide (Farberow and Shneidman, 1961: 28; Stengel, 1964: 76). Durkheim had found roughly three times as many male suicides as female suicides i n a l l age brackets. But the studies quoted i n above writings found the r a t i o of attempted suicide as three females for every one male. c. The rate of the attempted suicide by the late f o r -t i e s reaches pa r i t y between the sexes (McCulluch & P h i l i p , op, c i t . : 8). d. There are differences between the sexes i n the use of methods of suicide. That i s to say, males choose more l e t h a l methods to k i l l themselves, e.g., firearms, hanging and jumping from heights, whereas females use less l e t h a l methods, e.g., self-poisoning, mostly through ingestion of drugs. 34 2.5.3 Marital Status and Parenthood as Variables a. Following Durkheim's claim (1951: 198) that the 'co e f f i c i e n t of preservation' varied with age and sex, the rate of suicide was found to be low among those with stable marriages, but quite high among the widowed, divorced and single and those with unstable marriages (Dublin, 1963; Linden & Breed, 1976; Stengel, 1964). b. Single women under the age of 35 years are more at r i s k than single men of the same age, but over that age the r a t i o i s reversed. c. Married women tend to have higher rates for attempted suicide than single women of comparable age. d. Men under 35 years, both single and married, have comparable rates of suicide. In older age groups, the rate for single men i s double than that of th e i r married counterparts. e. The rates for the divorced and separated are very high as compared to the widowed. The above findings have been found to be constant over the years for the study of attempted suicide i n Edinburgh (McCulloch & P h i l i p , 1972: 12). f. Durkheim (1951) postulated that suicide varied 35 inversely with the degree of integration of domestic society, that married persons after age 20 had some immunity, that parenthood increased t h i s immunity and childlessness increased the problem of suicide. The rate declined i n widowhood when there were children. Maris (1969: 115) observes that Durkheim's contention that suicide rate i s low among the married and those with children i s confirmed by his Chicago study. Among those married with children, Maris suggests a large number of s i g n i f i c a n t others, e.g., spouse, children and r e l a t i v e s 'function to minimize anomie and egoism'. Other studies also support Durkheim's contentions. Notable among such studies include those of Breed, 1966; Dublin and Bunzell, 1933; Dublin,1963; Kozak and Gibbs, 1979; and Meer, 1976. The findings of these studies also confirmed the hypothesis by Henry and Short (1954: 16 and 75) that suicide varied inversely with the strength of the r e l a t i o n a l system. That i s to say that persons with strong r e l a t i o n a l systems are subjected to greater external r e s t r a i n t s than persons with weak r e l a t i o n a l systems. 2.5.4 Race as a Variable Researchers have found r a c i a l differences i n suicide frequency. a. Suicide rates for nonwhites i s found to be generally lower than the rate for whites (Busse and P f e i f f e r , 1969; Swanson 36 and Breed, 1976; and Maris, 1969). b. S u i c i d e r a t e s f o r American Indians and Blacks aged 15-2 9 was found to be higher than f o r whites a t those ages. But among whites, the s u i c i d e r a t e s i n c r e a s e throughout the l i f e c y c l e (Weiss, 1968: 255-267; Hendin, 1969). c. S u i c i d e among the o l d e r white males has been fo u r to s i x t e e n times h i g h e r than the o v e r a l l s u i c i d e r a t e i n U.S.A. since' World War I I (Dublin, 1963). d. A n t h r o p o l o g i s t s have found s u i c i d e r a t e s h i g h e r among the O r i e n t a l s , of which stock the Amerindians and the Eskimos come (Iga & T a t a i , 1975; Murphy, 1954). These s t u d i e s a l s o i n d i c a t e low r a t e of s u i c i d e i n A f r i c a , p a r t i c u l a r l y West A f r i c a , from which most American s l a v e s were drawn (Asuni, 1962; Bohannan,1960). S u i c i d e r a t e among the f o r e i g n - b o r n i n the U n i t e d S t a t e s i n the t w e n t i e t h century has f o l l o w e d the same r e l a t i v e p a t t e r n s as e x i s t i n g i n the r e s p e c t i v e c o u n t r i e s of b i r t h . To prove the p o i n t , deCatanzaro (1981) pr e s e n t s comparative t a b l e s of r a t e s of s u i c i d e (p. 14) and s u i c i d e r a t e s among f o r e i g n - b o r n i n the United S t a t e s (p. 34). He , thus, concludes t h a t t h e r e are c l e a r r a c i a l and e t h n i c d i f f e r e n c e s i n s u i c i d e r a t e s and other c h a r a c t e r i s t i c s of the a c t and t h a t these d i f f e r e n c e s i n r a t e s appear to be c o n s i s t e n t over time and a c r o s s i n t e r n a t i o n a l boundaries (p. 38). 37 2.5.5 Social Class as a Variable a. Durkheim's claim that suicide was exceptionally-frequent i n the highest classes of society has been supported by subsequent studies by Cavin, 1965; Gibbs & Martin, 1964; Henry & Short, 1954 and Powell, 1958. b. Studies by Breed (1963) i n New Orleans, Maris (1969) in Chicago, Sainsbury (19 55) i n London and Wilenskey and Edwards (1959) i n Los Angeles revealed that downward s o c i a l mobility was conductive to suicide. c. The findings from Edinburgh studies have shed l i g h t on most attempted suicide cases from u n s k i l l e d occupations, i . e . , 3/5 as compared to 1/5 from professions of an upper and middle status category (McCulloch & P h i l i p , 1972). d. Maris (1969: 142) found that median school years completed were s l i g h t l y higher i n high suicide areas. From the vast l i t e r a t u r e that exists on the etiology of suicide,." some of the important psychosocial correlates (and presumptive p r e c i p i t a t i n g f a c t o r s ) " i n s u i c i d a l attempts have been selected for review here. 2.5.6 Early L i f e Traumatizing Experiences a. Early traumatizing relationships are r e f l e c t e d i n late l i f e pathology (Bowlby, 1960 &1968; Dorpat et a l , 1965; Kl e i n , 38 1948; Spitz, 1946). For example, separation from parents i n childhood, s p e c i a l l y from the mother, represents the early object loss. This trauma was found greatest among non-fatal s u i c i d a l attempters i n a recent study by Maris (1981). b. Dorpat et a l . (1965) have stressed that divorce of parents among non-fatal attempters i s related to l a t e r s e l f -destructive behavior. c. The trauma of disrupted families i s said to be p o s i t i v e l y related to i n a b i l i t y to intera c t interpersonally. Substantial proportion of both children and young adults committing suicide have few strong relationships to others i n society (Breed, .1972; Ganzler, 1967; Stengler, 1973 and Worden, 1976). They are described as "a s o c i a l , withdrawn, t e r r i b l y shy, with minimal s o c i a l i n t e r a c t i o n " (Reese et a l , 1972 and Seiden, 1966). Such young people avoid close peer relationships (Jan-Tausch, 1963). d. Poor relationships with parents, broken homes or re j e c t i o n by b o y / g i r l friend may lead to suicidal" attempts (Jacob & Teischer, 1967: 139-149). 2.5.7 Chronic Emotional Problems Feelings of jealousy, anger, spite and hate have been found to be some of the causes i n acts of attempted suicide. Studies by Faigel (1966: 187-190) and Jacobziner (1960: 519 and 1965: 7) found that i n children and young people, hate directed against lovedcones. wassexpressed ;.through^attempted3suicide ,;7whi<£e pathological jealousy, persistent suspicion and spite led to suicide attempt among adults (Kessel and Lee, 1962: 130). Most such problems cause depression and hopelessness. 2.5.8 Social Isolation and Loneliness Sainsbury (1955) i n his study of suicide i n London found s o c i a l i s o l a t i o n as a major e t i o l o g i c a l factor i n s u i c i d a l behavior, whether f a t a l or not. Batchelor and Napier (1953: 99) found that more than half of a group of persons aged 40 and 60 gave loneliness as the p r e c i p i t a t i n g factor for attempted suicide. Stengel's study (19 64) provides evidence that the rate for s o c i a l i s o l a t i o n as a p r e c i p i t a t i n g factor for attempted suicide may be almost four times the rate for s o c i a l i s o l a t i o n among the general population. Claussen and Kohn (1954: 140) found that men i n rooming houses tended to d r i f t there because of socio-economic f a i l u r e or because of psychological i l l n e s s . Such s o c i a l i s o l a t i o n , they explain, can p r e c i p i t a t e mental i l l n e s s and hence s u i c i d a l behavior. It has been suggested by researchers that where there i s s o c i a l i s o l a t i o n or feelings of i t , the c a l l for help i n case of an attempted suicide may not even be heard and may r e s u l t i n death. 2.5.9 Loss and Bereavement The loss of a partner, spouse, r e l a t i v e or of a 40 s i g n i f i c a n t other has been said to be a p r e c i p i t a t i n g factor i n suicide or i t s attempt. The loss of a c h i l d , s i m i l a r l y , may cause bereavement and lead to s u i c i d a l behavior by a parent (McCulloch & P h i l i p , op. c i t . : 20). 2.5.10 Psychiatric I l l n e s s and Personality Disorders Studies by Batchelor & Napier, 1953; Kreitman & co-workers, 1977 and Stengel, 1977, confirm suicide attempts related to psy c h i a t r i c disorder. Almost two-thirds of repeaters of attempts of suicide had a history of psyc h i a t r i c treatment as compared to on e - f i f t h of f i r s t attempters. Freud had maintained that i n depressive i l l n e s s , e.g. manic-depressive i l l n e s s , psychotic depressive i l l n e s s and neurotic depressive reaction, there was object loss, ambivalence toward the l o s t object, regression and e g o - s p l i t t i n g . This gives r i s e to hopelessness, p r e c i p i t a t i n g i n the desire to k i l l oneself. 2.5.11 Alcohol and Drug Abuse a. The findings from researches ca r r i e d out i n Europe and i n the United States have shown that half of men suicide attempters and a quarter of women who attempted suicide had taken drink before the s u i c i d a l act. It i s further reported that almost 4 0% of men and 7% of women had alcoholism as a primary or secondary diagnosis i n suicide attempts (McCulloch, 1972: 27). 41 b. In the London, Canada study (Schober, 1980: 6), 94% of those who usually drank consumed alcohol p r i o r to suicide attempt as compared to 3 3% of those who did not usually drink. c. Stenback (1980: 640) points out that the frequency of chronic alcoholism was found to be more among those attempters who were under 65. d. The suicide rate for drug addicts i s reported to be f i f t y times higher than for non-addicts. Those dependent on soft are l i k e l y to be "repeaters" of suicide attempts, as demonstrated by studies i n Edinburgh (Kessel & Grossman, 1961). e. Drug abusers who had made a suicide attempt suffered more 'depression 1 than those who made no attempt (Harris et a l , 1979: 25). 2.5.12 Personal Stress and Mental Tension There are several events i n one's l i f e which can give stress, such as chronic i l l n e s s , incurable and terminal disease, f i n a n c i a l problems, l e g a l involvement, f a i l u r e i n ambition or i n socio-sexual r e l a t i o n s , unemployment, disharmony i n marital and family relationships which are c i t e d as other causes of s u i c i d a l attempts (Daly & Wilson, 1978; Symons, 1980). 2.5.13 History of Suicide Attempts Studies i n general indicate that persons who have made 42 previous attempts are more l i k e l y to die through suicide than those who have no history of suicide attempt. Stengel & Cook (1958) point out that the danger of r e p e t i t i o n of a s u i c i d a l attempt depends on whether the act has brought about a change i n the l i f e s i t u a t i o n and mental state. Subsequent attempts depend upon the reaction to the act by the caring persons, including the family and others i n the s o c i a l environment as well as on the diagnosis and treatment of the attempter. S u i c i d a l attempts i n manic-depressives and with psy c h i a t r i c i l l n e s s e s may be more f a t a l . I t may be concluded that the r i s k of suicide from past attempts depends on the seriousness of the p r i o r attempt, the l e t h a l i t y of methods and the a v a i l a b i l i t y of meaningful help to the c l i e n t following the p r i o r attempt (McCulloch, 1972: 48). 2.5.14 Temporal Variations i n Suicide a. Seasonal variations are mentioned by many observers, e.g., Curtin, 1909; Durkheim, 1951; Miner, 1922; Peterson, 1934; Sainsbury, 1955; and Vidoni, 1925 (Pokorny et a l . , 19.63). Such variations are explained due to weather changes. There has been f a i r l y general agreement among such observers that suicide rates are highest i n late spring or early summer. Durkheim found a perfect continuity of curve increasing from winter to summer. He considered length of the day, rather than weather fluctuations, as 43 the cause. That i s to say that the frequency of suicide at a pa r t i c u l a r time of the day was due to 'occupational anomie' and 'egoism' and not due to temporal variati o n s (Durkheim, 1960: 1-31). He regarded seasonal and diurnal variables as non-social and dismissed climate and "extra-social" influences as causes of suicide. b. Most papers on weather and climate are speculative. No single s i g n i f i c a n t r e l a t i o n s h i p was found (Pokorny et a l , 1963). c. The importance of the awareness of day-to-day variations i n s u i c i d a l attempts can hardly be ignored. In fact, much can be learned from such studies. For example, the Edinburgh study brought to l i g h t the fact that peak periods of suicide attempts occurred at time when professional s t a f f and many lay advisory bodies were not available (McCulloch, op. c i t . : 11). The observation of the frequency of suicide incidents on p a r t i c u l a r days of the week and time of the day or night has been found to be he l p f u l i n planning for deployment of manpower resources by the agencies concerned with the treatment and prevention of suicide. Patterns of Variables i n Suicide Attempts There i s general agreement among the researchers that the act of f a t a l or non-fatal attempt of suicide i s the r e s u l t of many varied complex processes. These processes include a number of antecedants or l i f e history events, acting singly or i n 44 concert. Along with the immediate s i t u a t i o n events produce the p r e c i p i t a t i n g e f f e c t . The events provide a causal network on the basis of which a Hypothetical Model of Suicide and Attempted Suicide has been constructed. Diagram I represents such a model (p. 45). Further, a p r o f i l e of attempted suicide has been drawn representing the modal c h a r a c t e r i s t i c s of a suicide attempter. Diagram II represents the p r o f i l e (p. 46). \ 2.6 S u i c i d a l Behavior among the E l d e r l y A large number of studies have been conducted to explore the factors which prove suicidogenic among the e l d e r l y attempters. The factors commonly held as causes of s u i c i d a l behavior are discussed here. 2.6.1 Mental I l l n e s s I t i s regarded as the most important determining factor for suicide i n old age (Batchelor, 1957: 143-152). a. The high frequency of serious suicide attempts among the older people as compared to younger i s found to be related to the occurrence of two diseases i n old age, namely, serious depressive psychosis and chronic brain syndrome (CBS). The p s y c h i a t r i c diagnosis of e l d e r l y who attempt and those who A. BACKGROUND VARIABLES HYPOTHETICAL MODEL IN FATAL AND NON-FATAL SUICIDE ATTEMPTS B. LONG TERM CAUSES C. TRIGGERING EVENTS AGE EARLY TRAUMA SOCIAL ISOLATION SEX MARITAL STATUS . HISTORY OF - fc SUICIDE ATTEMPTS MENTAL DISORDER )>. EMOTIONAL SEXUAL . PROBLEMS INABILITY TO COPE. DEPRESSION AND HOPELESSNESS ALCOHOL AND DRUG ABUSE PHYSICAL ILLNESS 1 PARENTAL STATUS (CHILDREN/NONE) LOSS OF SIGNIFICANT OTHER. FAILURE IN AMBITIONS DIVORCE AND SEPARATION OTHER ACUTE STRESS DIAGRAM I 1. USE OF LETHAL 1. USE OF NON-LETHAL METHOD METHOD 2. INTENT TO DIE 2. AMBIVALENCE 3. LACK OF 3. TIMELY INTERVENTION INTERVENTION PROFILE OF ATTEMPTED SUICIDE AS GLEANED FROM A REVIEW OF BACKGROUND LITERATURE 46 YOUNG FEMALE SECOND OR REPEATED ATTEMPTS USE OF NON-LETHAL METHODS COMPLETED SUICIDE 1. HISTORY OF ATTEMPTS 2. ATTEMPT DIRECTED TOWARD SIGNIFICANT OTHER 3. INSUFFICIENT RESPONSE FROM SIGNIFICANT OTHER ATTEMPTED SUICIDE 1. HISTORY OF ATTEMPTS 2. ATTEMPT DIRECTED TOWARD SIGNIFICANT 3. ATTENTION FROM SIGNIFICANT OTHER DIAGRAM I I 4 7 complete suicide are, however, sim i l a r (O'Neal et a l , 1956: 275-284; Buss & P f e i f f e r , 1969: 212-224). b. There i s an increased r i s k for suicide and attempted suicide due to lack of ps y c h i a t r i c care (Gardner et a l , 1964; Kastenbaum et a l , 1972) . c. There i s evidence of c o r r e l a t i o n between depression and low socio-economic status, e.g., poverty occurring i n adult l i f e may contribute more to mental i l l n e s s than l i f e long poverty 2.6.2 Depression 'Depression i s the most common psy c h i a t r i c syndrome i n old age'" (Batchelor, 1957; Butler, 1973; Kay, Beamish & Roth, 1964) . Depressions include those r e s u l t i n g from: (a) ps y c h i a t r i c i l l n e s s , (b) g r i e f , such as loss of s i g n i f i c a n t other, r e j e c t i o n , disappointment, dininished self-esteem, (c) physical i l l n e s s , such as v i r a l i n f e c t i o n or Parkinson'd disease (Bromley, 1966; Butler, 1973). Stenback (1980: 620) i n his a r t i c l e on 'Depression and S u i c i d a l Behavioe i n Old Age' points out that one factor alone may not cause depression, but a multiple int e r a c t i o n of factors may give r i s e to i t . He adds that depression i n l a t e r l i f e i s 48 partly due to i n d i v i d u a l events and partly to b i o l o g i c a l , s o c i a l and c u l t u r a l c h a r a c t e r i s t i c s of t h i s l i f e phase. B a i l i e r (1968) i n a study of 985 subjects found that depres-sion frequently remained unnoticed behind a 'barrier of s o c i a l i s o l o a t i o n ' . P a s s i v i t y , pessimism and hypochondriachal com-pl a i n t s are usually considered part of normal aging. He d i s -misses such notions are misleading on the basis of his own findings. In the Longitudinal Studies at Duke University (1955 & 1968) depression i n old age was not found to be a precursor of cerebral degeneration. Major correlates of organic brain syndrome were found to be lower socio-economic status, decreased physical and mental a c t i v i t y and decompensated heart disease (Maddox et a l : 1980). 2.6.3 Physical I l l n e s s a. F a i l i n g health i s associated p o s i t i v e l y with both age and suicide rate (Bromley, 1966: 125-140). b. Physical i l l n e s s played a lesser role i n attempted suicide than i n committed suicide (Shneidman & Farberow, 1961; Dorpat et a l . , 1968). c. Physical i n f i r m i t y brings the r e a l i z a t i o n of per-manent invalidism and dependency (Batchelor, 1957: 143-152). d. Hypochondriachal bodily complaints, though delusional, nevertheless, seem to cause extreme i n t e r n a l pressure (Mi l l e r , 1971: 13). e. Chronic i l l n e s s or the diagnosis of an incurable disease can cause d i s t r e s s , tension and insomnia. 2.6.4 Use of Alcohol and Drugs a. Many s u i c i d a l attempts occur among the old people who at the time are under the influence of alcohol or drugs (McCulloch, op. c i t . : 27). b. The prolonged use of s u i c i d a l behavior (Kahne, 1973: Farberow et a l , 1975: 333-337). alcohol was c l e a r l y related to 52-69; Gardner, 1964: 547-553; c. Known psyc h i a t r i c contacts had a history of alcoholism (Gardner, 1964). d. Alcohol abuse has been found to be more common among older men, although i t i s not uncommon among older women (Farberow & Moriwaki, 1975). e. Most alcoholics are also found to be either drug-addicts or drug dependent. The most commonly used drugs are analgesics, e._g. asprin; anxiolytyes, barbituates and s.edatives. 50 R e l i a n c e on drugs has o f t e n gone 'hand-in-hand' w i t h dependence on a l c o h o l ( M i l l e r , op. c i t . : 51). 2.6.5 S o c i a l F a c t o r s a. Divorced, widowed, never married men and those l i v i n g alone or i s o l a t e d from f r i e n d s , neighbours, r e l a t i v e s , and community o r g a n i z a t i o n s may be regarded as h i g h - r i s k groups i n both completed and attempted s u i c i d e (Gardner e t a l , 1964; Resnik & Cantor, 1970) . b. The impact of r e t i r e m e n t on the e l d e r l y i s s a i d to be even more s e r i o u s than widowhood. Retirement i s c l o s e l y i d e n t i f i e d w i t h d e c l i n e i n s t a t u s , income, power, years remaining to l i v e , r o l e s , p h y s i c a l and mental h e a l t h , numbers of f r i e n d s and r e l a t i v e s , i d e n t i t y , independence, p h y s i c a l m o b i l i t y , s e c u r i t y , hope, e t c . . . (Bock, 1972; R a c h l i s , 1970) The p i c t u r e of a r e t i r e d person i s , however, not so dismal as p o r t r a y e d above. The impact of r e t i r e m e n t on those who enter t h i s stage without v a r i e d i n t e r e s t s , k i n networks and other o u t l e t s i s found t o be more s e r i o u s . Sainbury (1961) observes t h a t i t may not be a c r i t i c a l f a c t o r f o r those who r e t i r e from secure economic p o s i t i o n s . He, t h e r e f o r e , concludes t h a t r e t i r e m e n t may be r e l a t e d to a decrease of o l d age s u i c i d e i n the hi g h e r s o c i a l c l a s s e s and an i n c r e a s e i n the lower c l a s s e s . c. Community a t t i t u d e s t h a t make the o l d e r person f e e l 51 useless and unwanted. More of those e l d e r l y who have l o s t s o c i a l status, f e e l rejected and are s o c i a l l y i s o l a t e d have resorted to attempt suicide (Batchelor & Napier, 1953). d. The s o c i a l factors impinge d i f f e r e n t l y on men and women. Widowhood and retirement may have a more depressing e f f e c t on men which explains higher rate of suicide among them. Women who, i n general, do not have to face retirement and who may have a wide kin network even a f t e r widowhood may f e e l less i s o l a t e d and are less prone to attempt suicide (Berardo, 1968). e. Number of children and s o c i a l r e l a t i o n s h i p with them help reduce the e f f e c t s of s o c i a l i s o l a t i o n and loneliness which might otherwise drive the old to depression and to end t h e i r lives.. (Sainsbury, 1963: 153-175). f. L i v i n g Situation: Persons from s o c i a l l y disorganized areas, l i v i n g i n overcrowded housing, i n the center of the c i t y , were found to be more suicide prone, also those l i v i n g out of a normal family setting (Busse & P f e i f f e r , 1969; Ettinger & Flordh, 1955; Kessel, 1965). Termansen's study (1972: 128) i n Vancouver City records high rates of attempted suicides i n the downtown area. Relocation or change of neighbourhood i s also found to be more s t r e s s f u l for the e l d e r l y (Sainsbury. 1973). 52 2.6.6 I n a b i l i t y to Cope with Losses i n L i f e S u i c i d a l behavior i s associated with i n a b i l i t y to cope with v i t a l losses i n l a t e r l i f e . Such losses may be economic (loss of job, income), physical (loss of healthy limb), s o c i a l (loss of f r i e n d ) , psychological (loss of self-esteem or confidence), emotional (loss of spouse or child) or any combination thereof. The older the person, the greater the losses he has incurred. The cumulative e f f e c t of such losses has a much greater e f f e c t than that exerted i n d i v i d u a l l y by any one of them (Mill e r , 1979: 24). 2.6.7 Hopelessness Farberow and Shneidman (19 57) analyzed suicide notes by age i n terms of predominant component expressed i n the note. Generally, they found that the 'wish to k i l l ' and the 'wish to be k i l l e d ' decreased with age and the 'wish to die' increased. The f e e l i n g of hopelessness i n the pld people i s that l i f e i s devoid of meaning, that they are a burden on others and of no use to them. I t i s often accompanied by depression. In a depressed, hopeless person, d i s s a t i s f a c t i o n may serve to 'ignite or c a t a l i z e s u i c i d a l action' (Maris, 1981: 338). 2.6.8 Unfavorable Factors i n F a m i l i a l and Personal Histories A number of negative factors have been singled out as traumatizing experiences i n the h i s t o r i e s of el d e r l y s u i c i d a l 53 victims and attempters of suicide. (a) Family members i n -s t i t u t i o n a l i z e d for mental i l l n e s s . (b) Broken homes i n childhood. (c) Pr i o r i n d i c a t i o n of depression. (d) A f a m i l i a l manic-depressive. (e) Personality t r a i t s which l i m i t s o c i a l adaptation, e.g., fewer friends, shyness, dependency, ego-c e n t r i c i t y and other psychological abnormalities, anxiety and hypochondriasis (Batchelor, 1953 & 1957; Birren, 1964; O'Neal et a l . , 1956). 2.6.9 Reaction to Multiple Factors M i l l e r (1979: 24) discussing the s u i c i d a l patterns among the e l d e r l y stresses that there i s no one simple reason for anyone to commit or attempt suicide. According to him, s u i c i d a l reactions in...late l i f e can be subsumed under the head-ing "multiple :factors". Such a reaction, M i l l e r explains, occurs as a r e s u l t of a lengthy and complex process of 'ero-sion'. A c r i s i s i s triggered when the 'line of unbearability 1 i s crossed. And unbearable plights vary from i n d i v i d u a l to i n d i v i d u a l . M i l l e r adds: "No two people have i d e n t i c a l con-s t e l l a t i o n of problems" (p. 8). 2.6.10 Characteristics of El d e r l y Suicide Attempters Based on causal factors i n s u i c i d a l behavior of the el d e r l y , s u i c i d o l o g i s t s have stated the following characteris-t i c s of the el d e r l y suicide attempters: a. In r e l a t i o n to the size of the other age-groups, the 54 e l d e r l y commit suicide most, but attempt suicide the l e a s t "Grollman, 1971) . b. They use l e t h a l weapons more often, e s p e c i a l l y the male e l d e r l y . c. They become more successful i n completing suicide (Bock, 1972; Maris, 1969; O'Neal et a l . , 1956). d. The aged communicate t h e i r s u i c i d a l intent less f r e -quently and do not use s u i c i d a l a c t i v i t i e s as a gesture to c a l l attention or 'cry out for help'. Their intent to die i s strong (Busse & P f e i f f e r , 1969; Butler & Lewis, 1973). e. Being less ambivalent than the younger, the old are less l i k e l y to be rescued from s u i c i d a l action (Rachlis, 1970; Resnik, 1970; Seiden, 1974) . f. Disparity between male and female suicide r a t i o be-comes more pronounced i n l a t e l i f e (Bromely, 1966; Rachlis, 1970; Weis, 1968). The suicide rate for women tends to reach i t s peak by or before 55, the rate for older men increases steadily through the eighth decade of l i f e (Birren, 1964; Botwinick, 1978; Sainsbury, 1962). g. In months preceding t h e i r death, a large percentage of e l d e r l y s u i c i d a l men are under a physician's care (Barraclough, 1971; Capstick, 1960; M i l l e r , 1976). 55 h. Included in the high-risk groups are old widowed with terminal i l l n e s s e s , with p r i o r s u i c i d a l behavior (self or pattern of suicide within the family), with losses (job, ,status, r e l a t i v e ) , and with the "empty nest syndrome" (Zusman & Davidson, 1971: 16). The combined e f f e c t of a l l such variables may produce a high-risk p r o f i l e . i . Most e l d e r l y attempters have a p s y c h i a t r i c i l l n e s s , brain damage from alcohol or depressive symptomatology. j . The e l d e r l y who commit suicide are similar i n popula-ti o n c h a r a c t e r i s t i c s to those who attempt. The p r o f i l e of an E l d e r l y Suicide Attempter i s i l l u s -trated i n Diagram II I . HIGH-RISK PROFILE OF ELDERLY SUICIDE AND ATTEMPTED SUICIDE 56 WHITE MALE . SEVERE AFFECTIVE . . DISORDER 1 ' • • . LIVING ALONE » • • ALCOHOLISM AND DRUG ABUSE .t INABILITY TO COPE AVAILABILITY OF LETHAL METHODS CONCOMITANT PHYSICAL . ILLNESS RECENT BEREAVEMENT . RETIREMENT, LOSSES RELOCATION HISTORY OF PRIOR ! ATTEMPTS USE OF NON-LETHAL METHODS (FATAL SUICIDE) (NONFATAL SUICIDE) DIAGRAM I I I 57 CHAPTER I I I STRUCTURE OF THE INQUIRY The r e v i e w o f b a c k g r o u n d l i t e r a t u r e as p r e s e n t e d i n C h a p t e r I I p r o v i d e s us w i t h t h e knowledge b a s e t o t e s t t h e a s s o c i a t i o n o f v a r i a b l e s i n a t t e m p t e d s u i c i d e . The e m p i r i c a l t e s t i n g h e r e w o u l d be k e e p i n g i n v i e w t h e s p e c i f i c o b j e c t i v e s o f t h e s t u d y w h i c h a r e o u t l i n e d b e l o w . O b j e c t i v e s o f t h e S t u d y The s p e c i f i c o b j e c t i v e s o f t h e p r e s e n t s t u d y a r e : 1. To c o n s t r u c t a b a s i c p r o f i l e o f t h e c a s e s i n c l u d e d i n t h e d a t a s e t . 2. To make a p r e l i m i n a r y a n a l y s i s t o d e t e r m i n e w h i c h o f t h e i t e m s i n t h e SIS r e l i a b l y d i s t i n g u i s h t h e s u i c i d e a t t e m p t e r s when c l a s s i f i e d i n v a r i o u s a g e - g r o u p s ( i . e . , a r e t h e r e r e c o g n i z a b l y d i f f e r e n t " p r o f i l e s " f o r S.A.F.E.R. c l i e n t s a t d i f f e r e n t a g e - l e v e l s ? ) . 3. To examine more c l o s e l y t h e c h a r a c t e r i s t i c s o f t h e e l d e r l y S.A.F.E.R. c l i e n t i n a r e a s , s u c h a s : (a) p o s s i b l e d i f -f e r e n c e s between t h e 'younger' and t h e ' o l d e r ' e l d e r l y , and (b) p o s s i b l e d i f f e r e n c e s i n s e r v i c e u t i l i z a t i o n among t h e e l d e r l y c l i e n t s . 4. To t r y t o d e v e l o p an i n c r e a s e d a w a r e n e s s o f "age" as a 58 f a c t o r r e l e v a n t to the p l a n n i n g and on-going e v a l u a t i o n o f s u i c i d e p r e v e n t i o n programs. With regard t o the l a s t two o b j e c t i v e s , the more s p e c i f i c q u e s t i o n s posed to gain i n s i g h t s i n t o Programmatic F a c t o r s i n -clude : Q l . Are t h e r e any d i f f e r e n c e s i n the tendency to r e t u r n to the program ( i . e . , to have m u l t i p l e re-openings) by age? Q2. For those c l i e n t s who r e t u r n to the program f o r m u l t i p l e re-openings, does the l e v e l o f s e r v i c e s r e c e i v e d change acr o s s openings and does age account f o r any such v a r i a n c e ? Q3. Are th e r e any d i f f e r e n c e s i n l e v e l or q u a l i t y of s e r v i c e s r e c e i v e d by age? Q4. Do more or fewer of the e l d e r l y ' s l i p through the s e r v i c e net' than those i n oth e r age-groups, i . e . , whether the reasons why no s e r v i c e was r e c e i v e d are the same acr o s s v a r i o u s age-groups among c l i e n t s whom S.A.F.E.R. i s aware o f , but who r e c e i v e no s e r v i c e . The Hypotheses The hypotheses are used mainly to e x p l o r e the c h a r a c t e r -i s t i c s o f the study p o p u l a t i o n we are d e a l i n g w i t h . T h e i r pur-pose i s d e s c r i p t i v e . No g e n e r a l i n f e r e n c e s to s u i c i d e attempts i n the p o p u l a t i o n can be made, because the sample i s s e l f -59 selected for service. Therefore no causal hypotheses can be tested. The assumed rela t i o n s h i p of age with the variables of the study are outlined as hypotheses. They appear i n the order i n which the variables are l i s t e d i n the SIS. S p e c i f i c Hypotheses 1. Frequency of contact with the S.A.F.E.R. program i s s i g n i -f i c a n t l y associated with age. 2. Persons who come to the attention of the S.A.F.E.R. Pro-gram by d i f f e r e n t r e f e r r a l routes also d i f f e r s i g n i f i c a n t l y by age. 3. Age differences i n suicide attempts are c l o s e l y associated with sex differences, i . e . , suicide attempts are more common among females than among males. 4. Occupational status varies with age among S.A.F.E.R. c l i e n t s . 5. Age and marital status of attempters are associated, i . e . , marital status, e.g., ' s i n g l e 1 , 'married', 'widowed', 'divorced and separated' i s associated with age d i f f e r -ences . 6. Change of abode i s associated with age differences, i . e . , older people who have to move are more prone to suicide attempts than the younger. 7. Age differences i n suicide attempts are associated with educational l e v e l . 60 8. Age differences i n suicide attempts are associated with employment status. 9. L i v i n g s i t u a t i o n i s associated with incidence of suicide attempts. 10. Age differences i n suicide attempts are associated with e t h n i c i t y . 11. Age differences i n suicide attempts are associated with f i n a n c i a l s i t u a t i o n of the attempter. 12. Sexual deviance i s associated with age differences i n suicide attempts. 13. Differences in the age of the attempter are associated with t h e i r l e g a l involvement. 14. There are differences i n primary problems by the age of the attempter. 15. Methods of suicide attempts d i f f e r with age. 16. Use of alcohol i n suicide attemps i s associated with age. 17. In suicide attempts, 'plan to die' i s associated with age, i . e . , most old people attempting suicide have a strong 'expressed intent to die'. 18. Older people who attempt suicide mostly plan t h e i r attempt, as compared to most younger people who do not 'plan t h e i r attempt'. 19. 'Attempt directed' i s c l o s e l y associated with age, i . e . , most young people d i r e c t t h e i r attempt of suicide toward some ' s i g n i f i c a n t other 1, whereas, i n the case of the old people, attempt i s not usually directed toward others. ' P r i o r communication' of s u i c i d a l i n t e n t i s a s s o c i a t e d w i t h age, i . e . , o l d e r people u s u a l l y communicate t h e i r s u i c i d a l i n t e n t , as opposed to younger who a c t more on impulse. Age d i f f e r e n c e s i n s u i c i d e attempts are a s s o c i a t e d w i t h having o r not having c h i l d r e n . The presence or absence of drug dependency among S.A.F.E.R. c l i e n t s v a r i e s w i t h age. A r e c e n t h i s t o r y o f p h y s i c a l i l l n e s s among s u i c i d e attempters i s a s s o c i a t e d w i t h age, i . e . , i t i s more common among the e l d e r l y . Age d i f f e r e n c e s i n s u i c i d e attempts are a s s o c i a t e d w i t h a c c i d e n t s experienced i n the p a s t . Age d i f f e r e n c e s i n s u i c i d e attempts are a s s o c i a t e d with the presence or absence of v i o l e n c e i n the f a m i l y . 'Death of s i g n i f i c a n t o t h e r s ' as a c o r r e l a t e o f attempted s u i c i d e i s s t r o n g l y a s s o c i a t e d w i t h age d i f f e r e n c e s . Age d i f f e r e n c e s are a s s o c i a t e d w i t h a h i s t o r y of p r i o r s u i c i d e attempts. Age d i f f e r e n c e s are a s s o c i a t e d w i t h the ' l e v e l o f s e r -v i c e ' r e c e i v e d i n p r i o r attempts. Age d i f f e r e n c e s are a s s o c i a t e d with the q u a n t i t y of s e r -v i c e s r e c e i v e d by s u i c i d e attempters i n 'present attempts' Reasons f o r n o n - u t i l i z a t i o n of S.A.F.E.R. S e r v i c e s d i f f e r w i t h age. 62 S i g n i f i c a n c e o f the Study The s i g n i f i c a n c e o f the study i s m a n i f o l d , but the two immediate c o n s i d e r a t i o n s a r e : F i r s t , t h a t the e m p i r i c a l i n -v e s t i g a t i o n w i l l expand our understanding o f the phenomenology o f attempted s u i c i d e , i . e . , o f s u i c i d o g e n i c f a c t o r s as they r e l a t e t o age. Such i n s i g h t s are o f importance i n view o f the r i s i n g r a t e o f s u i c i d e and attempted s u i c i d e i n Canada. T h i s knowledge w i l l be . b e n e f i c i a l f o r agencies f o r p l a n n i n g and/or a s s e s s i n g programs o f s u i c i d e p r e v e n t i o n . The agencies' concern w i t h ever i n c r e a s i n g r a t e s of s u i c i d e i s l e g i t i m a t e i n as much as i t p o i n t s to the need f o r a more e f f e c t i v e p r o -gram and s e r v i c e s i n s u i c i d e p r e v e n t i o n . Such a need i n t u r n , r e q u i r e s constant up-dating o f the understanding of the pre-c i p i t a t i n g f a c t o r s i n s u i c i d a l behavior, e s p e c i a l l y i n a s o c i e t y l i k e Canada w i t h f a s t moving changes i n l i f e - s t y l e s , economic c o n d i t i o n s and the va l u e system as a whole. T h i s w i l l mean a con s t a n t review o f the c a u s a l aspects o f the pro-blem i n view of changes i n the demographic, s o c i a l , psycho-l o g i c a l and emotional complexion o f the p o p u l a t i o n . Second, the study aims to e x p l o r e programmatic f a c t o r s i n r e l a t i o n to age and s u i c i d e p r e v e n t i o n . That i s to say the extent t o which s e r v i c e s are u t i l i z e d by a g e - s p e c i f i c popula-t i o n s o f attempters, the number of c o n t a c t s made with S.A.F.E.R. as a s e r v i c e - p r o v i d i n g agency, the l e v e l o f u t i l i z a t i o n of s e r v i c e s o f people i n a g e - s p e c i f i c groups and the reason f o r the n o n - u t i l i z a t i o n o f s e r v i c e s . These f i n d i n g s may improve our understanding of attempters i n d i f f e r e n t age groups and 63 w i l l g i v e c l u e s to s e r v i c e p r o v i d e r s about h i g h - r i s k c a t e -g o r i e s and how to d e a l w i t h them to c o n t r o l ' r e c i d i v i s m ' . T h i r d , a c l o s e e x p l o r a t i o n i n t o cases of e l d e r l y s u i c i d e attempters may enhance our knowledge about those who ' s l i p through the s e r v i c e net' and stand the r i s k o f f u r t h e r attempts w i t h -out a follow-up s e r v i c e . Information on such cases among the e l d e r l y may, to some extent, l e a d toward f i n d i n g ways how to seek such persons out and to save them from the disengage-ment dependency,(disengagement t h e o r y ) , which makes them h i g h -r i s k i n d i v i d u a l s . F o urth, updated knowledge o f causes of attempts and how best to d e a l w i t h t h e i r p r e v e n t i o n can be used as i n p u t f o r e d u c a t i o n programs planned f o r f a m i l i e s o f attempters as w e l l as f o r o t h e r community groups i n t e r e s t e d i n s a v i n g people from such s e l f - d e s t r u c t i v e b e h a v i o r . L a s t l y , the a n a l y s i s of the f i n d i n g s may l e a d to a range of p o s s i b l e t o p i c s f o r f u r t h e r r e s e a r c h w i t h i m p l i c a t i o n s f o r s t i l l more e f f e c t i v e use o f agency's resources i n the i n t e r -v e n t i o n and p r e v e n t i o n of s u i c i d e as a community-based program. 64 CHAPTER IV METHODOLOGY Type of Study Research on s u i c i d a l behavior i n the past has provided us with p r o l i f i c l i t e r a t u r e . No less than 5,000 publications (books and a r t i c l e s ) have been reported i n print up to 1976 and approximately 180 new publications per year have been estimated to be coming o f f the press (Alberta Task Force on Suicides, 1976: 5). The question can therefore be raised, 'what more i s there to discover that can add to our understanding of the s u i c i d a l phenomena'? Suic i d o l o g i s t s and researchers are interested i n the advancement of knowledge and in r e f i n i n g the concepts related to the dynamics of suicide. In t h i s respect, every research e f f o r t may be regarded as a step toward the integration of new knowledge and new ideas. Suicide i s seen as a recurring human problem. For deal-ing with i t more e f f e c t i v e l y , continued research i s necessary. Further, the problem of suicide i s regarded as multi-faceted i n the approach/approaches that may cover a wide range of questions. The recent inte r e s t i n community-based programs in suicide prevention has, p a r t i c u l a r l y brought the need for 65 constant updating of knowledge that can be applied for follow-up, intervention and other programs aimed toward prevention. The present study i s exploratory i n nature as i t seeks to investigate the patterns of suicide attempts peculiar to d i f f e r e n t age groups. The investigation also extends to examine the age differences i n suicide attempts within the 'elderly group'. The aim of such explorations i s to discover new forms of interactions of variables or to confirm the a l -ready e x i s t i n g ones i n suicide attempts. The Sample The Study population comprises of a l l cases on whom i n -formation was compiled by S.A.F.E.R. workers from mid-1977 to the end of 1981. I t i s , therefore, a Non-Probability Purposive Sampling. The Cases were drawn from the following sources: 1. The Emergency Wards of Hospitals i n the Greater Vancouver Area. These included mainly six acute-care hospitals as follows: Vancouver General Hospital St. Paul's Hospital Burnaby General Hospital Richmond General Hospital Lion's Gate Hospital St. Vincent's Hospital Some other hospitals from whence cases were referred to S.A.F.E.R. in small numbers were coded as 'other'. 66 2. Agency Referrals which included r e f e r r a l s from any com-munity s o c i a l services. Most c l i e n t r e f e r r a l s came from the Community-care teams of the Greater Vancouver Mental Health Association. There are altogether eight such teams i n operation. 3. Individual physicians or family physicians. 4. Referred by s e l f or brought by f r i e n d s / r e l a t i v e s to the attention of the S.A.F.E.R. s t a f f . The cases were assessed by Hospitals and physicians to be of suicide attempts when they were referred to S.A.F.E.R. for follow-up. Data C o l l e c t i o n : The data c o l l e c t i o n procedure i s described here as the design of the instrument of inquiry and i t s use. As mentioned at the beginning (Chapter I, p. 13), the designing of the instrument was i n i t i a l l y started as part of a b r i e f research project launched by S.A.F.E.R. i n mid-summer 1977. The set of forms were referred to as the S.A.F.E.R. Information Sheet or SIS. The information sought through the SIS was what was considered useful from the c l i n i c a l and pro-grammatic point of view for the S.A.F.E.R. Program. The Forms (Appendix A) remained i n continual use by 5. A.F.E.R. workers u n t i l the end of 1981. During a period of 67 4 1/2 years, information was recorded on 5,35 8 cases referred to the S.A.F.E.R. program from sources described under 'The Sample'. Consequently, a S.A.F.E.R. data base was prepared with a consistent set of computer-ready records. These records have formed the Source from which the data for analysis of our study has been drawn. The S.A.F.E.R. Data Base consists of 3 F i l e s c a l l e d the 'Code Book', the 'Raw Data' and the ' S a f e r a l l ' respectively. The f i r s t of the three f i l e s contains descriptions of the format of the raw data i n columns with names of varia b l e s . Additional comments are included where necessary with further d e f i n i t i o n s of the variables. The description of the handling of missing data i s also given. The Second F i l e c a l l e d 'Raw Data' i s an unedited f i l e which contains the raw data from the S.A.F.E.R. Information Summaries (SIS). As an unedited f i l e , i t may contain unde-fined variate values, so to say, the "wild codes" or out-of-range values. When copied on a disk f i l e , i t can be edited as deemed necessary. The 'Raw Data' f i l e has been used for data analysis for t h i s study. The t h i r d f i l e , ' S a f e r a l l ' i s an SPSS system f i l e , con-taining the data from the SIS. It can be operated using version 9.00 under MTS at the University of B r i t i s h Columbia. As explained i n the Handbook c a l l e d "An Introduction to the 68 S.A.F.E.R. Data Base" (1982:7), some of the variate values have been rearranged, r e - l a b e l l e d or re-combined and some new variables have been generated i n t e r n a l l y by the computer. A l l such changes are documented i n an appendix to the S.A.F.E. Data Base. Information was recorded on 44 variables, l i s t e d i n the SIS or the data f i l e . I t i s included here as Appendix C. The choice of the variables was made keeping i n mind the research perspective as well as the p r a c t i c a l u t i l i t y of the informa-t i o n . In other words, the information could be comparable, i n the f i r s t place, with research on suicide and attempted suicide conducted i n other regions and with population s t a t i s -t i c s compiled by S t a t i s t i c s , Canada. In the second place, information was to include questions which the S.A.F.E.R. st a f f found useful for day-to-day functioning with the c l i e n t s For instance, the data for p r a c t i c a l u t i l i t y to the s t a f f included items such as the time of day or week the demand for service was l i k e l y to occur most, the l e v e l of service needed and the reasons for sl i p p i n g out of the service net. Such information has implications for the deployment of man-power by S.A.F.E.R., both from the standpoint of intervention as well as delivery of services. V a l i d i t y and R e l i a b i l i t y of the Data The use of the same set of Forms throughout the period of data c o l l e c t i o n accounted for the prevalence of consistency 69 The data was, however, c o l l e c t e d by d i f f e r e n t workers. Never-t h e l e s s , a l l o f them were t r a i n e d i n s e v e r a l s e s s i o n s by the S.A.F.E.R. s t a f f to gather the data from the h o s p i t a l i n - t a k e sheets as w e l l as through p e r s o n a l i n t e r v i e w s w i t h the c l i e n t s , i . e . , those who had been assessed as cases o f attempted s u i -c i d e . In order to approach a p o t e n t i a l c l i e n t , the worker had to be s a t i s i f e d t h a t i t was a case of s u i c i d e attempt and not an a c c i d e n t o r a r e c u r r e n t overdose by a c h r o n i c drug-abuser. For such an assessment the worker had to depend on medical o p i n i o n and h i s own c l i n i c a l judgements based on s p e c i a l i s t e x perience. Even an assessment can be i n t e r p r e t e d d i f f e r e n t l y . T h e r e f o r e , the d e t e r m i n a t i o n o f h i g h - r i s k case i s s a i d t o be i n the hands o f a person who reads the c h a r t . The two main d i f f i c u l t i e s have been r e c a l l e d w i t h the use o f the data base f o r r e s e a r c h purposes i n 'An I n t r o d u c t i o n t o S.A.F.E.R. Data Base' (1982). The f i r s t concerns w i t h the r e l i a b i l i t y and v a l i d i t y o f some o f the items. The ;items, f o r example, were: "Did the C l i e n t p l a n to d i e " ? , and "Was there p r i o r communication of s u i c i d a l i n t e n t " ? These were s a i d to be coded on c l i n i c a l judgements. The i n t e r - r a t e r and i n t r a -r a t e r r e l i a b i l i t y o f these items or t h e i r v a l i d i t y can be que s t i o n e d . The second d i f f i c u l t y was r e l a t e d to the high p r o p o r t i o n o f m i s s i n g data on some of the items o f the SIS. In o t h e r words, when the a c t u a l c o n t a c t with the attempter has been l i m i t e d t o a s i n g l e meeting o n l y , the p r o p o r t i o n of the m i s s i n g data was hi g h e r . On the oth e r hand, g r e a t e r 70 rapport with an attempter resulted i n acquiring more complete information about him/her. Besides, items l i k e 'primary 1, 'secondary' and ' t e r t i a r y ' problems may be changing from time to time and may not r e l i a b l y measure the r i s k involved. On the whole, the data sheet was designed to s a t i s f y the needs of the S.A.F.E.R. Staff as far as possible. It helped answer some important questions for the operation of the S.A.F.E.R. Program. Selection of Variables The Data F i l e i s composed of 44 variables. These also include routine information required on c l i e n t s ' in-take, e.g., c l i e n t ' s i d e n t i f i c a t i o n number, S.A.F.E.R. Worker's name who f i l l e d the forms on each c l i e n t , month, year and day of week attempt was made and date and time of admission. Such items have not been cross-tabulated, although some of them have been diagrammatically represented to show frequency of occurrence of attempts. The Key Variable Age has been regarded i n previous research l i t e r a t u r e as a key variable. Its taxonomy i s represented through age-groups. The four age-groups formed for purposes of comparison with other factors i n suicide are: 0 - 1 9 years 20 - 39 years 40 - 64 years Above 65 years 71 Those above 65 years have been further subdivided into two groups, i . e . , 65-74 years and 75 years and above. The purpose of further subdivision has been to examine more i n -tensively the associational relationship of some selected factors with age-differences among the e l d e r l y group. Variables to be Intercorrelated with Age Most background variables included i n the data f i l e have been chosen for analysis to explore the relationship of age with those factors. Some have been l e f t out due to two main reasons. F i r s t , because they were r e p e t i t i o n of a certain factor, e.g., 'secondary problems' and ' t e r t i a r y problems' and 'second method of attempt' and 'third method of attempt'. Second, those items i n which information was limited only to those who were hospitalized, e.g., 'length of stay i n hours' and 'discharged before seen'. These two variables were l e f t blank for non-hospitalized suicide attempters. Moreover, they were not applicable for cases of suicide threats and c r i s i s interventions. The variables to be analyzed include: 1. The Background Factors which include s o c i a l characteris-t i c s , such as sex, marital status, occupation, education, e t h n i c i t y and having children. 2. Factors as antecedents i n attempt of suicide comprise employment status, l i v i n g s i t u a t i o n , f i n a n c i a l s i t u a t i o n , 72 l e g a l involvement, motives of attempt, methods used i n attempt, primary p r e s e n t i n g problem, p r i o r communication f o r attempt, past i l l n e s s , past a c c i d e n t s , death of s i g n i -f i c a n t other, drugs, p r e v i o u s attempts toward s u i c i d e , impending move and a l c o h o l abuse. 3. F a c t o r s r e l a t i n g to programming of s e r v i c e s take i n t o account f a c t o r s such as number o f c o n t a c t s made with S.A.F.E.R., source or method of r e f e r r a l , l e v e l of s e r -v i c e r e c e i v e d , reasons f o r no c o n t a c t w i t h the s u i c i d e p r e v e n t i o n agency (S.A.F.E.R.) and l e n g t h o f case. Method o f A n a l y s i s I t i s a Secondary a n a l y s i s of the S.A.F.E.R. data de-s c r i b e d b e f o r e . In order to f u l f i l l the f i r s t o b j e c t i v e of the study, namely the c o n s t r u c t i o n of a b a s i c p r o f i l e of cases of attempted s u i c i d e , the f i r s t step i n data a n a l y s i s has been a u n i v a r i a t e a n a l y s i s o f f r e q u e n c i e s . The second step takes i n t o account the c r o s s - t a b u l a t i o n o f a l l the 30 v a r i a b l e s chosen from the data f i l e . The pur-pose i s the t e s t i n g o f a s s o c i a t i o n between age and o t h e r v a r i a b l e s . The t e s t o f the c h i - s q u a r e has been a p p l i e d to f i n d the s i g n i f i c a n c e o f a s s o c i a t i o n between the v a r i a b l e s . F a c t o r s which have been found to be s i g n i f i c a n t l y r e l a t e d were f u r t h e r a n alyzed. T - t e s t s were ad m i n i s t e r e d to see whether the means 73 of the two population were homogeneous. Items with multiple categories were tested by the method of analysis of variance to test the significance of d i f f e r -ences between the means of age-groups vs. other correlated variables i n attempted suicide. The interaction e f f e c t s with-i n variables were noted. Other measures of contingency selected to test the strength of association between age and other variables include: contingency c o e f f i c i e n t , uncertainty,coefficient, lambda (symmetric) and lambda (asymmetric). D e f i n i t i o n of Key Concepts Cases: Include a l l units of observation, i . e . , S.A.F.E.R. c l i e n t s who have been assessed to have attempted suicide. Attempted Suicide: The decision as to whether or not a suicide attempt was made was based on the c l i n i c a l judgement of S.A.F.E.R. s t a f f members. The c l i n i c a l judgement was arrived at on review of hospital charts, physician's report and information from family members and from any other source available at the time. A formal d e f i n i t i o n of attempted suicide i s : "a non-f a t a l act i n which an i n d i v i d u a l d e l i b e r a t e l y causes s e l f -injury or ingests a substance i n excess of prescribed or gener-a l l y recognized therapeutic dosage." (Kreitman, 1977) 74 E l d e r l y : A l l those persons who f a l l i n the age category of 65 and above and who have been r e f e r r e d to S.A.F.E.R., assessed and accepted as cases o f s u i c i d e attempts. E x p l a n a t i o n o f Terms Used i n Hypotheses Sexual Deviance L e g a l Involvement: Primary Problem: Plan to Die: Attempt Planned: Attempt D i r e c t e d : P r i o r Communication: L e v e l o f S e r v i c e Refers to sexual o r i e n t a t i o n s r a t h e r than h e t e r o s e x u a l i t y . Refers to l e g a l involvement concurrent w i t h the c u r r e n t S.A.F.E.R. c o n t a c t . Refers to the primary p r e s e n t i n g problem o f the c l i e n t when he/she was f i r s t seen by the S.A.F.E.R. worker. Refers t o ' i n t e n t to k i l l o n e s e l f . Means s p e c i f i c p r e p a r a t i o n s made b e f o r e -hand, i . e . , i t was not an im p u l s i v e o r spontaneous a c t . Attempts with an i n t e r p e r s o n a l and i n -strumental q u a l i t y , as m a n i f e s t a t i o n s of anger, h o s t i l i t y , o r revenge d i r e c t e d toward s i g n i f i c a n t o t h e r s . Includes both ' D i r e c t ' and ' I n d i r e c t ' , e.g., g i v i n g away p r i z e d p o s s e s s i o n s , p r e p a r i n g a w i l l , o r d i r e c t v e r b a l t h r e a t s o f s u i c i d e . Refers to l e v e l o f c l i e n t c o n t a c t a t t a i n e d w i t h S.A.F.E.R. In data a n a l y s i s , i t i s r e f e r r e d to i a s "Contact type". There 75 are four lev e l s of contact i n the pro-cess of r e f e r r a l and counselling at S.A.F.E.R. They are: Assessment only, Offer of Service only, B r i e f counselling contact and Complete counselling contact. The f i r s t two levels are referred to i n the analysis of the data as 'No Service', and the l a s t two as 'Some Service'. Abbreviation Used i n S t a t i s t i c a l Analysis CC = Contingency C o e f f i c i e n t LI = Goodman's Lambda (Asymmetric) L2 - Goodman's Lambda (Symmetric) UC1 = Uncertainty C o e f f i c i e n t (Asymmetric) with Age-dependent and with Column-dependent UC2 = Uncertainty C o e f f i c i e n t (Symmetric) with Age-dependent and with Column-dependent. Note: The Code Book contains explanation of Variables. It can be referred to for any further explanations at the Central Office of the Greater Vancouver Mental Health Service. 76 CHAPTER V ANALYSIS OF DATA AND ITS INTERPRETATION The data have been analyzed keeping i n view the o b j e c -t i v e s s e t up i n the d e s i g n i n g of the study. The f i r s t o b j e c t i v e i s t o c o n s t r u c t a b a s i c p r o f i l e of s u i c i d e attempters. To t h i s end, a u n i v a r i a t e a n a l y s i s of the d i s t r i b u t i o n o f v a r i a b l e f r e q u e n c i e s has been presented through percentages. R a t i o s have been used f o r comparative purposes and some f r e q u e n c i e s have been i l l u s t r a t e d through bar c h a r t s . In o r d e r to meet the second o b j e c t i v e of f i n d i n g p r o-f i l e s of attempters by age groups, t e s t s of a s s o c i a t i o n have been a p p l i e d . Any d i f f e r e n c e s o c c u r r i n g i n a sample as l a r g e as f o r t h i s study have t o be i n t e r p r e t e d keeping i n mind t h a t the d i f f e r e n c e s w i l l be s t a t i s t i c a l l y s i g n i f i c a n t even though, i t may be very c l o s e t o zero, and too small t o have any p r a c t i c a l importance. In i n t e r p r e t i n g the r e s u l t s , we r e l y mainly on the measures of a s s o c i a t i o n . I t i s the s i z e of r e l a t i o n s h i p t h a t counts. For meeting the t h i r d o b j e c t i v e , the a n a l y s i s i s \ focussed on the two groups w i t h i n the e l d e r l y , namely the 77 'young' and the 'old' e l d e r l y and the same measures of associa-tion are applied, but in t h i s case on a small sample. An examination of the o v e r a l l findings goes to meet the fourth objective, i . e . , to determine the extent to which age as a factor i s relevant i n the planning of programmes i n suicide prevention. 1. Basic P r o f i l e of Attempters: 1.1 Demographic Variables: 1. The t o t a l cases of S.A.F.E.R. c l i e n t s referred from various sources t o t a l l e d 5,358. 2. The period of r e f e r r a l extended over a period of 4i years. The frequency of occurrence of suicide attempts was highest i n 1978 (Bar Chart I I I ) . 3. The highest incidence of attempts occurred in the month of August (Bar Chart IV). 4. The r e f e r r a l s to S.A.F.E.R. came mostly from the Vancouver General Hospital (51.9%) and the second most (21.3%) were received from the St. Paul's Hospital. Both the hospi-t a l s are located in the Downtown Vancouver Area. (M.O = 3.8%)"'" Note: Percentages are calculated from a t o t a l of those on whom information could be recorded. Number of missing obser-vations have, therefore, been excluded from such calcu-l a t i o n . "'"M.O = Missing Observations. CHART I I I BAR CHART SHOWING FREQUENCY OF SUICIDE ATTEMPTS BY YEAR NO. CASES 1 400 1200 1 000 800 600 400 200 YEAR OF ATTEMPT 1977 1978 1979 1980 1981 CHART IV 79 BAR CHART SHOWING FREQUENCY OF SUICIDE ATTEMPTS BY MONTH NO. CASES 500 400 300 505 450 444 429 410 398 436 407 489 475 466 446 200 1 00 MONTHS OF ATTEMPT JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 80 5. The ages of attempters ranged from 10-96 years with a mean age of 28.43, median 26.67 and mode 20.0 years. 6. The r a t i o of females to male.attempters stood at 2:1, i . e . , 66.8% were females and 33.2% were males. (M.O =4.1%) 7. The largest number of suicide attempts (49.1%) were among males and females who were never married and were c l a s s i f i e d as ' s i n g l e 1 . Married c l i e n t s formed 30.7%, divorced and separated 17.5% and widowed 2.7% of the t o t a l . (M.O =25.1%) 8. Of a l l the cases recorded, 57% were either u n s k i l l e d or had no occupation. Among such cases included 14.6% (432) students and 13.4% (396) housewives. (M.O. = 44.8%) 9. Level of education attained by most (77.4%) was up to secondary school. (M.O = 63%) 10. By ethnic c l a s s i f i c a t i o n , 84.5% were 'whites'. Native Indians and Inuits comprised 6.7%, o r i e n t a l s c o n s t i -tuted 4.5% and the remaining c l a s s i f i e d as 'other' formed 4.5% of the attempters. (M.O = 37.7%) 11. Sixty percent of a l l observed cases were without children. (M.O = 52.9%) The age range here starts from 10 years because the cases of attempted suicide under 15 years numbered 113. It was too large a number to be ignored. 81 1.2 Variables Held as Antecedants i n Suicide Attempts 1. Employment Status: The unemployed constituted 68.2% of a l l observed cases. Unemployment status comprised those without jobs, r e t i r e d , dependents or l i v i n g on welfare. (M.O = 34.7%) 2. Liv i n g Situation: Most c l i e n t s (69.8%) shared accommodations with parents, r e l a t i v e s , friends or were l i v i n g communally, while 24.8% l i v e d alone and 5.4% were in r e s i d e n t i a l institutions.(M.O =37. 3. F i n a n c i a l Situation: F i f t y percent of attempters described t h e i r f i n a n c i a l s i t u a t i o n as insecure. (M.O = 51.6%) 4. Sexual Orientation: There were 94.5% who were heterosexual. The remaining are referred to here as 'sexually deviant'. (M.O = 51.9%) 5. Legal Involvement: Of those who were involved i n court cases, 47% had c i v i l s u i ts and cases in family courts and 28.4% i n criminal courts. Another 5.8% of the cases were drug/alcohol abuse related. (M.O = 93.9%) 6. Primary Problem: Primary problem of most attempters (46.8%) revolved around family, marital and s o c i a l r e l a t i o n s h i p s . Separation 82 or loss of s i g n i f i c a n t others was the second most frequently-experienced, stated by 23.5%. Alcohol and drug related problem was the t h i r d most frequently (10.4%) stated problem. I s o l a -tion and psychosis were experienced by 5.4% and physical i l l -ness was the primary problem of 3.4% of a l l observed cases. (M.O = 34.5%) 7. Method of Attempt: Most attempters (75.2%) made use of drugs c l a s s i f i e d as 'psychotropics', 'barbituates' and 'analgesics' with f r e -quency of ingestion i n order of the drugs named here. There were 21% cases of s e l f - i n j u r y which included f i r e -arms, hanging, slashing of wrist, drowning, and jumping from heights, while 3.8% were cases i n c r i s i s or had threatened suicide. (M.O = 5.4%) 8. Abuse of Alcohol: Alcohol was d i r e c t l y involved i n the s u i c i d a l act by one t h i r d of the 2,919 cases on whom information could be ascertained. (M.O = 45.5%) 9. Intent to Die: There were 88.4% of the attempters who stated that they had no intent to k i l l themselves. (M.O = 62%). 10. Attempt Planned: Those who had not 'planned t h e i r attempt' beforehand formed 93.4% of a l l cases. In other words, i t was an emotional 83 and impulsive act. 11. Attempt Directed: Attempts were mostly directed (57.2%) toward lover/ f r i e n d . Another 17.4% were directed towards parents or other family members. In the case of 25.4% i t could not be ascer-tained toward whom they were directed. (M.O = 80.2%) 12. Communication of Intent: Attempts who did not communicate t h e i r intention to die pr i o r to attempt were 94.2%. (M.O = 68.5%) 13. Drug Dependency: The cases found to be drug dependent formed 84.2%. (M.O = 58.5%) 14. Past I l l n e s s : Those who had suffered no past physical i l l n e s s comprised 91.8%. (M.O = 64.1%) 15. Past Accidents: Those who had encountered no accidents in the past formed 97.8%. (M.O = 70.4%) 16. Death of S i g n i f i c a n t Others: Those who experienced no death or loss of s i g n i f i c a n t other formed 93.8%. (M.O = 77.2%) 17. Violence in the Family: Those who mentioned no violence i n the family were 92.6%. 84 (M.O = 74.4%) 18. History of Attempts: Seventy-eight percent had not made an attempt previously or had no record of attempt. (M.O = 45.4%) 1.3 Factors i n Programming and Service U t i l i z a t i o n 1. Days of Occurrence of Suicide Attempts: Most attempts occurred on Saturdays and second most on Wednesdays (bar chart V). 2. Time of Occurrence: Most attempters (42.6%) were admitted i n the hospital between mid-night and 5:59 a.m. (bar chart VI). 3. Length of Stay: The length of stay of most attempters (36.9%) in the hospital was between 1 to 4 hours. F i f t y - t h r e e percent were discharged from the hospital before they were seen by a S.A.F.E.R. worker. For those whose source of r e f e r r a l was other than a hospital (3.2%), information on the duration of treatment was not available. (M.O = 25%) 4. Level of Service Achieved with S.A.F.E.R. i n Previous Attempt/Attempts (PrioContype): Of the 76 2 attempters who had made previous contacts with S.A.F.E.R., 60.6% had achieved the service l e v e l through either 'brief counselling' or 'complete counselling'. 5. Level of Service Reached with S.A.F.E.R. by those BAR CHART SHOWING FREQUENCY OF SUICIDE ATTEMPTS BY DAY OF WEEK NO. CASES 800 700 600 500 400 300 200 100 DAY OF WEEK MON TUE WED THU FRI SAT SUN CHART V 86 CHART VI BAR CHART SHOWING FREQUENCY OF SUICIDE ATTEMPTS HOURS OF DAY NO. CASES 2400 2000 1600 2281 1 1 54 1200 800 400 919 596 HOURS OF DAY 12:00 PM 6:00 AM 12:00 AM 6:00 PM 5:59 AM 11:59 AM 5:59 PM 11:59 PM 87 who had No record.of Previous Contacts (Contype): Of those, 33.6% had b r i e f counselling and 26.7% went for 'complete counselling' with S.A.F.E.R. Such cases formed 60.2% of a t o t a l of 5,347 cases observed. (M.O = 11 cases) 6. Reasons for 'Assessment' Only: Those who were offered service by S.A.F.E.R. after t h e i r cases were ascertained to be those of suicide attempts were approached for finding reasons for n o n - u t i l i z a t i o n of service. Those who were unable to contact S.A.F.E.R. formed 49.9%. Reasons given included: i n a c c e s s i b i l i t y to a t e l e -phone, S.A.F.E.R.'s i n a b i l i t y to trace the c l i e n t post-dis-charged from h o s p i t a l . Other reasons were ref u s a l by kin, friends and professionals to contact the service (20.9%), c l i e n t ' s involvement with other agencies (29.3%) and c l i e n t being non-English speaking. Only 7 out of a t o t a l of 2,138 such cases were S.A.F.E.R. ongoing, i . e . , r e c e i v i n g counselling. The Findings: The p r o f i l e that emerges from the foregoing analysis corresponds with the one formulated from a review of back-ground l i t e r a t u r e . We are, therefore, i n c l i n e d to confirm that in general, i t i s young, never married females who became S.A.F.E.R. c l i e n t s . In general, they had no p a r t i c u l a r occupation, being mostly housewives or students, mostly dependent on family for 88 a l i v i n g or were on welfare. Their primary problems were family, marital or sex related. Past physical i l l n e s s or past accidents or loss of s i g n i f i c a n t others did not feature prominently as precursors of attempts. Their intent to die was marked by ambivalence and unplanned attempts. Most attempters ingested substances for self-poisoning and directed t h e i r attempts mostly toward parents, friends or a lover. The period of intervention was b r i e f , both at the hospital and with S.A.F.E.R. From the available data, i t i s , however, not possible to t e l l whether the group i s representative of attempters i n the general population. 2. Testing of Hypotheses: The r e s u l t s of tests of hypotheses appear i n Table 8 (pages 92-97). Measures of association as applicable to nominal data have been selected for interpreting the r e s u l t s . The Computer Run Tables appear i n Appendix C from which the r e s u l t s have been c o l l a t e d i n Table 8. The hypotheses are recapitulated b r i e f l y here i n the n u l l form. Their s e r i a l numbers correspond with the s e r i a l numbers of variables i n Table 8. The N u l l Hypotheses: 1. There i s no association of age with frequency of 89 contact with S.A.F.E.R. Program. The Null Hypotheses: Age differences i n suicide attempters are not s i g n i f i c a n t -l y associated with: 1. Frequency of contact with S.A.F.E.R. Program 2. Different r e f e r r a l routes 3. Sex differences 4. Differences i n occupational status 5. Differences in marital status 6. Those who changed t h e i r abode or not ' (move) 7. Differences in educational status 8. Differences in employment status 9. Differences i n l i v i n g s i t u a t i o n 10. Differences i n ethnic o r i g i n 11. Differences i n f i n a n c i a l s i t u a t i o n 12. Differences in sexual orientation 13. Legal involvement 14. Differences .in primary problems 15. Methods of attempt 16. Alcohol abuse 17. Differences in seriousness of intent (plan to die) 18. Differences i n attempt planned or unplanned 19. Attempt directed toward others or riot 20. Differences i n p r i o r communication of intent 21. Having or not having children 22 . Having or not having drug dependency 90 23. Physical i l l n e s s or i t s absence 24. Experience with past accidents 25. Violence i n the family 26. Death of s i g n i f i c a n t others 27. History of p r i o r attempt 28. Level of service received in p r i o r attempts 29. Quantity of service received by those who had made no p r i o r attempts 30. Reasons for n o n - u t i l i z a t i o n of S.A.F.E.R. service S t a t i s t i c a l Results: A. The Chi-square Test: 27 out of 30 variables assumed to be correlated with age were found with s i g n i f i c a n t l y high values with a p r o b a b i l i t y of 0.0000, i . e . , less than one chance i n 10,000 that values t h i s large or larger could be due to sampling error alone. The three n u l l hypotheses which were accepted were those numbered as 13 (Legal Involve-ment) , 20 (prior communication) and 28 (level of service re-ceived i n p r i o r attempts or PrioContype). In our analysis the sample size being large yielded large values of chi-squares. The large values imply a systematic r e l a t i o n s h i p that exists between age and correlated variables. Further, to test the strength of r e l a t i o n s h i p be-tween age and correlated variables i n suicide attempts, values from other tests of association were examined. Consistently 91 weak relationships were evident from the r e s u l t s (Table 8, pages 92-97). It may, therefore, be inferred that variables assumed to be associated with age, though not independent of each other, are nevertheless, not strongly related. B. Results of t - t e s t s : The 14 null-hypotheses for which t-tests were administered had dichotomous variables. The n u l l hypotheses assumed that the two populations would have equal age means (Tables 9, 98-101). Only one n u l l hypothesis was accepted as the means of the populations were found to be equal (referred as PrioContype). The other 13 were rejected at .05 l e v e l of significance as t h e i r means on age were not found to be equal. C. Tests of ANOVA were applied on variables with multiple categories (Table 10, 102-103). The main ef f e c t s of variables with age were found to be s i g n i f i c a n t at .05 l e v e l of s i g n i f i c a n c e . The variables of occupation and e t h n i c i t y were found to have s i g n i f i c a n t variance i n age means. Again the differences i n means were small. 'Employ-ment' as a variable did not seem to have high variance i n means and may, therefore, be treated as being of a borderline si g n i f i c a n c e . As regards the two-way i n t e r a c t i o n a l e f f e c t s , the var-iable of 'marital status 1 and 'primary problem' showed no TABLE 8 TESTS OF HYPOTHESES Age by C o r r e l a t e d V a r i a b l e s Variables Correlated With Age Chi-Square x 2 df. Proba-b i l i t y Contin-gency Coef-f i c i e n t LAMBDA' (Asymmetrical) LAMBDA (Symmet-r i c a l ) Uncertainty C o e f f i c i e n t (Asymmetrical) Uncertainty C o e f f i c i e n t (Symmetrical) 1. Number of S.A.F.E.R. Contacts (NumCon) 32.31 9 0.002 0.078 0.00 with age Dep. 0.00 with NumCon Dep. ' 0.0 0.003 with age Dept. 0.008 with NumCon Dep. 0.004 2. Method of Re f e r r a l 70.66 18 0.00 0.116 0.0 with age Dep. 0.0 with method Dep. 0.0 0.007 with age Dep. 0.005 with method Dep. 0.006 3. Sex 52.37 3 0.00 0.09 0.0 with age Dep. 0.0 with sex Dep. 0.0 0.032 with age Dept. 0.037 with Occup. Dep. 0.006 4. Occupa-t i o n a l Status 171.05 9 0.00 0.23 0.0 with age Dep. 0.0 with Occup Dep. 0.0 0.032 with age Dep. 0.037 with Occup. Dep. 0.034 5. M a r i t a l Status 1371.4.3 9 0.0 0.50 0.0 with age Dep. 0.135 with Marital Dep. 0.08 0.080 with age Dep. 0.137 with Ma r i t a l Dep. 0.144 NOTE: The Variables are numbered here i n the same order as Hypotheses are stated i n Chapter 3. Abbreviation: Dep. = Dependant. TABLE 8 ( C o n t i n u e d ) Variables Correlated With Age Chi-Square x 2 df. Proba-b i l i t y Contin-gency Coef-f i c i e n t LAMBDA (Asymmetrical) LAMBDA (Symmet-r i c a l ) Uncertainty C o e f f i c i e n t (Asymmetrical) Uncertainty C o e f f i c i e n t (Symmetrical) 6. Move 30.31 3 0.00 0.07 0.0 with age Dep. 0.06 with move Dep. 0.0 0.002 with age Dep. 0.006 with move Dep. 0.004 7. Educational Level 116.80 9 0.00 0.23 0.00 with age Dep. 0.00 with educa-t i o n Dep. 0.0 0.035 with age Dep. 0.042 with edu-cation Dep. 0.038 8. Employment Status 110.77 3 0.00 0.17 0.00 with age Dep. 0.0 with employ-ment Dep. 0.0 0.017 with age Dep. 0.029 with em-ployment Dep. 0.022 9. L i v i n g S i t u a t i o n 161.71 6 0.00 0.21 0.0 with age Dep. 0.0 with l i v i n g Dep. 0.0 0.026 with age Dep. 0.036 with l i v -ing Dep. 0.03 10. E t h n i c i t y 27.94 3 0.00 0.09 0.0 with age Dep. 0.0. with e t h n i -c i t y Dep. 0.0 0.004 with age Dep. 0.10 with eth-n i c i t y Dep. TABLE 8 ( C o n t i n u e d ) Variables Correlated With Age Chi-Square x 2 df. Proba-b i l i t y Contin-gency Coef-f i c i e n t LAMBDA (Asymmetrical) LAMBDA (Symmet-r i c a l ) Uncertainty C o e f f i c i e n t (Asymmetrical) Uncertainty C o e f f i c i e n t [Symmetrical) 11. F i n a n c i a l 81.43 6 0.00 0.122 .0.0 with _age Dept. •0.0 with -finan-c i a l Dep. 0.0 0.00/7-with age Dep. 0.008 with f i n -a n c i a l Dep-.. 0.006 0.007 12. Sexual Orienta-t i o n 30.05 3 0.00 0.10 0.00 with age Dep. 0.0 with sexual o r i e n t a t i o n 0.0 0.007 with age Dep. 0.035 with sex-ual o r i e n t a t i o n 0.012 13. Legal In-volvement 14.58 9 0.10 0.206 0.0 with age Dep. 0.01 with l e g a l Dep. 0.08 0.025 with age Dep. 0.02 with l e g a l Dep. 0.022 14. Primary Problem 258.68 18 0.000 0.26 0.00 with age Dep. 0.0 with primary Dep. 0.0 0.02 with age Dep. 0.023 15. Method of Attempt 45.58 6 0.000 0.09 0.0 with age Dep. 0.0 with method Dep. 0.0 0.004 with age Dep. 0.007 with method Dep. 0.005 VO 4^ . TABLE 8 (Continued) Variables Correlated With Age Chi-Square x 2 df. Proba-b i l i t y Contin-gency Coef-f i c i e n t LAMBDA (Asymmetrical) LAMBDA (Symmet-r i c a l ) Uncertainty C o e f f i c i e n t (Asymmetrical) Uncertainty C o e f f i c i e n t (Symmetrical) 16. Alcohol 125.35 3 0.000 0.15 0.0 with age Dep. 0.0 with alcohol Dep. 0.0 0.012 with age Dep. 0.019 with a l c o -hol Dep. 0.014 17. Plan to Die 75.43 3 0.000 0.117 0.0 with age Dep. 0.0 with die Dep. 0.0 0.006 with age Dep. 0.019 with die Dep. 0.010 18. Attempt Planned 29.65 3 0.000 0.07 0.0 with age Dep. 0.0 with planned Dep. 0.0 0.002 with age Dep. 0.010 with planned Dep. 0.004 19. Attempt Directed 175.68 6 0.000 0.37 0.104 with age Dep. 0.072 with directed Dep. 0.08 0.072 with age Dep. 0.074 with d i r e c t e d Dep. 0.073 20. P r i o r Communica-t i o n 4.09 n"i s* 3 0.25 0.027 0.0 with age Dep. 0.0 with Commun Dep. 0.0 0.00 with age Dep. 0.001 with Commun Dep. 0.000 *n.s = not s i g n i f i c a n t TABLE 8 ( C o n t i n u e d ) Variables Correlated With Age Chi-Square x 2 df. Proba-b i l i t y Contin-gency Coef-f i c i e n t LAMBDA (Asymmetrical) LAMBDA (Symmet-r i c a l ) Uncertainty C o e f f i c i e n t (Asymmetrical) Uncertainty C o e f f i c i e n t (Symmetrical) 21. Children 395.56 3 0.000 0.26 0.0 with age Dep. 0.0 with children Dep. 0.0 0.040 with age Dep. 0.086 with chi l d r e n Dep. 0.054 22. Drug Dependent 88.77 3 0.000 0.127 0.0 with age Dep. 0.0 with drug Dep. 0.0 0.008 with age Dep. 0.020 with Drug Dep. 0.012 23. Past I l l n e s s 154.53 3 0.000 0.16 0.0 with age Dep. 0.0 with i l l -ness Dep. 0.01 0.01 with age Dep. 0.042 with n i -nes Dep. 0.018 24. Past Accident 17.76 3 0.000 0.05 0.0 with age Dep. 0.0 with a c c i -dent Dep. 0.0 0.001 with age Dep. 0.014 with ac c i -dent Dep. 0.002 25. Family-Violence 12.89 3 0.004 0.04 0.0 with age Dep. 0.0 with v i o -lence Dep. 0.0 0.001 with age Dep. 0.005 with v i o -lence Dep. 0.002 TABLE 8 ( C o n t i n u e d ) Variables Correlated With Age Chi-Square x 2 df. Proba-b i l i t y Contin-gency Coef-f i c i e n t LAMBDA (Asymmetrical) LAMBDA (Symmet-r i c a l ) Uncertainty C o e f f i c i e n t (Asymmetrical) Uncertainty C o e f f i c i e n t (Symmetrical) 26. Death of S i g n i f i c a n t Other 67.66 3 0.000 0.111 0.0 with age Dep. 0.0 with death Dep. 0.0 0.0 0.004 with age Dep. 0.019 with death Dep. 0.007 27. P r i o r Attempts 57.99 3 0.000 0.103 0.0 with age Dep. 0.0 with attempt Dep. 0.0 0.005 with age Dep. 0.010 with attempt Dep. 0.007 28. P r i o r Contact Type 1.64 n.s* ' 3 0.649 0.04 0.0 with age Dep. 0.0 with p r i o r type Dep. 0.0 0.001 with age Dep. 0.001 with p r i o r Type Dep. 0.001 29. Contact Type 36.38 3 0.000 0.082 0.0 with age Dep. 0.0 with Contype Dep. 0.003 with age Dep. 0.005 with Con-type Dep. 0.004 30. Reason for Assess-ment Only 118.25 9 0.000 0.22 0.0 with age Dep. 0.0 with reason Dep. 0.0 0.024 with age Dep. 0.019 with reason Dep. 0.021 *n.s = not s i g n i f i c a n t TABLE 9: t-tests on 14 Selected Correlates of Age GROUP 1 - SEX GROUP 2 - SEX EO EO T E S T POOLED VARIANCE ESTIMATE * SEPARATE VARIANCE ESTIMATE VARIABLE NUMBER OF CASES MEAN STANDARD DEVIATION STANDARD ERROR F VALUE 2 -TA IL PROB. T VALUE DEGREES OF 2 - T A I L FREEDOM PROB. T VALUE DEGREES OF 2 - T A I L FREEDOM PROB. AGE <AGE> * * * GROUP 1 3574 27.6984 14.754 0 .247 * * * * 1.24 0 .000 * - 5 . 3 3 5355 0 .000 * - 5 . 5 3 3925.14 0 . 0 0 0 GROUP 2 1783 29.9030 13.232 0 .313 * * * _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ T . T E S T _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ GROUP 1 - MOVE EO 1. GROUP 2 - MOVE EO 2. * * * * AGE <AGE> * * * GROUP 1 4412 28 .6002 14 . 798 0 .223 * * * * 1.60 0 .000 * 1 .88 5356 0 .060 * 2 . 19 1664 . 25 0. .029 GROUP 2 946 27 .6364 1 1 .687 0. . 380 * * * * * * - T - T E S T - -GROUP 1 - FINANC EO 1 . GROUP 2 - FINANC EO 2 . * * * * AGE <AGE> * * * GROUP 1 645 31 . 5550 15 . 134 O. 596 * * * * 1.73 0 .000 * 4 . 29 1945 0 . 000 * 3. 92 1024 . ,61 0 . 000 GROUP 2 1302 28 . 9040 1 1 . 514 0. 319 * * * * * T - T E S T GROUP 1 - ALCOHOL EO 1 . GROUP 2 - ALCOHOL EO 2. AGE <AGE> * * * GROUP 1 3553 27.4909 15.234 0 .256 * * * >D * 1.60 0 . 0 * - 6 . 7 7 5356 0 .000 * - 7 . 3 0 4436.02 0 . 0 0 0 0 0 GROUP 2 1805 30.2787 12.054 0.284 * * * TABLE 9 ( C o n t i n u e d ) T - T E S T GROUP 1 - PLANNED EO 1.. GROUP 2 - PLANNED EQ 2. * * POOLED VARIANCE ESTIMATE * SEPARATE VARIANCE ESTIMATE OF CASES MEAN DEVIATION ERROR * VALUE PROB. * VALUE FREEDOM PROB. * VALUE FREEDOM PROB. * * AGE <AGE> * * * GROUP 1 4736 27.7627 14.092 0 . 205 * * * * 1.11 0 .069 -9 . 50 5356 0 .000 * - 9 . 1 2 774 .76 0 . 0 0 0 GROUP 2 622 33.5113 14.868 0 .596 * * * * * * - T - T E S T - -GROUP 1 - ATTEMPT EO 1 . GROUP 2 - ATTEMPT EO 2 . AGE <AGE> * * * GROUP 1 5007 28.1218 14.207 0 . 201 * * * * 1 . 10 0. 188 * - 5 . 9 8 5356 0 .000 * - 5 . 7 2 395.71 0 . 0 0 0 GROUP 2 351 32.8262 14.934 0. 797 * * * * * T - T E S T GROUP 1 - CHILDREN EO 1. GROUP 2 - CHILDREN EO 2. AGE <AGE> * * * GROUP 1 4353 26 .5798 13 . 823 0 .210 * * * * 1.04 0 .446 * - 2 0 . .46 5356 0 .000 * - 20 .71 1523 .31 0 .000 GROUP 2 1005 36 . 4438 13. .561 0. .428 * * * * * * - T - T E S T - -GROUP. 1 - DRUG EO 1 . GROUP 2 - DRUG EO 2 . * * * AGE <AGE> * * * GROUP 1 4490 27 . 7987 14 . 522 0. 217 * * * * 1.32 0 .000 * - 7 . 29 5331 0. 000 * -8 . .01 1295. 32 0. ,000 GROUP 2 843 31 . 6963 12 . 650 0. 436 * * * * * VD VD TABLE 9 ( C o n t i n u e d ) _ _ _ _ _ _ _ _ _ _ - - _ - - _ _ _ _ _ _ _ _ _ _ _ _ - - - T _ T E S T GROUP 1 - ILLNESS EO 1 . GROUP 2 - ILLNESS EO 2. * * * POOLED VARIANCE ESTIMATE * * SEPARATE VARIANCE ESTIMATE VARIABLE NUMBER STANDARD STANDARD * F 2 -TA IL * T DEGREES OF 2 - T A I L * T DEGREES OF 2 - T A I L OF CASES MEAN DEVIATION ERROR * VALUE PROB. * VALUE FREEDOM PROB. * VALUE FREEDOM PROB. AGE <AGE> * * * GROUP 1 4917 27.6213 13.809 0. 197 * * * * 1.42 0 .000 * - 1 4 . 0 2 5355 0 .000 * - 1 2 . 11 495 .76 0 . 0 0 0 GROUP 2 440 37.4227 16.474 0. 785 * * * * * T - T E S T GROUP 1 - ACCIDENT EQ 1. GROUP 2 - ACCIDENT EO 2. * * * AGE <AGE> * * * GROUP 1 5242 28 . 3079 14 . 269 0. 197 * * * * 1.07 0.602 * -4 .21 5356 0 .000 * - 4 . 0 8 1 19.83 0 . 0 0 0 GROUP 2 1 16 33. ,9483 14 . 728 1 . 367 * * * * * * T - T E S T GROUP 1 - VIOLENCE EO 1. -GROUP 2 - VIOLENCE EO 2. AGE <AGE> * * GROUP 1 4961 28 .4773 14 . 543 0. .206 * * * * 1.80 0 .000 * 0 .82 5355 0 .411 * 1 .05 516 .00 0. .292 GROUP 2 396 27 .8636 10 .832 0. .544 * * * * * * - T - T E S T - -GROUP 1 - DEATHS EO 1 . GROUP 2 - DEATHS EO 2 . * * * * AGE <AGE> * * * GROUP 1 5022 28 .0325 14. .012 0. 198 * * * * 1.48 0 .000 * -7 , ,89 5354 0, ,000 * -6 .64 363 .46 0. .000 GROUP 2 334 34 . 3743 17 . 072 0. 934 * * * * * * o o TABLE 9 (Continued) T - T E S T GROUP 1 - PATTEMPT EO 1 . GROUP 2 - PATTEMPT EO 2 . * * POOLED VARIANCE ESTIMATE * * SEPARATE VARIANCE ESTIMATE VARIABLE NUMBER STANDARD STANDARD * F 2 -TA IL * T DEGREES OF 2 - T A I L * T DEGREES OF 2 - T A I L OF CASES MEAN DEVIATION ERROR * VALUE PROB. * VALUE FREEDOM PROB. * VALUE FREEDOM PROB. AGE <AGE> * * * GROUP 1 4177 28.0259 14.841 0. 230 * * * * 1.53 0 .000 * -3 .81 5355 0 .000 * - 4 . 2 8 2293 .68 0 . 0 0 0 GROUP 2 1180 29.8169 12.017 0. 350 * * * * * * * * * - - _ _ _ - - - - - - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ T _ T E S T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ GROUP 1 - CONTYPE EO 1. GROUP 2 - CONTYPE EQ 2. * AGE <AGE> * * * GROUP 1 2127 29.9027 13.894 0.301 * * * * 1.08 0 .045 * 6.11 5345 0 .000 * 6 .16 4675 .12 0 .000 GROUP 2 3220 27.4739 14.458 0 .255 * * * TABLE 10: T e s t s o f ANOVA on 8 S e l e c t e d C o r r e l a t e s o f Age * * * * * * * * * * A N f l L Y S I S 0 F V A R I A N C E * * * * * * * * * * AGE BY MARITAL <MARITAL STATUS> EMPLOY EMPLOYMENT STATUS> LIVING <LIVING SITUATION> PRIMARY <PRIMARY PROBLEM> SUM OF MEAN SIGNIF SOURCE OF VARIATION SQUARES DF SOUARE F OF F MAIN EFFECTS 149924. .500 12 12493 .707 1 16. . 556 0 .0 MARITAL 122635 .938 3 40878 .645 381 . . 363 0 .000 EMPLOY 390 .595 1 390 .595 3. .644 0 .056 LIVING 9830. .871 2 4915 .434 45. .857 0 .000 PRIMARY 14906 .277 6 2484 . 379 23 . . 177 0. .0 2-WAY INTERACTIONS 16322 .625 47 347 . 290 3 . . 240 0. .000 MARITAL EMPLOY 3163 .659 3 1054 .553 9 . .838 0. .000 MARITAL LIVING 2507 . .954 6 417 .992 3 . .900 0. .001 MARITAL PRIMARY 2987 .355 18 165 . 964 1 . . 548 O. .065 EMPLOY LIVING 756 .833 2 378 .417 3 . . 530 0. .029 EMPLOY PRIMARY 614 . 130 6 102 . 355 0. .955 0. .454 LIVING PRIMARY 3732 . . 324 12 311 .027 2 . ,902 0. .001 EXPLAINED 166247 . 125 59 2817 .748 26. . 287 0. .0 RESIDUAL 278160. .313 2595 107 . 191 TOTAL 444407. . 438 2654 167 . 448 5358 CASES WERE PROCESSED. 2703 CASES ( 50 .4 PCT) WERE MISSING. DUE TO EMPTY CELLS OR A SINGULAR MATRIX, HIGHER ORDER INTERACTIONS HAVE BEEN SUPPRESSED. O TABLE 10 (Continued) * * * * * * * * * * A N A L Y S I S O F V A R I A N C E * * * * * * * * * * AGE BY OCCUP <OCCUPATION> ETHNIC <ETHNICITY> METHOD <METHOD OF ATTEMPT> ATTEMPT <ATTEMPT DIRECTED> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * SUM OF MEAN SIGNIF SOURCE OF VARIATION SQUARES DF SOUARE F OF F MAIN EFFECTS 9245 .098 9 1027 . 233 7 .095 0 .000 OCCUP 646 .599 3 215 .533 1 .489 0 .216 ETHNIC 222 .556 2 111 .278 0 . 769 0 .464 METHOD 1844 . .814 2 922 . .407 6 . 371 0 .002 ATTEMPT 5837 . 109 2 2918. .555 20 . 158 0 .000 EXPLAINED 9245 . . 125 9 1027 .236 7 .095 0 .000 RESIDUAL 127846. .063 883 144 . . 786 TOTAL 137091, , 188 892 153. .690 5358 CASES WERE PROCESSED. 4465 CASES ( 8 3 . 3 PCT) WERE MISSING. DUE TO EMPTY CELLS OR A SINGULAR MATRIX, HIGHER ORDER INTERACTIONS HAVE BEEN SUPPRESSED 104 s i g n i f i c a n t i n t e r a c t i o n . Similar was the case between the variables of 'employment' and 'primary problems'. D. Multivariate analysis was attempted to explore question No. 2 posed in Chapter I I I , i . e . , i f age was associ-ated with the l e v e l of service for those who returned to the program for multiple re-openings. The variables of p r i o r service l e v e l (PrioContype) with" concurrent service l e v e l (ConType) were cross-tabulated with < age (Table 11a & b, 105-106). The r e s u l t s did not y i e l d any s i g n i f i c a n t r e l a t i o n s h i p s . It may, therefore, be concluded that no change occurred i n the l e v e l of services received i n the past as compared to the present l e v e l of service when age lev e l s were taken into account. Answers to Question Numbers 1, 3 and 4 can be explained through the r e s u l t s of tests of hypotheses Nos. 1, 29 and 30. It may be concluded that the number of contacts made with S.A.F.E.R. by attempters are age related, that the l e v e l of service received and reason for assessment only or for non-u t i l i z a t i o n of service are also age related. Nevertheless, relationships between the variables are not strong enough to be of much p r a c t i c a l s i g n i f i c a n c e . Far more important for t h i s reason than s t a t i s t i c a l sign-ficance i s the degree of association between variables. This has been thoroughly tested by using several d i f f e r e n t measures, a l l of which were i n agreement. TABLE 11-A: M u l t i v a r i a t e A n a l y s i s of Age by PrioContype by Contype (No Service) * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * PRIOR PRIOR CONTACT TYPE BY AGE RECODED AGE CONTROLLING F O R . . CONTYPE CONTACT TYPE V A L U E . . 1 NO SERVICE * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 0 F 1 AGE COUNT ROW PCT K L 0 - 1 9 > <20-39> <40-64> <65-HI> ROW COL PCT I TOTAL TOT PCT I 0 I 1 I 2 3 PRIOR I-1 I 12 I 109 I 34 2 [ 157 NO SERVICE I 7 .6 I 69 .4 I 21 .7 I 1 3 45 .6 I 30 .8 I 47 . 4 I 48 . 6 I 40 0 I 3 . 5 I 31 .7 I 9 . 9 I 0 6 2 1 I 27 I 121 I 36 3 187 SOME SERVICE I 14.4 I 64 . 7 I 19.3 I 1 6 54 .4 I 69 . 2 I 52 .6 I 51 .4 I 60 0 I I 7 .8 I 35 . 2 I 10.5 I 0 9 COLUMN 1 39 230 70 5 344 TOTAL 11.3 66 . 9 20. 3 1 5 100.0 2 OUT OF 8 ( 25.0%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 . MINIMUM EXPECTED CELL FREOUENCY = 2.282 RAW CHI SOUARE = 4.06711 WITH 3 DEGREES CF FREEDOM. SIGNIFICANCE = 0 .2543 CRAMER'S V = 0 .10873 CONTINGENCY COEFFICIENT = 0 .10810 LAMBDA (ASYMMETRIC) = 0 . 0 WITH PRIOR DEPENDENT. = 0 . 0 WITH AGE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00883 WITH PRIOR DEPENDENT. = 0 .00675 WITH AGE DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00765 KENDALL 'S TAU B = -0 .07034 SIGNIFICANCE (2 -TAILED) = 0 .1877 KENDALL 'S TAU C = - 0 . 0 6 9 9 7 SIGNIFICANCE (2 -TAILED) = 0 .1877 CONDITIONAL GAMMA = -0 .14163 SIGNIFICANCE (2 -TAILED) = 0 .1877 SOMERS'S D (ASYMMETRIC) = -0 .07018 WITH PRIOR DEPENDENT. = -0 .07051 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = -0 .07034 ETA = 0 .10874 WITH PRIOR DEPENDENT. = 0 .07083 WITH AGE DEPENDENT. PEARSON'S R =-0.07081 SIGNIFICANCE = 0.0951 TABLE 11-B: - M u l t i v a r i a t e A n a l y s i s o f Age by PrioContype by Contype (Some Se r v i c e ) * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * PRIOR PRIOR CONTACT TYPE BY AGE RECODED AGE CONTROLLING F O R . . CONTYPE CONTACT TYPE VALUE. . ' 2 SOME SERVICE * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * AGE COUNT ROW PCT [<L0-19> <20-39> <40-64> <65- HI> ROW COL PCT TOTAL TOT PCT [ 0 I 1 I 2 3 ] PRIOR -I -I 1 [ 20 I 91 I 29 2 ] 142 NO SERVICE [ 14.1 I 64 . 1 I 20 .4 I 1 .4 ] 34 . 3 [ 36 .4 I 33 .0 I 37 . 7 I 33 . 3 ] [ 4 . 8 I 22 .0 I 7 .0 I 0 .5 ] - -I -I 2 [ 35 I 185 I 48 4 ] 272 SOME SERVICE t 12.9 I 6 8 . 0 I 17.6 I 1 . 5 ] 65 .7 [ 6 3 . 6 I 67 .0 I 62. 3 I 66 . 7 ] [ 8 . 5 I 44 . 7 I 11.6 I 1 .0 ] -] -I -I COLUMN 55 276 77 6 414 TOTAL 13.3 66 . 7 18.6 1 .4 100.0 * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 2 OUT OF 8 ( 25.0%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 . MINIMUM EXPECTED CELL FREOUENCY = 2.058 RAW CHI SOUARE = 0 .70904 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0.8711 CRAMER'S V = 0 .04138 CONTINGENCY COEFFICIENT = 0.04135 LAMBDA (ASYMMETRIC) = 0 . 0 WITH PRIOR DEPENDENT. = 0 . 0 WITH AGE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.00132 WITH PRIOR DEPENDENT. = 0 .00093 WITH AGE DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00109 KENDALL 'S TAU B = - 0 . 0 1 2 5 7 SIGNIFICANCE (2 -TAILED) = 0 .8178 KENDALL 'S TAU C = - 0 . 0 1 1 9 7 SIGNIFICANCE (2 -TAI LED) = 0 .8178 CONDITIONAL GAMMA = -0 .02606 SIGNIFICANCE (2 -TAILED) = 0.8178 SOMERS'S D (ASYMMETRIC) = - 0 .01190 WITH PRIOR DEPENDENT. = -0 .01328 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = -0 .01255 ETA = 0 .04142 WITH PRIOR DEPENDENT. = 0 .01115 WITH AGE DEPENDENT. PEARSON'S R =-0 .01119 SIGNIFICANCE = 0 .4102 SUMMARY GAMMAS FOR CROSSTABULATION OF PRIOR BY AGE ZERO-ORDER GAMMA = - 0 . 0 8 7 9 7 FIRST-ORDER PARTIAL GAMMA = - 0 . 0 7 5 3 0 NUMBER OF MISSING OBSERVATIONS = 4600 O 107 P r o f i l e s by Different Age Levels:* The s t a t i s t i c a l r e s u l t s give only the estimates of values, but help l i t t l e to throw l i g h t on p r o f i l e s by age categories. Tables i n Appendix C have been scrutinized to e l i c i t such p r o f i l e s . 1. More than half of the attempters (57.5%) were com-prised of those i n the age group 20-39 years. A l i t t l e less than one quarter (23.4%) constituted those under 20 years. The e l d e r l y formed 2% of the t o t a l attempters and those 40-64 years 17.1%. 2. The r a t i o of males to females under 20 years of age was 1:3 and i n a l l other age groups 1:2. 3. The f i r s t two groups under 40 were predominantly of 'single' marital status among both males and females. Highest percentage of 'divorced and separated' was found among 4 0-6 4 years group. They also formed the highest percentage (40%) among the 'widowed' status. 4. The e l d e r l y had the highest percentage (40%) among those who l i v e d 'alone 1. 5. The youngest and the oldest had mostly directed t h e i r attempts toward the parent and the family and those in The age lev e l s are referred to sometimes as youngest or f i r s t age group (under 20), second age group (20-39), t h i r d age group (40-64) and oldest age group (65 & over). 108 the two middle groups toward friend/lover. 6. More el d e r l y were a f f l i c t e d with physical i l l n e s s . 7. Among the ethnic groups, 'white' attempters pre-dominated. With the age categories of 'other' ethnic groups, the younger had higher proportion of attempters. 8. The r a t i o of 'prior attempt' to 'no p r i o r attempt' was found to be 1:3 among the second and the t h i r d age groups and 1:6 among the youngest and the oldest age groups. 9. The r a t i o of 'some se r v i c e 1 to 'no service' (Appen-dix C, p. 19 3) was higher for the youngest age group. It i n -dicates a growing demand on the services for prevention and intervation of suicide for younger groups due to higher i n c i -dence of attempts among them. Their easier i d e n t i f i c a t i o n due to 'cry for help' makes t h e i r rescue from completed suicide more possible as compared to older age groups who on account of i s o l a t i o n and seriousness of intent (resulting in use of more l e t h a l methods) may not get the attention of service agencies i n time to save t h e i r l i v e s . 10. Among the reasons for n o n - u t i l i z a t i o n of S.A.F.E.R. services, ' I n a b i l i t y to contact' was the common response for a l l groups. But among the younger groups, 'refusal by family, f r i e n d or professional' was a more frequent response, whereas, among the 'elderly group', 'Involvement with other agencies' appeared to be a common answer. 109 S i m i l a r i t i e s of P r o f i l e s : The attempters in our study population exhibited the following features in common, irrespec t i v e of age categories: 1. 'impending move' or change of abode 2. secondary school l e v e l education 3. disruption i n family, marital and s o c i a l r e l a t i o n -ships as 'primary problem' 4. self-poisoning as the predominant method of attempt 5. ambivalence of 'intent to k i l l ' themselves 6. attempts as unplanned or spontaneous acts 7. no 'prior communication' of the intent to k i l l . 3. Comparative Analysis of the E l d e r l y _Group: Within the e l d e r l y group those between 65-74 years numbered 69 and those 75 years and above consisted of 39 persons. Tests of association were applied to f i n d s i g n i f i c a n t differences between the two age groups i n respect of six variables related with attempts toward suicide. The six variables were sex, marital status, method of attempt, intent to k i l l , p r i o r attempt and Contype (No service or Service). No association was found to e x i s t between age and correlated variables (Table 12, p. 110). The chi-square values were below c r i t i c a l values at the .05 l e v e l of s i g n i f i c a n c e . Other tests of association also yielded zero values, thus showing no TABLE 12 Test s of A s s o c i a t i o n of Age and C o r r e l a t e d V a r i a b l e s Variables Correlated With Age Chi-Square x 2 df. Proba-b i l i t y Contin-gency Coef-f i c i e n t LAMBDA (Asymmetrical) LAMBDA (Symmet-r i c a l ) Uncertainty C o e f f i c i e n t (Asymmetrical) Uncertainty C o e f f i c i e n t Symmetrical) ' .1. Sex 0.0 1 1.000 o:o' 0.0 with age Dep. 0.0 with sex Dep. 0.0 0.000 with age Dep. 0.000 with sex Dep. 0.000 2. Method of Attempt 1.35 2 0.50 0.112'. 0.026 with age Dep. 0.0 with method Dep. 0.018 0.009 with age Dep. 0.012 with marital Dep. 0.105 3. M a r i t a l Status 10.23 3 0.016 0.338 0.103 with age Dep. 0.083 with marital Dep. 0.090 0.125 with age Dep. 0.067 with marital Dep. 0.087 4. Planned to 'die' 0.0 1 1.00 0.0 with age Dep. 0.0 with planned Dep. 0.0 0.000 with age Dep. 0.000 with planned Dep. 0.000 5. Prior. Attempt 0.0 1 1.000 0.018 0.0 with age Dep. 0.0 with p r i o r Dep. 0.0 0.000 with age Dep. 0.000 with p r i o r Dep. 0.000 6. Contact Type 0.133 1 0.7 0.05 0.0 with age Dep. 0.0 with Contype Dep. 0.0 0.002 with age Dep. 0.002 with Contype Dep. 0.002 *65+ I l l evidence of s t r e n g t h of r e l a t i o n s h i p s between age and the t e s t e d v a r i a b l e s . The F i n d i n g s : I t i s e v i d e n t from the above a n a l y s i s t h a t 'young' and 'o l d ' e l d e r l y do not show any d i f f e r e n t p a t t e r n of s u i c i d a l attempts or d i f f e r i n r e s p e c t of the v a r i a b l e s t e s t e d . 112 CHAPTER VI SUMMARY OF FINDINGS, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS Summary o f F i n d i n g s : The h i g h l i g h t s o f t h e f i n d i n g s o f o u r s t u d y a r e sum-m a r i z e d b e l o w : 1. The p r o f i l e o f t h e s u i c i d e a t t e m p t e r among t h e S.A.F.E.R. c l i e n t s t h a t has emerged f r o m t h e a n a l y s i s o f t h e d a t a c o r r e s p o n d s w i t h t h e model w h i c h was d e p i c t e d f r o m a r e v i e w o f b a c k g r o u n d l i t e r a t u r e . 2. R e c o g n i z a b l e d i f f e r e n c e s by age l e v e l s were o b s e r v e d i n t h e s u i c i d a l b e h a v i o r o f a t t e m p t e r s i n r e s p e c t o f most 2 f a c t o r s when X t e s t was a p p l i e d . O t h e r t e s t s o f a s s o c i a t i o n , however, showed c o n s i s t e n t l y weak r e l a t i o n s h i p s ; most were i n t h e n e i g h b o u r h o o d o f z e r o . I n t e r p r e t a t i o n s o f t h e f i n d i n g s were b a s e d p r i m a r i l y on t h e s t r e n g t h o f a s s o c i a t i o n r a t h e r t h a n on s t a t i s t i c a l s i g n i f i c a n c e . 3. D i f f e r e n c e s between t h e 'young' and t h e ' o l d ' e l d e r l y d i d n o t p r o v e t o be s i g n i f i c a n t . I n o t h e r words, t h e e l d e r l y who a t t e m p t showed no s i g n i f i c a n t l y d i f f e r e n t p a t t e r n w i t h i n t h e i r age c a t e g o r i e s . E v e n t h e sex d i f f e r e n c e s between m a l e s and f e m a l e s i n l a t e r y e a r s o f l i f e r e p o r t e d i n o t h e r s t u d i e s 113 were not confirmed from our analysis. Conclusions: In concluding, i t may be said that the findings of our study, i n general, corroborates the results of most previous studies on attempted suicide. The main conclusions which sub-stantiate results of previous studies are as follows: 1. The preponderence of young women in attempted suicide makes i t evident that such s u i c i d a l behavior i s age and sex related. 2. Age differences were found associated with marital status i n the same way as they would be i n the general popula-t i o n . That i s to say that 'single' or never married mostly f a l l i n the youngest age category and those 'married', 'divorced', 'separated' and 'widowed' in the middle and older age groups. The younger people appear more prone to s u i c i d a l attempts than those 4 0 years of age and older. 3. The r e l a t i o n a l system of most attempters appeared weak i n terms of more having 'no children'. This i s , however, related c l o s e l y with age and marital status, most c l i e n t s being young with 'single' marital status. 4. Marital status and l i v i n g s i t u a t i o n provide the shi e l d against loneliness, separation or loss for our study population i n as much as the observed frequencies indicate that those who are 'single' share l i v i n g with parents. Those 114 married l i v e d with families or spouses. We may conclude that ' l i v i n g alone' as loneliness may not be the p r e c i p i t a t i n g factor in suicide attempts of those younger i n age (below 40 years). 5. As i n the general population, unemployment seems to be both age and sex related. Women, students and old people depending on family, welfare or pensions face insecure finan-c i a l s i t u a t i o n s . Rudolf (1975) found the factor of mental i l l n e s s associated with unemployment. He commented that a 'housewive's role i s a source of mental i l l n e s s 1 . Johnson (1979) found a r e l a t i o n s h i p between employment of married women and lower suicide rates. 6. The most prevalent 'primary problem' i n attempts being disrupted family, marital and s o c i a l relationships has led us to conclude that i t i s a s o c i e t a l or group problem as much as an i n d i v i d u a l problem. Richman (1967: 379) writing on 'Family determinants of attempted suicide' had aptly re-marked, "A s u i c i d a l attempt i s not only an i n d i v i d u a l but a c o l l e c t i v e cry for help." The implications of these findings are worth noting for intervention strategies. 7. Physical i l l n e s s proving to be age related makes us suspect that chronic i l l n e s s and sufferings from diseases i n l a t e r l i f e may turn older people into high-risk i n d i v i d u a l s . 8. Age appears to be associated with 'plan to die', but gives l i t t l e clue about the seriousness of intent. Since the majority of respondents had indicated no plan to die, we might 115 conclude that attempted suicide follows weak intent to k i l l oneself. That i s to say, attempts are 'gestures' or 'ambiva-lent' and are not 'serious acts'. Such conclusions may, how-ever, be accepted with caution. Sometimes, poor planning, p a r t i c u l a r l y i n the case of the old and the mentally disturbed, may lead to non-fatal outcome, although the intention might have been serious. In the past research on 'intent', there are c l i n i c a l references of intent, l e t h a l i t y and diagnostic syndromes. On the basis of studies on the subject of 'intent', Goldney (1980: 134) had observed that there had been a broad continuum of 'wishing to l i v e ' and 'wishing to die' i n suicide. 9. Attempt directed toward others i s to be viewed along with problems i n the family and with s o c i a l relationships. The interventive process has to be directed toward bringing a change i n the s i t u a t i o n . Since the attempt i s usually directed toward a family member or a s i g n i f i c a n t other, t h e i r help and cooperation i s needed for therapeutic purposes to create a supportive environment. 10. Absence of communication p r i o r to the act of suicide, unplanned attempts and ambivalence of intent seem to be shared by attempters i n general across age le v e l s and provide us with a 'prototype' of attempters, regardless of age. 11. Use of less l e t h a l methods (poisoning drugs) charac-t e r i z e d most attempts. I t may par t l y explain the degree of seriousness of intent. The explanation, however, seems to l i e 116 i n the a c c e s s i b i l i t y of self-poisoning substances these days and the ease of t h e i r ingestion i n the privacy of one's abode. 12. Frequency of alcohol and drug abuse was found to be greater among those in the early and late middle age groups, i . e . , 20-64 years. This i s consistent with the findings re-ported by Stenback (1980: 64) that chronic alcoholism more often a f f l i c t e d those who were under 65 years of age. 13. Frequency of suicide reported at late evenings, during the night and i n the early hours of the morning and dur-ing week-ends as well as during the weekdays c a l l s for the need for emergency services and the services round-the-clock. There i s no pattern of seasonal variations, as a substantial number of suicides are reported not only i n summer, but i n f a l l , winter and spring months as well. Hence, a year round team of workers i s required. 14. In regard to the u t i l i z a t i o n of services, the e l d e r l y seek counselling services with S.A.F.E.R., the least and youngest the most. This p a r t l y r e f l e c t s the i n a b i l i t y of old people to avoid such services and p a r t l y the agency's i n a b i l i t y to reach the e l d e r l y . The incomplete addresses i n the records of emergency services of hospitals seems to thwart the e f f o r t s of the suicide prevention agency for an outreach program or to seek high-risk s u i c i d a l e l d e r l y . Limitations of the Study: The large number of missing observations (40-80%) from 117 almost 50% of the v a r i a b l e s used i n the a n a l y s i s has a f f e c t e d the r e l i a b i l i t y o f our r e s u l t s . Some i n f o r m a t i o n recorded under 'yes, but not otherwise s p e c i f i e d ' o r 'yes, but I don't know a t whom' (as i n the case of ' l e g a l involvement' and * 'attempt d i r e c t e d ' ) made i t s i n t e r p r e t a t i o n or c l a s s i f i c a t i o n d i f f i c u l t . A l s o , there were no separate codes f o r 'don't know', and 'no answer' or 'not a p p l i c a b l e ' . In the absence of such codes, i n f o r m a t i o n on 'no answer' and 'not a f f e c t e d ' has probably mingled. More p r e c i s e i n f o r m a t i o n c o u l d have a f f e c t e d changes i n the d i s t r i b u t i o n o f f r e q u e n c i e s and consequently i n the c o n c l u s i o n o f r e s u l t s . Another l i m i t a t i o n o f the study i s i t s r e t r o s p e c t i v e nature. The r e l i a b i l i t y o f c o n c l u s i o n s i n such cases i s o f t e n q u e s t i o n e d . Despite t h i s l i m i t a t i o n , however, the f i n d i n g s of our study were c o n s i s t e n t w i t h r e s u l t s of p r e v i o u s r e s e a r c h . F u r t h e r , a r e s e a r c h attempt to manipulate a l a r g e data base may obscure the q u a l i t a t i v e aspect o f the problem, i n as much as the r e s e a r c h e r r e l i e s h e a v i l y on the q u a n t i t a t i v e a n a l y s i s . G e n e r a l i z a t i o n s are based on i n f e r e n c e s drawn from s t a t i s t i c a l f i n d i n g s . I t i s s a i d t h a t i n s u i c i d a l b ehavior, no two people's c o n s t e l l a t i o n i s i d e n t i c a l . Each case d i a g -nosed on the b a s i s o f i t s background f a c t o r s can pr o v i d e r e a l i n s i g h t i n t o the causes o f the a c t . T h i s study must omit such c o n s i d e r a t i o n s . * Code Book, S.A.F.E.R. Database. 118 Assuming that suicidogenic behavior i s the r e s u l t of a complex inte r a c t i o n of variables, i t has to be viewed from a multi-dimensional perspective. One cannot, therefore, be content to conclude results through the process of b i - v a r i a t e analysis alone. A reference of the study by Sawyer and Jameton (1979) may elucidate t h i s point. In the study, repeated con-tacts with a suicide prevention centre gave the 1 prototype 1 of a chronic c a l l e r which was not simply age related, but sex, marital status, alcohol involvement, drug dependency and mental i l l n e s s , a l l combined completed the picture of the 'pro-totype' . In other words, simultaneous te s t i n g of many variables i s more l i k e l y to provide clues, on the basis of which conclu-sions can more r e l i a b l y be stated. Therefore, our answer to question No. 1 raised in Chapter III ( i f age differences were associated with number of contacts) could only p a r t i a l l y be answered. Due to limited time and resources of the researcher, and above a l l , commitment to the objectives set up at the be-ginning of the study, i t was not feasible to expand our per-spective to attempt multi-dimensional analyses. Multivariate analysis requires that the time order of events be c l e a r l y established, a condition which we found very d i f f i c u l t to sat-i s f y with the data at hand. Also, useful multivariate analysis depends on at least a subset of strong biva r i a t e r e l a t i o n -ships. We were unable to f i n d any such relationships. Lastly, the p o s s i b i l i t y was considered of combining columns and rows to meet the expected frequency requirements 119 for use of the chi-square. Since t h i s would have destroyed the age-categories being tested i n the study, i t was not pur-sued. In some purely "data-dredging" approach to the data-base, i t could be t r i e d , but was not appropriate for t h i s study. Recommendations: 1. Self-poisoning as a method of suicide attempt has been found to predominate i n our study. Drug-poisoning as a method of sel f - d e s t r u c t i o n has also been reported to be on the increase i n the United States and Canada (Boldt, 77). S.A.F.E.R. could recommend to the medical profession to de-crease the amount of dosage i n drug prescriptions. I t may also recommend to the pharmacists to r e s t r i c t the.placing of non-prescriptive l e t h a l drugs on open counter, e.g., s a l i c y -l a t e s . I t i s apparent that l i m i t i n g the a v a i l a b i l i t y of the means w i l l bring about a decrease i n the incidence of suicide attempts. The recommendations of the Alberta Task Force (1976: 78) i n - t h i s regard are e s p e c i a l l y noteworthy. In consonance with other related agencies, S.A.F.E.R. can also recommend to the Government to formulate a more r e s t r i c t i v e p o l i c y on the sale and monitoring of such drugs to the public. 2. Suicide prevention centres and agencies have learnt from years of experience that the r e f e r r a l approach as well as the c r i s i s intervention model have been found wanting. I t 120 i s believed that services to emergency room attempters reach only a small proportion of those at r i s k and that a reduction i n suicide and suicide attempts can more e f f e c t i v e l y occur by concentrating on high-risk groups. The search for high-risk i n d i v i d u a l s , however, requires an aggressive and extensive out-reach e f f o r t with l i a i s o n with many agencies and community and c i t i z e n ' s groups. The problem can be tackled through the support of and coordination with welfare agencies, community, neighbourhood and c i t i z e n ' s groups and through the use of volunteers. S.A.F.E.R. claims to have adopted a r e h a b i l i t a t i o n model instead of r e l y i n g exclusively on a c r i s i s intervention model. I t i s understood that the S.A.F.E.R. workers do not wait for r e f e r r a l s to come to them, they a c t i v e l y seek t h e i r c l i e n t s out from l o c a l hospitals. Further, the S.A.F.E.R. st a f f deal p a r t i c u l a r l y with cases of chronic attempters where there often i s no c r i s i s and counselling focusses on long term l i f e style and s o c i a l relationships. To provide e f f e c t i v e service, S.A.F.E.R. has to maintain good l i a i s o n with other s o c i a l service agencies i n the Vancouver area. The future projections may c a l l for heavier load with more and more cases of suicide attempts surfacing as the taboo on suicide information slowly wears o f f . 3. The volunteer services can be used f o r : (1) active out-reaching, long-term follow-up and for r e h a b i l i t a t i v e care, (2) mobilizing resources of the family, friends and the com-121 munity to reduce the s u i c i d a l person's sense of i s o l a t i o n and rej e c t i o n . S.A.F.E.R. seems to be dealing with some of the functions mentioned above, but with i t s limited resources of workers, the need for the use of volunteers i n the near future may become more r e a l and urgent. I t i s our suggestion that a p i l o t project may be undertaken on the use of volun-teers i n one area of the c i t y f i r s t where high-risk groups are more l i k e l y to be found. The project may be extended i n stages to other areas. 4. The selection and t r a i n i n g of workers has received a great deal of emphasis for bringing effectiveness to the suicide prevention programs. The report of the Alberta Task Force on Suicide (op, c i t . , 102-107) incoporates many good suggestions on the designation, selection and t r a i n i n g of volunteers. Training programs for volunteers, would, however, need to be reviewed from time to time to improve i t s q u a l i t y arid f u n c t i o n a l i t y i n reducing the incidence of suicide. 5. Over-the-phone r e f e r r a l services have been c r i t i c a l l y reviewed elsewhere (Alberta Task Force on Suicide, 76: 48). But the Vancouver C r i s i s Centre as a l o c a l service seems to consider such a service useful i n i n i t i a t i n g dialogue with people i n c r i s i s . It i s t h e i r opinion that some r e f e r r a l s and resources may not have followed i f the c r i s i s centres would not have been i n existence. Moreover, the i n s t a l l a t i o n of a 'Senior-Line' for the senile, the i s o l a t e d , the distressed, a l c o h o l i c s and the hide-away persons may b r i n g more cases of the o l d e r s u i c i d e s to s u r f a c e . The Emergency V i s i t i n g Teams c o n s i s t i n g o f male and female workers ( f l y i n g squads) reach the persons i n c r i s i s . Thus telephone response supplemented by v i s i t s from f l y i n g squads i n d i c a t e i n i t i a l e f f o r t s to save a c u t e l y s u i c i d a l persons from the c r i s i s s i t u a t i o n . The danger l i e s when the e n t i r e approach might be misguided. S.A.F.E.R.'s E d u c a t i o n programs f o r v o l u n t e e r s from the C r i s i s I n t e r v e n t i o n and S u i c i d e P r e v e n t i o n Centres i n the Greater Vancouver area may be designed to h e l p i n the e f f e c t i v e use o f such a f a c i l i t y . I t i s important to d i s p e l doubts about the u t i l i t y o f such s e r v i c e by improving the s k i l l s o f v o l u n t e e r s i n h a n d l i n g cases i n c r i s i s through phoning i n s e r v i c e s or through a c t u a l c o n t a c t s w i t h such persons. Such a focus on 'Education f o r C r i s i s I n t e r v e n t i o n ' may a l s o h elp the v o l u n -t e e r s and workers of c r i s i s c e n t r e s to l e a r n to d i s t i n g u i s h between an a c u t e l y s u i c i d a l person from the c h r o n i c a l l y s u i c i d a l person. I t would a l s o be h e l p f u l f o r them i n making a p p r o p r i a t e r e f e r r a l s . As the cases o f the c h r o n i c a l l y s u i c i d a l persons have to be handled d i f f e r e n t l y from those who are a c u t e l y s u i c i d a l , i t might be worth c o n s i d e r i n g separate phone-in l i n e s f o r e f f e c t i v e r e f e r r a l . 6. S.A.F.E.R. may a l s o work toward the s t a n d a r d i z a t i o n and c e r t i f i c a t i o n o f t r a i n i n g programs f o r p r o f e s s i o n a l s . In o r d e r to t r a i n p r o f e s s i o n a l s or support s e r v i c e s p e r s onnel to r e c o g n i z e s u i c i d e symptoms and to i d e n t i f y danger s i g n a l s , 123 the t r a i n i n g has to be supplemented with supervision to ensure competent functioning of such workers. 7. As our research data revealed, a substantial number of attempters comprised of those who were students i n the i r teen years, S.A.F.E.R.'s extensive program of education i n schools and colleges can be h e l p f u l . In order to make them on-going, S.A.F.E.R. may recommend the integration of the topics, on the subject of suicide, personal c r i s i s and death i n the program of formal education. 8. Considering the prevalence of the problem of un-happy relationships i n the family and marriage, causing suicide attempts, a coordinated approach with the family, r e l a t i v e s and s i g n i f i c a n t others may help prevent 'recidivism'. It i s understood that S.A.F.E.R. Counsellors routinely engage family and s i g n i f i c a n t others i n the counselling process. To ensure that the family relationships continue as improved, long-term follow-up services may be required with the coopera-t i o n of family welfare agencies, mental health c l i n i c s and other relevant services. I t may be noted that the f i r s t 2-3 years are c r u c i a l a f t e r an attempt i s made. If the s i t u a t i o n does not improve, the attempt i s either repeated or suicide i s completed. 9. Realizing that a suicide prevention agency has to face a plethora of problems i n suicide attempts, e.g., alcohol and drug abuse, physical and mental i l l n e s s , family tensions, 124 emotional and f i n a n c i a l d i f f i c u l t i e s , problems of loneliness, bereavement and i s o l a t i o n , i t may have to make r e f e r r a l to concerned agencies dealing with those special problems. A good r e f e r r a l gets the right place at once and saves the c l i e n t from being tossed around from one agency to the other. Another suggestion that may be considered i s a pol i c y of ce n t r a l i z a t i o n of services for prevention of suicide. I t may save many c l i e n t s from despair and inconvenience they might f e e l by knocking at the doors of d i f f e r e n t agencies. 10. Research being one of the basic aims of the S.A.F.E.R. Program requires p a r t i c u l a r attention. To serve i t s aims d i r e c t l y , there i s need to organize research around program-matic responses to case i d e n t i f i c a t i o n and ind i v i d u a l i n t e r -vention. Better diagnosis and treatment programs, however, depend on a sound data base. S.A.F.E.R. can advocate the case for good research by helping r e f e r r a l agencies i n systematic record keeping of cases of attempted suicide so that complete and accurate i n f o r -mation may be obtainable for required research purposes. Boldt (1981: 95-96) points out that d e f i c i e n c i e s i n the data are the most important factor as to why research e f f o r t s remain r e l a t i v e l y unproductive. Some of the d e f i c i e n c i e s pointed out by him are: underreporting, absence, of a cumula-ti v e "history" of the individual's experiences and circum-stances to understand causes of motivation, need for record 125 linkages and lack of a m u l t i d i s c i p l i n a r y data-base. To over-come the problem, he recommends a Research-oriented Registry on s u i c i d a l behavior to avoid duplication and to follow i n d i -viduals over time and through a variety of agencies. Boldt's 'Plan for Improved Research on S u i c i d a l Behavior' contains many p r a c t i c a l proposals for achieving comprehensive and com-plete reporting. In our study 53% of the cases were discharged from the hospitals before they were seen by a S.A.F.E.R. worker. In-formation recorded after the incidence i s over can be changed by the c l i e n t or friends and r e l a t i v e s , thus, the factual aspects of the problem can be l o s t . The hospitals have, there-fore, to be urged to keep a systematic r e f e r r a l and a record of attempters. This may make follow-up and continuity of care of attempters possible and may prevent 'recidivism'. 11. Services are few a f t e r 5 p.m. and on weekends. It i s i n the late evenings, at night and i n the early hours of the morning that most suicide attempts are reported. S.A.F.E.R. may recommend a 2 4 hour, 7 days a week service to take care of those i n c r i s i s and i n need of emergency services. I t i s found that the e f f e c t o f some poisoning substances has led to other complications due to delay i n attending to victims of suicide. Cases of s e l f - i n j u r y w i l l also be i n need of prompt care. 12. Focus on the e l d e r l y i s needed for several reasons. 126 F i r s t , because they are among the known high-risk groups for suicide along with those who are iso l a t e d , r e t i r e d , mentally or p h y s i c a l l y handicapped or s o c i a l l y and f i n a n c i a l l y under-p r i v i l e g e d . Second, the el d e r l y do not usually cry for help to be saved when they.commit the act. They can only be d i s -covered through active outreach programs. Third, most of them being lonely have no way of being helped i n time. Fourth, the attitude of professionals and the unconcern of the r e l a t i v e s makes the s u i c i d a l e l d e r l y vulnerable to completed suicides. I t i s evident from our data that 45% of those who attempted did not a v a i l themselves of S.A.F.E.R. services. A person a f f l i c t e d with disease, depression and lack of strength can hardly care to reach a prevention service. I t i s an active dut-reach program that can save him from an ultimate s e l f -destruction. A befriending r e l a t i o n s h i p i s recognized to bring a change i n outlook. In the words of Rev. Chad Varah (1967: 91), "a Samaritan friend unqualified and unassuming may be the one whose involvement at the c r u c i a l time swings the issue from death to l i f e , from despair to hope". Hence the use of lay-volunteers i s again stressed, p a r t i c u l a r l y i n the case of those who cannot reach an agency e a s i l y . S o c i a l i s o l a t i o n i s considered as one of the p r e c i p i t a t -ing causes i n el d e r l y suicide. Most e l d e r l y have t h e i r own homes (64.3%: Census, 1976). I t i s believed that 85% of el d e r l y are managing without any additional assistance, neverthe-l e s s , economic s e l f - s u f f i c i e n c y or physical functioning cannot 127 compensate for t h e i r ' s o c i a l i s o l a t i o n ' . There are a good many old men occupying rooming houses i n downtown hotels, i n skid-row areas and i n r e s i d e n t i a l care f a c i l i t i e s (senior c i t i -zen's residences). Senior c i t i z e n s ' groups can help reach the e l d e r l y in rooming houses and i n i s o l a t e d l i v i n g s ituations. Therefore, S.A.F.E.R.'s contact with such groups and other community workers can help i n the out-reach of the high-risk s u i c i d a l e l d e r l y s u f f e r i n g from loneliness and i s o l a t i o n . The Long-Term Care Program established in 1978 has brought the services i n the el d e r l y " s own homes which include health and home-making services. This has p a r t l y broken the i s o l a t i o n of some of the e l d e r l y who may have no r e l a t i v e s to take care of them. The v i s i t s from home-nurses and home-makers can help i d e n t i f y p o t e n t i a l cases of suicide. Many studies have been conducted on the 'attitudes of p r a c t i c i n g professionals toward the e l d e r l y c l i e n t s . Their findings indicate negative images and negative stereotypes held of the el d e r l y by health care and s o c i a l service providers (Blank, 1971; Campbell, 1971; Kahana and Coe, 1969; and Kosberg, 1978). The negative attitude of professionals may have been a discouraging factor for the old people from seeking help and counselling. Although the problem needs further re-search, nevertheless, to combat the s i t u a t i o n , t r a i n i n g and education programs for volunteers and professionals are recom-mended to promote r e a l i s t i c and supportive attitudes toward the e l d e r l y . A study conducted by Kwan (19 82) covers a compre-128 hensive review on attitudes toward e l d e r l y and contains many proposals for changing attitudes through education and t r a i n -ing of s o c i a l workers. The researcher endorses his proposals. Implications for So c i a l Work: The role of s o c i a l work as a helping profession in suicide prevention, intervention and postvention i s of key importance. Like the physician, the nurse, p s y c h i a t r i s t , the po l i c e and clergy, s o c i a l workers are regarded as the gatekeepers of the community. Among the s o c i a l welfare workers, those i d e n t i f i e d more d i r e c t l y with suicide prevention programs would be mental health workers, senior c i t i z e n ' s and c h i l d welfare workers, family counsellors, alcohol and drug abuse counsellors and volunteer workers. Social workers can s p e c i f i c a l l y strengthen some of the tasks of the following nature: 1. "Reaching out" and providing a face to face contact with the person or his r e l a t i v e s by arranging home v i s i t s . 2. Involving r e l a t i v e s i n family and group therapy i n order to provide an emotionally supportive environment for the s u i c i d a l victim. 3. Mobilizing other agencies i n the community i n the prevention and postvention process with the in d i v i d u a l and his family. 4. S i g n i f i c a n t l y widening the s o c i a l contacts of the person with individuals and groups with e f f e c t i v e use of the 129 c o m m u n i t y 1 s c o m m u n i c a t i o n n e t w o r k s o f s e l f h e l p and m u t u a l s u p p o r t . 5. O r g a n i z i n g and s t i m u l a t i n g t h e community t o u n d e r -t a k e r e c r e a t i o n a l and e d u c a t i o n a l a c t i v i t i e s i s s i g n i f i c a n t i n as much as i t c a n make l i f e more m e a n i n g f u l and p u r p o s e f u l f o r t h o s e who a r e s e i z e d b y h o p e l e s s n e s s and h e l p l e s s n e s s among t h e more v u l n e r a b l e men, women, young and o l d . 6. P l a y i n g a k e y r o l e as a d v o c a t e s f o r i m p r o v i n g s u i c i d e p r e v e n t i o n , i n t e r v e n t i o n and p o s t v e n t i o n s e r v i c e s l o c a l l y a nd r e g i o n a l l y , a l s o f o r u p g r a d i n g a n d s t a n d a r d i z i n g t h e q u a l i t y o f s e r v i c e , r e c o r d - k e e p i n g o f a l l s u i c i d e and s e l f - i n j u r y c a s e s t h r o u g h o u t t h e p r o v i n c e . 7. The c l o s e l i a i s o n o f s o c i a l w o r k e r s w i t h t h e m e n t a l h e a l t h s e r v i c e s on a r e g i o n a l a s w e l l as l o c a l l e v e l i n v o l v e s them i n o r g a n i z i n g s e r v i c e s o f a p r e v e n t i v e t y p e f o r h i g h -r i s k g r o u p s i n d i s r u p t e d f a m i l i e s , among y o u t h and e l d e r l y , t h e unemployed, t h e h a n d i c a p p e d and among t h e e x - i n m a t e s . 8. C r e a t i n g a w a r e n e s s o f t h e p r o b l e m and o f i t s p r e -v e n t i o n by h e l p i n g i n t h e o r g a n i z a t i o n o f p u b l i c e d u c a t i o n p r o g r a m s , i n s c h o o l s and v a r i o u s g r o u p s and o r g a n i z a t i o n s i n t h e community. S u g g e s t i o n s f o r F u r t h e r R e s e a r c h : E f f o r t s i n t h e d i r e c t i o n o f p r e d i c t i n g and i d e n t i f y i n g s u i c i d a l b e h a v i o r have been o f l o n g s t a n d i n g . B u t i n v i e w o f 130 the growing need for expansion of suicide intervention and prevention programs, i t i s necessary to focus the research e f f o r t s toward evaluation of e x i s t i n g programs i n suicide pre-vention . At present, there i s l i t t l e or no data to document the effectiveness of such programs i n Canada. 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(no-0 yee=1) Time of Admission Sex (female=0 raale=l) Occupation (Code) Bitthdate Age Marital Statue (S*2 Mx=3 R6-H-J+ W«5 D=6 Sep*'/ C-L=8) Recent or impending more (notO yes=l) Educational StoiuS (Code) Urnploijfrieoi S ta tua (code) Living Situation (Code) Racial Origin (Code) Financial Situation (Secure=2 Incecure=3 Not an issued) Sexual Orientation (Het»2 Homo=3 Bi=^ Traua»5) Legal Involvement (Code) PrinarY Problem(Code) Secondary Problem (Code) J j J - J ° 1 - < * > 2 5 J 105) J j J J J J J j 26 (06,07)27 (08,09)28 (10) 29 (11) 30 31 32 33, (12,13). (1^,15) (16) _ J J . J J J J _ J 1 7 - 2 0 J _ J 34 Summary Sheet •Tertiary Problera(code) • ljlethod of Attempt(code} •2nd method of attempt(code) 3rd method of attempt(code) Was alcohol involved? (n=0 y=l) Did cl ient plan to die? (n=G y = l) Was attempt planned? (n-O y=l) Was attempt directed? (Code) Was there prior communication? (n=0 y=l) Does client have any children? (n=0 y = l ) If yes, how many Ho'w many l ive with client 35. (21) 36 (2?,23) 37 J J J ! j J J J J J J J J J J J J (2^,25) (26) 38. (IP (28,29) (30,31) (32) (33) 39. Does client have any drug dependency? (n--0 y = l) If yes, what? Does client have an important i l lnose?(n -0 y = l) If yes, what? Did cl ient have an important accident?(n^O y-1) If yes, what and when? Was there violence in c l i en t ' s family?(n=0 y^i) If yes, c l ien t 's role? T/tJre thcfC any signif icant deaths in c l i en t ' s background? (n=0 y-1) If yes, vho how long ago nature of death . _ U J J J J J J J J J J j J J J J J J 40. 41. (35) 42. (36) (37,3of 3 ( 3 9 , W Were there any previous l A u c i r i e at t-»mpt3?V.n=0 y If yes, method How long ago .. P r i m a r y p r o b l e m S.A.F. i - .H. Contact Worker Contact Type (None=2 Brief=3 Completed) •Reason for no contact (Code) If 62 i s ' 2 ' . .Length o f C a s e = 1 ) (40 (4?) ('<?) (50) (5T) (52) (53) (5*0 (55) (5b) (57) (5b) v59) (60, J J J j J J J ( ^ ) (6/) (SZ) 149 APPENDIX A -SIS - VARIABLES Number of Contacts 0 F i r s t Contact 1 Second Contact 2 Third Contact 3 • N-th Contact Method of Referral 02 S e l f - r e f e r r a l 03 Doctor r e f e r r a l 04 Agency r e f e r r a l 05 Vancouver General 06 St. Paul's 07 Burnaby General 08 Royal Columbian 09 Lion's Gate 10 St. Vincent's 11 Other hospital Sex 0 Female 1 Male Occupation 02 Professional. 0 3 Semi-professional 04 Artisan 05 White C o l l a r Worker 06 C l e r i c a l 07 S k i l l e d Manual 08 Semi-skilled 09 Unskilled 10 Student 11 Housewife 12 None Marital Status 2 Single 3 Married 4 Re-married 5 Widowed 6 Divorced 7 Separated 8 Common Law 2 CODES * Impending Move (Change of Abode) 0 No 1 Yes Educational Status 02 Some elementary 03 Elementary 04 Some secondary 05 Secondary 06 University 07 Completed University 08 Post Graduate 09 Technical 10 Apprenticeship Employment Status 02 Unemployed 03 Employed 04 Welfare 05 Housewife 06 Student 07 Retired 10 Dependent 11 On s t r i k e 12 Self-employed Living Situation 2 Alone 3 With parents 4 With other family (e.g. children 5 With lover/mate 6 I n s t i t u t i o n a l residence 7 Communally 8 Share with friends 9 Extended family E t h n i c i t y 2 White 3 Black 4 Oriental 5 Native Indian 6 Indo-Pakestani 7 Polynesian 8 Inuit/Eskimo 9 Other *Source: "CODE BOOK", An Introduction to S.A.F.E.R. Data Base, G.V.M.H.S., June 1982. 150 Fi n a n c i a l Situation 2 Secure 3 Insecure 0 Not a c l i n i c a l Issue Sexual Orientation 2 Heterosexual 3- Homosexual 4- Bisexual 5 Transvestite Legal Involvement 1 Yes, Not Otherwise Specified 2 C i v i l s u i t 3 P r o s t i t u t i o n 4 Family Court 5 Other criminal 6 Drug related 7 Theft 8 Impaired d r i v i n g 9 Rape Primary Problem 02 Marital 03 Nuclear family 04 Extended family 05 Social i s o l a t i o n 06 Drug dependency 07 Sexual c o n f l i c t 08 F i n a n c i a l problem 09 Separation or loss 10 Fear of separation 11 Physical I l l n e s s 12 Legal 13 Social r e l a t i o n s h i p 14 Psychotic 15 Alcohol problem 16 Boyfriend/ G i r l f r i e n d 17 No job 18 School related Method of Attempt 02 Slashing 03 Stabbing 04 Firearms 05 Jumping 06 Asphyxiation 07 Drowning 08 Hanging 09 Poisons ( s o l i d or liquid) 10 Unspecified non-prescription drugs 11 Analgesics 12 Antihistamines 13 Sleep-inducers 14 Cold remedies 15 Laxatives 16 Street drugs 17 Threatening suicide 18 In c r i s i s 30 T r a f f i c accidents 40 Burning (Immolation) 50 In d u s t r i a l machinery 60 Unspecified pr e s c r i p t i o n drugs 62 Antianxiety, antidepressant, antipsychotic 63 Analgesics 64 Anticonvulsants 65 Antiasthmatics 66 Barbiturate sedatives 67 Non-barbiturate sedatives 68 A n t i b i o t i c s 69 Cardiovascular agents 7 0 Amphetamines Was Alcohol Involved? 0 No 1 Yes Did C l i e n t Plan to Die? 0 No 1 Yes Was Attempt Planned? 0 No 1 Yes Was Attempt Directed? 1 Yes, but I don't know who 2 Parent 3 Other family 4 Lover/mate 5 Friend 6 Stranger 7 Other Was there P r i o r Communication? 0 No 1- Yes 151 Does C l i e n t have Children? 0 No 1- Yes Is C l i e n t Drug Dependent? 0 No 1 Yes Important I l l n e s s i n Past Year? 0 No 1 Yes Important Accident i n Past Year? 0 No 1 Yes History of Family Violence? 0 : No 1 Yes History of Deaths of  Si g n i f i c a n t Others? 0 No 1 Yes History of Prior Attempts? 0 No 1 Yes Prior Contact Type 1 Assessment only 2 Offer of Service only 3 B r i e f Counselling Contact A Complete Counselling Contact Contact Type 1- - Assessment only 2- Offer of Service only 3 B r i e f Counselling Contact 4 Complete Counselling Contact Reason for Assessment or Offer  of Service only 02 Unable to contact 03 C l i e n t has no phone 04 C l i e n t r e f u s a l 05 Parent r e f u s a l 06 Other family r e f u s a l 07 Lover/mate re f u s a l 08 Refused by frie n d 09 Doctor re f u s a l 10 Other professional r e f u s a l 11 Refused by other than 4-10 12 Other agency involved 13 Community Care Team involved 14 Chimo involved 15 Group home involved 16 In-Patient Psychiatric Unit involved 17 C l i e n t committed 18 C l i e n t h o s p i t a l i z e d 19 C l i e n t i n j a i l 2 0 C l i e n t i n rest home 21 Long ps y c h i a t r i c history 22 Non-English speaking 23 Le f t Vancouver 24 C l i e n t died 25 Denies suicide attempt 26 S.A.F.E.R. ongoing 152 A P P E N D I X B 153 ./.. APPENDIX B RECODES FOR VARIABLES 1. Age i n Years: (Low -• 19= 0) (20 - 39= 1) (40 - 64= 2) (65 - High= 3) 2. Number of Contacts (Numcon): (0= 1) (1= 2) (2= 3) (N - th Contact= 4) 3. Method of Referral: (2= 1) (3,4= 2) (5= 3) (6= 4) (7= 5) (8= 6) (9,10,11= 7) 4. Sex: (0= 1) female (1= 2) male 5. Occupation: (2,3= 1) (4,7= 2) (5,6= 3) (8,9,10,11,12= 4) 6. Marital Status: (2= 1) (3,4,8= 2) (5= 3) (6,7= 4) 7. Impending Move (Change of Abode): (0= 1) (1= 2) 8. Education: (2,3= 1) (4,5= 2) (6,7,8= 3) (9,10= 4) 9. Employment Status: (3,12= 1) (2,4,5,6,7,10,11= 2) 10. Liv i n g Situation: (2= 1) (3,4,5,7,8,9= 2) (6= 3) 11. E t h n i c i t y : (2= 1) (3,4,5,6,7,8,9= 2) 12. F i n a n c i a l Situation: (0= 1) (2= 2) (3= 3) 13. Sexual Orientation: (2= 1) (3,4,5= 2) 14. Legal Involvement: (1= 1) (2,4= 2) (3,5,7,8,9= 3) (6= 4) 15. Primary Problem: (2,3,4,13,16= 1) (5= 2) (6,15= 3) (9,10= 4) (11= 5) (14= 6) (7,8,12,17,18= 7) 16. Method of Attempt: (2,8,= 1) (9,16,60,62,70= 2) (17,18= 3) 17. Alcohol Involvement: (0= 1) (1= 2) 18. Plan to Die: (0= 1) (1= 2) 19. Attempt Planned: (0= 1) :(1= 2) 20. Attempt Directed: (1,6,7= 1) (2,3= 2) (4,5= 3) 154 21. Prior Communication: (0= 1) (1= 2) 22. Children/no Children: (0= 1) (1= 2) 23. Drug Dependency: (0= 1) (1= 2) 24. Past I l l n e s s : (0= 1) (1= 2) 25. Past Accident: (0= 1) (1= 2) 26. Family Violence: (0= 1) (1= 2) 27. Death of S i g n i f i c a n t Other: (0= 1) (1= 2) 28. History of P r i o r Attempts: (0= 1) (1= 2) 29. Prior Contact Type (Priotype): (1,2= 1) (3,4= 2) 30. Contact Type (Contype): (1,2=1) (3,4= 2) 31. Reason for Assessment: (2,3,23,24= 1) (12,16,20,26= 2) (17,18,19,21,22,25= 3) 155 A P P E N D I X C AGE <AGE> RELATIVE ADJUSTED CUM ABSOLUTE FREO FREO FREO CATEGORY LABEL CODE FREO (PCT) (PCT) (PCT) <LO-19> 0 . 1254 23.4 23.4 23 . 4 <20-39> 1 . 3082 57 . 5 57 .5 8 0 . 9 <40-64> 2 . 914 17. 1 17.1 9 8 . 0 <65-HI> 3. 108 2 . 0 2 .0 100.0 TOTAL 5358 100.0 100.0 A G E < A G E > C O D E Q_ * * * * * * * * * * * * * * ( 1 2 5 4 ) < L 0 - 1 9 > * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ( 3 0 8 2 ) < 2 0 - 3 9 > * * * * * * * * * * ( 9 1 4 ) < 4 0 - 6 4 > * ( 1 0 8 ) < 6 5 - H I > 0 1 0 0 0 F R E O U E N C Y 2 0 0 0 3 0 0 0 4 0 0 0 5 0 0 0 M E A N M O D E K U R T O S I S M I N I M U M 0 . 9 7 7 1 . 0 0 0 0 . 1 4 1 0 . 0 S T D E R R S T D D E V S K E W N E S S M A X I M U M 0 . 0 1 0 0 . 6 9 6 0 . 3 9 0 3 . 0 0 0 M E D I A N V A R I A N C E R A N G E V A L I D C A S E S 5 3 5 8 M I S S I N G C A S E S O 0 . 9 6 2 0 . 4 8 5 3 . 0 0 0 I— 1 Ln * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY NUMCON <NUMBER OF CONTACTS> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 0 F 1 NUMCON COUNT I ROW PCT IFIRST SECOND THIRD N-TH ROW COL PCT ICONTACT CONTACT CONTACT CONTACT TOTAL TOT PCT I 1 2 ] 3 I 4 I AGE -I - - I- -I 0 I 1 165 74 ] 13 I 2 I 1254 <LO-19> I 9 2 . 9 J 5 .9 ] 1 .0 I 0 .2 I 23 . 4 I 24 . 3 ] 16.9 ] 13.0 I 6 . 3 I I 21 .8 J 1.4 ] 0 .2 I 0 . 0 I - I - -I - -I 1 I 2698 ] 287 ] 68 I 26 I 3079 <20-39> I 8 7 . 6 ] 9 . 3 ] 2 . 2 I 0 .8 I 57 . 5 I 56 .4 ] 6 5 . 5 ] 68 .0 I 81 .3 I I 50 .4 ] 5.4 ] 1 . 3 I 0 . 5 I - I - - I - -I 2 I 821 ] 71 1 18 I 4 I 914 <40-64> I 89 . 8 ] 7 .8 I 2 . 0 I 0 .4 I 17.1 I 17.2 1 16.2 I 18 .0 I 12.5 I I 15.3 1 1.3 I 0 .3 I 0. 1 I - I - - I- -I 3 I 101 1 6 I 1 I 0 I 108 <65-HI> I 93 . 5 I 5 .6 I 0 . 9 I 0 . 0 I 2 . 0 I 2.1 I 1.4 I 1 .0 I 0 . 0 I I 1.9 I 0.1 I 0 . 0 I 0 . 0 I - I - - I - -I COLUMN 4785 438 100 32 5355 TOTAL 8 9 . 4 8 .2 1 .9 0 .6 100.0 2 OUT OF 16 ( 12.5%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 . MINIMUM EXPECTED CELL FREOUENCY = 0 .645 RAW CHI SOUARE = 32 .31229 WITH 9 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0002 CRAMER'S V = 0 .04485 CONTINGENCY COEFFICIENT = 0 .07745 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 WITH NUMCON DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00323 WITH AGE DEPENDENT. = 0 .00819 WITH NUMCON DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.00464 K E N D A L L ' S TAU B = 0 .03216 SIGNIFICANCE (2-TAI LED) = 0 .0125 K E N D A L L ' S TAU C = 0 .01446 SIGNIFICANCE (2 -TAILED) = 0 .0125 GAMMA = 0 .10047 SIGNIFICANCE (2 -TA I LED) = 0 .0125 SOMERS'S D (ASYMMETRIC) = 0.05578 WITH AGE DEPENDENT. = 0.01854 WITH NUMCON DEPENDENT. SOMERS'S D (SYMMETRIC) = 0 .02783 ETA = 0 .02870 WITH AGE DEPENDENT. = 0 .07625 WITH NUMCON DEPENDENT. PEARSON'S R = 0 .02819 SIGNIFICANCE = 0 .0196 NUMBER OF MISSING OBSERVATIONS = 3 Ln CO * * * * AGE * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * <AGE> BY METHOD <METHOD OF REFERRAL> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 COUNT ROW PCT COL PCT METHOD SELF DOCTOR AGENCY VAN GEN ST PAULS BURNABY RICHMOND OTHER ROW TOTAL TOT PCT I 1 I 2 I 3 4 ] 5 I 6 I 7 I AGE 0 I 23 I 15 I 534 166 1 138 I 168 I 10 I 1054 <LO-19> I 2 .2 I 1 .4 I 50 .7 [ 15.7 1 13.1 I 15.9 I 0 .9 I 2 0 . 5 I 22 . 8 I 20 .8 I 19.9 t 15.1 ] 26 .7 I 25 .4 I 45 . 5 I I 0 . 4 I 0 . 3 I 10.4 [ 3.2 ] 2 .7 I 3 .3 I 0 . 2 1 1 I 60 I 41 I 1586 [ 708 1 275 I 401 I 10 I 3081 <20-39> I 1 . 9 I 1.3 I 5 1 . 5 2 3 . 0 ] 8 .9 I 13.0 I 0 . 3 I 59 .8 I 59 .4 I 56 .9 I 59 .2 [ 64 .2 ] 53 .3 I 60 .6 I 45 . 5 I I 1 .2 I 0 .8 I 30 .8 13.7 ] 5 .3 I 7 .8 I O . 2 1 2 I 16 I 15 I 489 [ 209 ] 97 I 84 I 2 I 912 <40-64> I 1 .8 I 1.6 I 53 .6 22 .9 ] 10.6 I 9 .2 I 0 . 2 I 17.7 I 15.8 I 20 .8 I 18.3 19.0 1 18.8 I 12.7 I 9 . 1 I I 0 . 3 I 0 . 3 I 9 . 5 [ 4.1 ] 1.9 I 1.6 I 0 .0 j 3 I 2 I 1 I 70 [ 19 1 6 I 9 I 0 I 107 <65-HI> I 1 .9 I 0 . 9 I 65 .4 [ 17.8 ] 5 .6 I 8 .4 I 0 .0 I 2.1 I 2 . 0 I 1.4 I 2 .6 [ 1.7 ] 1.2 I 1.4 I 0 .0 I 1 0 . 0 I 0 . 0 I 1 .4 [ 0 .4 ] 0. 1 I 0 .2 I 0 .0 j COLUMN 101 72 2679 1 102 516 662 22 5154 TOTAL 2 . 0 1 .4 52 .0 21.4 10.0 12.8 0 .4 100.0 5 OUT OF 28 ( 17.9%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 MINIMUM EXPECTED CELL FREOUENCY = 0 .457 RAW CHI SOUARE = 70.65944 WITH 18 DEGREES OF FREEDOM. SIGNIFICANCE CRAMER'S V = 0 .06760 CONTINGENCY COEFFICIENT = 0 .11629 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.00678 WITH AGE DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00590 K E N D A L L ' S TAU B = -0 .04258 SIGNIFICANCE (2-TAI LED) = 0 .0005 K E N D A L L ' S TAU C = -0 .03471 SIGNIFICANCE (2-TAI LED ) = 0 .0005 GAMMA = - 0 . 0 6 9 6 5 SIGNIFICANCE ( 2 - T A I L E D ) = 0.0005 SOMERS'S D (ASYMMETRIC) = -0 .03963 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = -0 .04247 ETA = 0 .09047 WITH AGE DEPENDENT. = 0.064 12 WITH METHOD PEARSON'S R =-0.06326 SIGNIFICANCE = 0 .0000 O. OOOO WITH METHOD DEPENDENT. 0 .00522 WITH METHOD - 0 . 0 4 5 7 5 WITH METHOD DEPENDENT. DEPENDENT. DEPENDENT. NUMBER OF MISSING OBSERVATIONS = 204 L n VO * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> • BY SEX <SEX> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 0 F 1 COUNT ROW PCT COL PCT TOT PCT AGE <L0-19> <20-39> <40-64> <65-HI> COLUMN TOTAL SEX FEMALE MALE 940 75 .0 26 . 3 17.6 1959 6 3 . 6 54 .8 3 6 . 6 603 66 .0 16.9 11.3 72 66 . 7 2 . 0 1 . 3 3574 6 6 . 8 1 313 2 5 . 0 17.6 5 .8 I 1 120 I 36 . 4 I 6 3 . 0 I 20 .9 I 310 I 34 .0 I 17.4 I 5 .8 I 36 I 33 . 3 I 2 . 0 I 0 . 7 1779 33 . 2 ROW TOTAL 1253 23 .4 3079 57 . 5 913 17.1 108 2 . 0 5353 100.0 RAW CHI SOUARE = 52 .37930 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0000 CRAMER'S V = 0 .09892 CONTINGENCY COEFFICIENT = 0.09844 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 WITH SEX DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.00487 WITH AGE DEPENDENT. = 0 .00795 WITH SEX DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.00604 K E N D A L L ' S TAU B = 0 .06505 SIGNIFICANCE (2-TAI LED) = 0 .0000 KENDALL 'S TAU C = 0 .06628 SIGNIFICANCE (2 -TA ILED) = 0 .0000 GAMMA = 0 .12901 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .0000 SOMERS'S D (ASYMMETRIC) = 0.07468 WITH AGE DEPENDENT. = 0 .05666 WITH SEX DEPENDENT. SOMERS'S D (SYMMETRIC) = 0.06443 ETA = 0 . 0 6 2 8 0 WITH AGE DEPENDENT. = 0.09892 WITH SEX DEPENDENT. PEARSON'S R = 0 .06277 SIGNIFICANCE = 0.OOOO NUMBER OF MISSING OBSERVATIONS = 5 O * * * * * * * * * * * * * * * * * * C R 0 S S T A B U L A T I 0 N AGE <AGE> BY OCCUP * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * OCCUP COUNT ROW PCT PROFNALL ARTISAN WCOLLAR OTHER ROW COL PCT TOTAL TOT PCT 1 I 2 I 3 I 4 AGE 0 t 12 I 17 I 36 I 603 [ 668 <L0-19> [ 1.8 I 2 . 5 I 5 .4 I 90 .3 22 .6 t 5.4 I 6 .9 I 9 . 3 I 28 . 7 [ • 0 .4 I 0 . 6 I 1.2 I 20 .4 1 [ 155 I 173 I 277 I 1 120 [ 1725 <20-39> [ 9 . 0 I 10.0 I 16.1 I 64 .9 58.4 [ 70. 1 I 7 0 . 0 I 71 .8 I 53 . 3 [ 5.2 I 5 .9 I 9 .4 I 37 .9 2 [ 51 I 56 I 68 I 327 [ 502 <40-64> [ 10.2 I 11.2 I 13.5 I 65 . 1 [ 17.0 [ 23 . 1 I 22 . 7 I 17.6 I 15.6 t 1.7 I 1.9 I 2 .3 I 11.1 3 [ 3 I 1 I 5 I 51 [ 60 <65-HI> [ 5 .0 I 1.7 I 8 .3 I 8 5 . 0 [ 2 . 0 [ 1.4 I 0 . 4 I 1.3 I 2 .4 [ 0.1 I 0 . 0 I 0 .2 I 1.7 COLUMN 221 247 386 2101 2955 TOTAL 7 .5 8 .4 13.1 71.1 100.0 Q f * * * * * * * * * * * * <OCCUPATION> * * * * PAGE 1 OF 1 SIGNIFICANCE = 0 . 0 = 0 . 0 DEPENDENT. 1 OUT OF 16 ( 6.3%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 MINIMUM EXPECTED CELL FREOUENCY = 4 .487 RAW CHI SOUARE = 171.05701 WITH 9 DEGREES OF FREEDOM CRAMER'S V = 0.13891 CONTINGENCY COEFFICIENT = 0.23392 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.03278 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .03483 K E N D A L L ' S TAU B = - 0 . 1 6 0 4 7 SIGNIFICANCE (2 -TA ILED) = 0 . 0 K E N D A L L ' S TAU C = - O . 11098 SIGNIFICANCE (2 -TA ILED) = 0 . 0 GAMMA = - 0 . 3 2 2 7 7 SIGNIFICANCE ( 2 - T A I L E D ) = 0 . 0 SOMERS'S D (ASYMMETRIC) = -0 .17907 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = -0 .15951 ETA = 0 .15585 WITH AGE DEPENDENT. = 0 .21887 WITH OCCUP PEARSON'S R =-0 .14908 SIGNIFICANCE = 0 .0000 WITH OCCUP DEPENDENT. = 0 .03714 WITH OCCUP DEPENDENT. - 0 . 1 4 3 8 0 WITH OCCUP DEPENDENT. DEPENDENT. NUMBER OF MISSING OBSERVATIONS 2403 * * * * AGE * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * <AGE> BY MARITAL <MARITAL STATUS> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 MARITAL COUNT ROW PCT ISINGLE MARRIED WIDOWED DIVSEP ROW COL PCT TOTAL TOT PCT I 1 I 2 I 3 I 4 AGE -I 0 I 787 I 94 I 5 I 18 I 904 <LO-19> I 8 7 . 1 I 10.4 I 0 . 6 I 2 . 0 I 22 .5 I 3 9 . 9 I 7 .6 I 4 . 5 I 2 .6 I 19.6 I 2 .3 I 0.1 I 0 .4 1 I 1 103 I 780 I 26 I 467 I 2376 <20-39> I 46 .4 I 32 . 8 I 1.1 I 19.7 I 59 .2 I 5 5 . 9 I 63 . 3 I 23 .6 I 66 . 5 I 2 7 . 5 I 19.4 I 0 . 6 I 11.6 2 I 73 I 328 I 48 I 208 I 657 <40-64> I 11.1 I 49 . 9 I 7 .3 I 31 .7 I 16.4 I 3 .7 I 26 .6 I 4 3 . 6 I 29 .6 I 1.8 I 8 .2 I 1.2 I 5 .2 3 I 9 I 30 I 31 I 9 I 79 <65-HI> I 11.4 I 3 8 . 0 I 39 .2 I 11.4 I 2 . 0 I 0 . 5 I 2 .4 I 28 .2 I 1.3 I 0 . 2 I 0 .7 I 0 .8 I 0 .2 COLUMN 1972 1232 1 10 702 4016 TOTAL 4 9 . 1 30. 7 2 . 7 17.5 100.0 VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5. 2 . 164 9 DEGREES OF FREEDOM. DEPENDENT. DEPENDENT. 1 OUT OF 16 ( 6.3%) OF THE MINIMUM EXPECTED CELL FREOUENCY = RAW CHI SOUARE = 1371.43872 WITH CRAMER'S V = 0 .33739 CONTINGENCY COEFFICIENT = 0.50454 LAMBDA (ASYMMETRIC) = 0.01341 WITH AGE LAMBDA (SYMMETRIC) = 0 .08116 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .15080 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .14406 K E N D A L L ' S TAU B = 0 .42572 SIGNIFICANCE (2-TAI LED) = O K E N D A L L ' S TAU C = 0 .34173 SIGNIFICANCE (2 -TA ILED) = 0 GAMMA = 0 .67223 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .0 SOMERS'S D (ASYMMETRIC) = 0.40459 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = 0.42517 ETA = 0 .50368 WITH AGE DEPENDENT. = 0.41294 WITH MARITAL PEARSON'S R = 0.40071 SIGNIFICANCE = 0 .0000 SIGNIFICANCE = 0 . 0 = 0.13552 WITH MARITAL DEPENDENT. 0 .13789 WITH MARITAL DEPENDENT. .0 .0 0 .44796 WITH MARITAL DEPENDENT. DEPENDENT . NUMBER OF MISSING OBSERVATIONS 1342 INJ * * * * * * * * * * * * * * * * * * C R O S S AGE <AGE> * * * * * * * * * * * * * * * * * * * * * * * * MOVE COUNT ROW PCT MOVE NO MOVE ROW COL PCT TOTAL TOT PCT 0 I 1 AGE 0 [ 1033 I 221 [ '1254 <L0-19> [ 82 .4 I 17.6 [ 23 .4 [ 23 .4 I 23 . 4 [ 19.3 I 4 . 1 1 [ 2480 I 602 [ 3082 <20-39> [ 8 0 . 5 I 19.5 [ 57 . 5 t 56 .2 I 63 . 6 [ 4 6 . 3 I 11.2 2 t 807 I 107 I 914 <40-64> [ 8 8 . 3 I 11.7 I 17.1 [ 18.3 I 11.3 [ 15.1 I 2 . 0 3 [ 92 I 16 I 108 <65-HI> [ 85 .2 I 14.8 [ 2 . 0 t 2.1 I 1 . 7 t 1 . 7 1 0 . 3 COLUMN 4412 946 5358 TOTAL 82 . 3 17.7 100.0 RAW CHI SOUARE = 30 .31810 WITH 3 DEGREES BY MOVE Q ( r * * * * * * * * * * <RECENT-PENDING MOVE> * * * * * * * PAGE 1 OF 1 = 0 . 0 DEPENDENT. FREEDOM. SIGNIFICANCE = 0 .0000 CRAMER'S V = 0 .07522 CONTINGENCY COEFFICIENT = 0.07501 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00293 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.00404 K E N D A L L ' S TAU B = -0 .03901 SIGNIFICANCE (2-TAI LED) = 0 .0028 K E N D A L L ' S TAU C = - 0 . 0 3 2 1 8 SIGNIFICANCE (2 -TA ILED) = 0 .0028 GAMMA = - 0 . 0 9 7 6 6 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .0028 SOMERS'S D (ASYMMETRIC) = -0 .05533 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = -0 .03675 ETA = 0 .04226 WITH AGE DEPENDENT. = 0.07522 WITH MOVE DEPENDENT PEARSON'S R =-0.04226 SIGNIFICANCE = 0 .0010 WITH MOVE DEPENDENT. = 0 .00652 WITH MOVE DEPENDENT. = -0 .02751 WITH MOVE DEPENDENT. * * * * AGE * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * <AGE> BY EDUC <EDUCATION> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 0 F 1 EDUC COUNT ROW PCT ISOME ELE SOME SEC UNIV TECH ROW COL PCT TOTAL TOT PCT I 1 2 3 I 4 AGE I 0 I 62 498 17 I 8 I 585 <L0-19> I 10.6 85 . 1 2 .9 I 1.4 I 29 .5 I 40 .8 33 . 8 ] 7 . 1 I 7 .0 I 3.1 25. 1 0 . 9 I 0 .4 1 I 63 798 ] 179 I 84 I 1 124 <20-39> I 5 .6 7 1 . 0 1 15.9 I 7 .5 I 56 .7 I 4 1.4 54 . 1 ] 74 . 3 I 73.7 I 3 .2 40 .3 1 9 . 0 I 4 .2 2 I 26 163 ] 40 I 21 I 250 <40-64> I 10.4 65 . 2 ] 16.0 I 8 .4 I 12.6 I 17.1 11.1 ] 16.6 I 18.4 I 1 . 3 1 8 .2 ] 2 . 0 I 1.1 3 I 1 1 16 ] 5 I 1 I 23 <65-HI> I 4 . 3 ] 6 9 . 6 ] 21 .7 I 4 .3 I 1.2 I 0 . 7 1 1.1 ] 2 . 1 I 0 .9 I 0.1 1 0 .8 ] 0 . 3 I 0.1 COLUMN 152 1475 24 1 114 1982 TOTAL 7 . 7 74 . 4 12.2 5.8 100.0 0 . 0 DEPENDENT. WITH EDUC 3 OUT OF 16 ( 18.8%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 MINIMUM EXPECTED CELL FREOUENCY = 1.323 RAW CHI SOUARE = 116.80562 WITH 9 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0000 CRAMER'S V = 0 .14016 CONTINGENCY COEFFICIENT = 0.23591 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.03572 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .03878 K E N D A L L ' S TAU B = 0 .17312 SIGNIFICANCE (2 -TAILED) = 0 . 0 K E N D A L L ' S TAU C = 0 .11375 SIGNIFICANCE (2 -TAILED) = 0 . 0 GAMMA = 0 .35222 SIGNIFICANCE ( 2 - T A I L E D ) = 0 . 0 SOMERS'S D (ASYMMETRIC) = 0.20207 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = 0.17107 ETA = 0 .19660 WITH AGE DEPENDENT. = 0.21414 WITH EDUC DEPENDENT PEARSON'S R = 0.17041 SIGNIFICANCE = O.OOOO NUMBER OF MISSING OBSERVATIONS = 3376 DEPENDENT. 0 .04243 WITH EDUC DEPENDENT. 0. 14831 WITH EDUC DEPENDENT. C T i * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY EMPLOY EMPLOYMENT STATUS> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 EMPLOY COUNT ROW PCT I EMPLOYED UNEMPLOY ROW COL PCT TOTAL TOT PCT I 1 [ 2 I AGE 0 I 150 599 I 749 <LO- 19> I 2 0 . 0 8 0 . 0 I 21 .4 I 13.5 25. 1 I I 4 . 3 17.1 I 1 I 786 1305 I 2091 <20- 39> I 3 7 . 6 ] 62 . 4 I 59 .8 I 7 0 . 6 ] 54 . 7 I I 2 2 . 5 ] 37 . 3 I 2 I 175 ] 407 I 582 <40- 64> I 30.1 ] 6 9 . 9 I 16.6 I 15.7 ] 17.1 I I 5 . 0 1 11.6 I 3 I 2 ] 74 I 76 <65- HI> I 2 . 6 I 97 .4 I 2 .2 I 0 . 2 ] 3.1 I I 0 . 1 1 2.1 I COLUMN 1113 2385 3498 TOTAL 31 .8 68 .2 100.0 RAW CHI SOUARE = 110.77328 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0000 CRAMER'S V = 0 .17795 CONTINGENCY COEFFICIENT = 0 .17520 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 WITH EMPLOY DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.01781 WITH AGE DEPENDENT. = 0 .02902 WITH EMPLOY DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .02207 K E N D A L L ' S TAU B = - 0 . 0 4 9 2 7 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .0023 K E N D A L L ' S TAU C = - 0 . 0 4 8 9 4 SIGNIFICANCE (2 -TAI LED) = 0 .0023 GAMMA = - 0 . 1 0 2 0 2 SIGNIFICANCE (2 -TA I LED) = 0 .0023 SOMERS'S D (ASYMMETRIC) = - 0 .05640 WITH AGE DEPENDENT. = - 0 .04303 WITH EMPLOY DEPENDENT. SOMERS'S D (SYMMETRIC) = -0 .04882 ETA = 0 .03032 WITH AGE DEPENDENT. = 0.17797 WITH EMPLOY DEPENDENT. PEARSON'S R =-0.03032 SIGNIFICANCE = 0 .0365 NUMBER OF MISSING OBSERVATIONS = 1860 * * * * AGE * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * <AGE> BY LIVING <LIVING SITUATION> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 LIVING COUNT ROW PCT IALONE SHARING INST RES ROW COL PCT TOTAL TOT PCT I 1 I 2 I 3 I AGE I 0 I 69 I 621 I 70 I 760 <LO- 19> I 9.1 I 8 1 . 7 I 9 .2 I 22 .8 I 8 .3 I 26 .7 I 39.1 I I 2.1 I 18.6 I 2.1 I 1 I 560 I 1291 I 87 I 1938 <20- 39> I 2 8 . 9 I 6 6 . 6 I 4 . 5 I 58 . 1 I 6 7 . 6 I 55 .4 I 48 .6 I I 16.8 I 38 . 7 I 2 .6 I 2 I 169 I 379 I 14 1 562 <40- 64> I 30 . 1 I 67 . 4 I 2 . 5 I 16.8 I 20 .4 I 16.3 I 7 .8 I I 5.1 I 11.4 I 0 .4 I 3 I 31 I 38 I 8 I 77 <65- HI> I 40 . 3 I 49 . 4 I 10.4 I 2 . 3 I 3 .7 I 1.6 I 4 . 5 I I 0 . 9 I 1.1 I 0 .2 1 COLUMN 829 2329 179 3337 TOTAL 24 .8 69 .8 5 .4 100.0 VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 . 4 . 130 6 DEGREES OF FREEDOM. SIGNIFICANCE = 0 . 0 = 0 .0 DEPENDENT. 1 OUT OF 12 ( 8.3%) OF THE MINIMUM EXPECTED CELL FREOUENCY = RAW CHI SOUARE = 161.71571 WITH CRAMER'S V = 0 .15566 CONTINGENCY COEFFICIENT = 0.21499 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .02620 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.03037 KENDALL 'S TAU B = - 0 . 1 7 2 7 2 SIGNIFICANCE (2-TAI LED) = 0 . 0 K E N D A L L ' S TAU C = - 0 . 1 3 2 3 3 SIGNIFICANCE (2 -TA ILED) = 0 . 0 GAMMA = - 0 . 3 3 9 3 6 SIGNIFICANCE ( 2 - T A I L E D ) = 0 . 0 SOMERS'S D (ASYMMETRIC) = -0 .19679 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = -0 .17126 ETA = 0 .17838 WITH AGE DEPENDENT. = 0.20888 WITH LIVING PEARSON'S R =-0.17571 SIGNIFICANCE = 0 .0000 NUMBER OF MISSING OBSERVATIONS 2021 WITH LIVING DEPENDENT. = 0 .03612 WITH LIVING DEPENDENT. •0 .15160 WITH LIVING DEPENDENT. DEPENDENT. * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY ETHNIC <ETHNICITY> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 ETHNIC COUNT ROW PCT IWHITE OTHER ROW COL PCT TOTAL TOT PCT I 1 I 2 AGE -I 0 I 576 I 134 I 710 <LO- 19> I 81.1 I 18.9 I 21 .8 I 2 0 . 9 I 26 .6 I 17.7 I 4.1 1 I 1612 I 314 I 1926 <20- 39> I 8 3 . 7 I 16 . 3 I 59 .2 I 58 .6 I 62 .4 I 4 9 . 5 I 9 .6 2 I 497 I 50 I 547 <40- 64> I 9 0 . 9 I 9.1 I 16.8 I 13.1 I 9 . 9 I 15.3 I 1.5 3 I 66 I 5 I 71 <65- HI> I 9 3 . 0 I 7 . 0 I 2 .2 I 2 .4 I 1.0 I 2 . 0 I 0 .2 COLUMN 2751 503 3254 TOTAL 84 . 5 15.5 100.0 RAW CHI SOUARE = 27.94151 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0000 CRAMER'S V = 0 .09267 CONTINGENCY COEFFICIENT = 0.09227 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 WITH ETHNIC DEPENOENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.00461 WITH AGE DEPENDENT. = 0 .01099 WITH ETHNIC DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00650 K E N D A L L ' S TAU B = - 0 . 0 8 1 9 0 SIGNIFICANCE (2 -TAILED) = 0 .0000 K E N D A L L ' S TAU C = -0 .06341 SIGNIFICANCE (2 -TAILED) = 0 .0000 GAMMA = -0 .21651 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .0000 SOMERS'S D (ASYMMETRIC) = - 0 . 1 2 1 3 0 WITH AGE DEPENDENT. = - 0 . 0 5 5 3 0 WITH ETHNIC DEPENDENT. SOMERS'S D (SYMMETRIC) = -0 .07596 ETA = 0 .08741 WITH AGE DEPENDENT. = 0 .09270 WITH ETHNIC DEPENDENT. PEARSON'S R =-0.08741 SIGNIFICANCE = 0 .0000 NUMBER OF MISSING OBSERVATIONS = 2104 * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY FINAN <FINANCIAL SITUATION> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 COUNT ROW PCT COL PCT TOT PCT A G E <L0-19> <20-39> <40-64> <65-HI> O FINAN OTHER SECURE INSECURE COLUMN TOTAL I 1 I - I-2 1 3 I 890 I 128 1 236 I 7 1 . 0 I 10.2 ] 18.8 I 26 . 1 I 19.8 ] 18 . 1 I 16.6 I -I-2 .4 ] 4 .4 I 1872 I 352 1 858 I 6 0 . 7 I 11.4 ] 27 .8 I 54 . 9 I 5 4 . 6 I 6 5 . 9 I 3 4 . 9 I - I-6 . 6 ] 16 .0 I 583 I 138 ] 193 I 63 .8 I 15.1 ] 21.1 I 17.1 I 21 .4 ] 14.8 I 10.9 I -I-2 .6 ] 3 .6 I 66 I 27 ] 15 I 61 .1 I 2 5 . 0 ] 13.9 I 1.9 I 4 . 2 1 1 . 2 I 1.2 I -I-0 . 5 ] 0 . 3 341 1 645 1302 63 . 7 12 .0 24 . 3 ROW TOTAL 1254 23.4 3082 57 .5 914 17.1 108 2 .0 5358 100.0 RAW CHI SOUARE = 81.43951 WITH 6 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0000 CRAMER'S V = 0 .08718 CONTINGENCY COEFFICIENT = 0.12236 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 WITH FINAN DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00709 WITH AGE DEPENDENT. = 0.00831 WITH FINAN DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00765 K E N D A L L ' S TAU B = 0 .04414 SIGNIFICANCE (2 -TAILED) = 0 .0004 K E N D A L L ' S TAU C = 0 .03655 SIGNIFICANCE (2 -TAILED) = 0.0004 GAMMA = 0 .08065 SIGNIFICANCE ( 2 - T A I L E D ) = 0.0004 SOMERS'S D (ASYMMETRIC) = 0 .04675 WITH AGE DEPENDENT. = 0 .04166 WITH FINAN DEPENDENT. SOMERS'S D (SYMMETRIC) = 0.04406 ETA = 0 .06963 WITH AGE DEPENDENT. = 0.09501 WITH FINAN DEPENDENT. PEARSON'S R = 0 .03565 SIGNIFICANCE = 0 .0045 CTi CO * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY SEXUAL <SEXUAL ORIENTATION> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 COUNT ROW PCT COL PCT TOT PCT SEXUAL HETROSEX 1 AGE <L0-19> <20-39> <40-64> <65-HI> HOMOSEX OTHERS I 2 466 9 5 . 9 19.1 18.1 I 20 I 4.1 I 14.2 I 0 .8 1490 9 2 . 8 61 .1 5 7 . 8 I 116 I 7.2 I 82. 3 I 4 . 5 435 98 .9 17.8 16.9 I 5 I 1.1 I 3 .5 I 0 .2 48 100.0 2 . 0 1 .9 COLUMN TOTAL 2439 94 . 5 I O I 0 . 0 I 0 . 0 I 0 . 0 141 5 .5 ROW TOTAL 486 18.8 1606 62 . 2 440 17.1 48 1 .9 2580 100.0 1 OUT OF 8 ( 12.5%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 . MINIMUM EXPECTED CELL FREOUENCY = 2 .623 RAW CHI SOUARE = 30 .05219 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0000 CRAMER'S V = O.10793 CONTINGENCY COEFFICIENT = 0 .10730 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 WITH SEXUAL DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.00772 WITH AGE DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.01271 K E N D A L L ' S TAU B = - 0 . 0 4 0 2 8 SIGNIFICANCE (2 -TAILED) = 0 .0343 KENDALL 'S TAU C = - 0 . 0 1 9 1 6 SIGNIFICANCE (2 -TA ILED) = 0 .0343 GAMMA = - 0 . 1 9 9 8 7 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .0343 SOMERS'S D (ASYMMETRIC) = -0 .09274 WITH AGE DEPENDENT. = - 0 . 0 1 7 5 0 WITH SEXUAL SOMERS'S D (SYMMETRIC) = -0 .02944 ETA = 0 .04596 WITH AGE DEPENDENT. = 0.10791 WITH SEXUAL DEPENDENT. PEARSON'S R =-0 .04595 SIGNIFICANCE = 0 .0098 NUMBER OF MISSING OBSERVATIONS = 2778 = 0 .03590 WITH SEXUAL DEPENDENT. DEPENDENT. 0> * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY LEGAL <LEGAL INVOLVMENT> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 LEGAL COUNT ROW PCT IYES NOS CIVIL CRIMINAL DRUG ROW COL PCT TOTAL TOT PCT 1 I 2 I 3 4 AGE -I -I 0 20 I 24 I 23 4 I 71 <LO- 19> I 28 . 2 I 33 .8 I 32 .4 [ 5 .6 I 21 .6 I 32 . 3 I 15.6 I 24 . 7 [ 21 . 1 I G . 1 I -I 7 . 3 I -I 7 .0 [ 1 .2 1 36 I 103 I 59 12 I 210 <20- 39> I 17 . 1 I 4 9 . 0 I 28 . 1 [ 5 . 7 I 6 4 . 0 I 58 . 1 I 6 6 . 9 I 63 . a t 63 . 2 I 1 1 .0 I -I 31 .4 I -I 18 .0 [ 3 . 7 2 5 I 27 I 9 3 I 44 <40- 64> I 1 1 . 4 I 61 .4 I 20 . 5 [ 6 . 8 I 13.4 I 8 . 1 I 17.5 I 9 . 7 [ 15 .8 _ I 1 .5 . I -I 8 . 2 I -I 2 . 7 [ 0 . 9 3 1 I 0 I 2 0 I 3 <65- HI> I 33 . 3 I 0 . 0 I 66 . 7 [ 0 .0 I 0 .9 I 1 .6 I 0 . 0 I 2 .2 I 0 .0 I 0 . 3 I -I 0 . 0 I -I 0 .6 [ 0 .0 COLUMN 62 154 93 19 328 TOTAL 18 . 9 47 .0 28 . 4 5 .8 100.0 6 OUT OF 16 ( 37.5%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 . MINIMUM EXPECTED CELL FREOUENCY = 0 .174 RAW CHI SOUARE = 14.58299 WITH 9 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .1030 CRAMER'S V = 0 .12174 CONTINGENCY COEFFICIENT = 0.20632 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 .01149 WITH LEGAL DEPENDENT. LAMBDA (SYMMETRIC) = 0 .00685 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.02571 WITH AGE DEPENDENT. = 0 .02004 WITH LEGAL DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.02252 K E N D A L L ' S TAU B = 0 .02444 SIGNIFICANCE (2 -TA ILED) = 0.6307 K E N D A L L ' S TAU C = O.01919 SIGNIFICANCE (2 -TAILED) = 0.6307 GAMMA = 0 .04092 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .6307 SOMERS'S D (ASYMMETRIC) = 0 .02180 WITH AGE DEPENDENT. = 0 .02740 WITH LEGAL DEPENDENT. SOMERS'S D (SYMMETRIC) = 0 .02428 ETA = 0 .14295 WITH AGE DEPENDENT. = 0 .03809 WITH LEGAL DEPENDENT. PEARSON'S R = 0 .03285 SIGNIFICANCE = 0 .2767 | _ i NUMBER OF MISSING OBSERVATIONS = 5030 ° * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY PRIMARY <PRIMARY PROBLEM> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 PRIMARY COUNT I ROW PCT IMARITAL ISOLATE ALCOHOL SEPARATE PHYSICAL PSYCHO OTHER ROW COL PCT IFAMILY DRUG LOSS TOTAL TOT PCT I 1 I 2 I 3 I 4 [ 5 [ 6 I 7 AGE 0 I 457 I 21 I 46 I 152 [ 6 [ 29 I 32 I 743 <L0-19> I 61 . 5 I 2 .8 I 6 .2 I 20 .5 [ 0 .8 [ 3 .9 I 4 . 3 I 20 .9 I 27 .4 I 10.8 I 12.4 I 18.2 [ 5 . 0 [ 14.9 I 17.7 I 12.8 I 0 . 6 I 1.3 I 4 .3 [ 0 .2 [ 0 .8 I 0 . 9 1 I 946 I 114 I 219 I 553" [ 58 [ 120 I 121 I 2131 <20-39> I 44 . 4 I 5 . 3 I 10.3 I 26 .0 t 2 .7 t 5 .6 I 5 .7 I 5 9 . 9 I 5 6 . 8 I 58 .8 I 59 . 2 I 66 . 2 [ 47 .9 [ 61 .9 I 6 6 . 9 I 2 6 . 6 I 3 .2 I 6 .2 I 15.5 [ 1.6 [ 3 .4 I 3 .4 2 I 243 I 47 I 101 I 1 14 [ 40 [ 41 I 25 I 611 <40-64> I 39 .8 I 7 . 7 I 16.5 I 18.7 [ 6 .5 t 6 .7 I 4.1 I 17.2 I 14.6 I 24 . 2 I 27 . 3 I 13.7 [ 33 . 1 [ 21.1 I 13.8 I 6 .8 I 1 . 3 I 2 .8 I 3.2 [ 1.1 t 1.2 I 0 . 7 3 I 19 I 12 I 4 I 16 [ 17 [ 4 I 3 I 75 <65-HI> I 25 . 3 I 16 .0 I 5 .3 I 21 .3 [ 22 .7 [ 5 .3 I 4 . 0 I 2.1 I 1.1 I 6 .2 I 1.1 I 1.9 [ 14.0 [ 2.1 I 1.7 I 0 . 5 I 0 . 3 I 0.1 I 0 .4 [ 0 . 5 [ 0.1 I 0 . 1 COLUMN 1665 194 370 835 121 194 181 3560 TOTAL 46 .8 5 .4 10.4 23 . 5 3.4 5 .4 5. 1 100.0 VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 . 2 .549 18 DEGREES OF FREEDOM. SIGNIFICANCE 0 . 0 4 OUT OF 28 ( 14.3%) OF THE MINIMUM EXPECTED CELL FREOUENCY = RAW CHI SOUARE = 258.68823 WITH CRAMER'S V = 0 .15563 CONTINGENCY COEFFICIENT = 0.26027 LAMBDA (ASYMMETRIC) = O .O WITH AGE DEPENDENT. = 0 . 0 LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .02899 WITH AGE DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.02331 K E N D A L L ' S TAU B = 0 .10812 SIGNIFICANCE (2 -TAILED) = 0 . 0 K E N D A L L ' S TAU C = 0 .09129 SIGNIFICANCE (2 -TAILED) = 0 . 0 GAMMA = 0 .17040 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .0 SOMERS'S D (ASYMMETRIC) = 0.09701 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = 0 .10749 ETA = O.22328 WITH AGE DEPENDENT. = 0 .12487 WITH PRIMARY DEPENDENT PEARSON'S R = 0 .10882 SIGNIFICANCE = 0 .0000 WITH PRIMARY DEPENDENT. 0 .01949 WITH PRIMARY DEPENDENT. 0 .12049 WITH PRIMARY DEPENDENT. NUMBER OF MISSING OBSERVATIONS 1798 AGE AGE <L0-19> <20-39> <40-64> <65-HI> * * * * * * * * * * * * C R 0 S <AGE> * * * * * * * * * * * * * * * * * METHOD COUNT ROW PCT [SELF SELF OTHER COL PCT t INJURY POISON TOT PCT [ 1 I 2 I 3 0 [ 240 I 765 I 29 t 23 . 2 I 74 O I 2 .8 [ 21 .6 I 20. 1 I 19.9 [ 4 .7 I 15.1 I 0 . 6 1 t 725 I 2212 I 97 t 23 . 9 I 72 .9 I 3 .2 t 65 . 2 I 58 .0 I 66 .4 t 14.3 I 4 3 . 6 I 1.9 2 [ 134 I 744 I 17 [ 15 .0 I 83 . 1 I 1.9 t 12.1 I 19.5 I 11.6 [ 2 . 6 I 14.7 I 0 . 3 3 13 I 90 I 3 [ 12.3 I 84 .9 I 2 .8 [ 1.2 I 2 .4 I 2.1 [ 0 . 3 I 1.8 I 0.1 COLUMN 1112 381 1 146 TOTAL 21 .9 75 . 2 2 .9 * * * * * * * * U L A T I O N O F * * * * * BY METHOD <METHOD OF ATTEMPT> * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 ROW TOTAL 1034 20.4 3034 59 .9 895 17.7 106 2 . 1 5069 100.0 1 OUT OF 12 ( 8.3%) OF THE VALID CELLS HAVE EXPECTED CELL FREQUENCY LESS THAN 5 . 0 MINIMUM EXPECTED CELL FREOUENCY = 3 .053 RAW CHI SOUARE = 45 .58813 WITH 6 DEGREES OF FREEDOM. SIGNIFICANCE CRAMER'S V = 0 .06706 CONTINGENCY COEFFICIENT = 0.09441 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00474 WITH AGE DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00578 K E N D A L L ' S TAU B = 0 .05223 SIGNIFICANCE (2 -TAILED) = 0.0001 K E N D A L L ' S TAU C = 0 .03669 SIGNIFICANCE (2 -TAILED) = 0.0001 GAMMA = 0 .11473 SIGNIFICANCE ( 2 - T A I L E D ) = 0.0001 SOMERS'S D (ASYMMETRIC) = 0 .06340 WITH AGE DEPENDENT. = 0 .04303 WITH METHOD SOMERS'S D (SYMMETRIC) = 0.05126 ETA = 0 .07020 WITH AGE DEPENDENT. = 0.06953 WITH METHOD DEPENDENT. PEARSON'S R = 0 .05532 SIGNIFICANCE = 0 .0000 O.OOOO WITH METHOD DEPENDENT. = 0 .00743 WITH METHOD DEPENDENT. DEPENDENT . NUMBER OF MISSING OBSERVATIONS 289 —1 M * * * * * * * * * * * * * * * * * * C R 0 S AGE <AGE> * * * * * * * * * * * * * * * * * * * * * * * ALCOHOL COUNT ROW PCT NO YES ROW COL PCT TOTAL TOT PCT 1 I 2 AGE -I 0 [ 973 I 281 I 1254 <L0-19> [ 77 .6 I 22 .4 I 23 .4 [ 27 .4 I 15.6 [ 18.2 I 5 .2 1 t 1947 I 1 135 I 3082 <20-39> [ 63 .2 I 36 .8 I 57 . 5 [ 54 .8 I 6 2 . 9 [ 3 6 . 3 I 21 .2 2 [ 540 I 374 I 914 <40-64> t 59 . 1 I 4 0 . 9 I 17.1 t 15.2 I 20 .7 [ 10. 1 I 7 . 0 3 [ 93 I 15 I 108 <65-HI> [ 86 . 1 I 13.9 I 2 . 0 [ 2 . 6 I 0 .8 [ 1.7 I 0 . 3 COLUMN 3553 1805 5358 TOTAL 66 . 3 33 . 7 100.0 B U L A T I O N O F * * * * * * * * * * * * * * * * * * BY ALCOHOL <ALCOHOL INVOLVEMENT> * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 125.35793 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0000 RAW CHI SOUARE • CRAMER'S V = 0 .15296 CONTINGENCY COEFFICIENT = 0 .15120 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .01193 WITH AGE DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .01477 K E N D A L L ' S TAU B = 0 .10496 SIGNIFICANCE (2 -TAILED) = 0 . 0 KENDALL 'S TAU C = 0 .10730 SIGNIFICANCE (2 -TAILED) = 0 . 0 GAMMA = 0 .20666 SIGNIFICANCE ( 2 - T A I L E D ) = 0 . 0 SOMERS'S D (ASYMMETRIC) = 0.12008 WITH AGE DEPENDENT SOMERS'S D (SYMMETRIC) = 0.10401 ETA = 0 .09346 WITH AGE DEPENDENT. = 0.15297 WITH ALCOHOL DEPENDENT PEARSON'S R = 0 .09346 SIGNIFICANCE = 0 .0000 WITH ALCOHOL DEPENDENT. = 0 .01939 WITH ALCOHOL DEPENDENT. 0 .09174 WITH ALCOHOL DEPENDENT. —I 00 * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY DIE <PLAN TO DIE> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 COUNT ROW PCT COL PCT I TOT PCT I 1 I 2 AGE -I-0 I 1 177 I 77 <L0-19> 93 .9 I 6 . 1 24 .9 I 12.4 22 .0 I 1 . 4 -1 -I-1 I 2713 I 369 <20-39> 88 .0 I 12 .0 57 . 3 I 5 9 . 3 5 0 . 6 I 6 . 9 -I - I-2 I 765 I 149 <40-64> 83 . 7 I 16. 3 16 . 2 I 2 4 . 0 14.3 I 2 .8 -1 -I-3 I 81 I 27 <65-HI> 75 .0 I 2 5 . 0 1 .7 I 4 . 3 1 .5 I 0 . 5 -I - I -COLUMN 4736 622 TOTAL 8 8 . 4 11.6 DIE NO YES ROW TOTAL 1254 23 .4 3082 57 . 5 914 17.1 108 2 .0 5358 100.0 75 .43619 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0000 0 . 0 DEPENDENT. RAW CHI SOUARE = CRAMER'S V = 0 .11866 CONTINGENCY COEFFICIENT = 0 .11783 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.00684 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.01017 K E N D A L L ' S TAU B = 0 .10885 SIGNIFICANCE (2 -TAILED) = 0 . 0 K E N D A L L ' S TAU C = 0 .07542 SIGNIFICANCE (2 -TAILED) = 0 . 0 GAMMA = 0 .31148 SIGNIFICANCE ( 2 - T A I L E D ) = 0 . 0 SOMERS'S D (ASYMMETRIC) = 0 .18376 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = 0.09547 ETA = 0 .11749 WITH AGE DEPENDENT. = 0 .11870 WITH DIE PEARSON'S R = 0 .11749 SIGNIFICANCE = O.OOOO WITH DIE DEPENDENT. 0 .01979 WITH DIE DEPENDENT. = 0 .06448 WITH DIE DEPENDENT. DEPENDENT. 4^ * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY PLANNED <ATTEMPT PLANNED> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 PLANNED COUNT AGE <L0-19> <20-39> <40-64> <G5-HI> ROW PCT INO YES ROW COL PCT TOTAL TOT PCT I 1 I 2 0 I 1201 I 53 I 1254 I 95 .8 I 4 .2 I 23 .4 I 2 4 . 0 I 15.1 I 22 . 4 I 1.0 1 I 2879 I 203 I 3082 I 93 .4 I 6 . 6 I 57 .5 I 57 . 5 I 57 .8 I 53 .7 I 3 .8 2 I 835 I 79 I 914 I 91 .4 I 8 .6 I 17.1 I 16.7 I 22 . 5 I 15.6 I 1.5 3 I 92 I 16 I 108 I 85 .2 I 14.8 I 2 . 0 I 1.8 I 4 . 6 I 1.7 I 0 . 3 COLUMN 5007 351 5358 TOTAL 93 . 4 6 .6 100.0 29.65877 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0000 RAW CHI SOUARE = CRAMER'S V = 0 .07440 CONTINGENCY COEFFICIENT = 0 .07420 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = O.O LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00248 WITH AGE DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00403 K E N D A L L ' S TAU B = 0 .06446 SIGNIFICANCE (2 -TA ILED) = 0 .0000 K E N D A L L ' S TAU C = 0 .03450 SIGNIFICANCE (2 -TA ILED) = 0 .0000 GAMMA = 0 .23763 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .0000 SOMERS'S D (ASYMMETRIC) = 0.14088 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = 0.04878 ETA = 0 .07164 WITH AGE DEPENDENT. = 0.07451 WITH PLANNED PEARSON'S R = 0 .07165 SIGNIFICANCE = 0 .0000 WITH PLANNED DEPENDENT. = 0 .01066 WITH PLANNED DEPENDENT 0 .02949 WITH PLANNED DEPENDENT. DEPENDENT. -O Ln * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY DIRECTED <ATTEMPT DIRECTED> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 AGE <L0-19> <20-39> <40-64> <65-HI> DIRECTED COUNT ROW PCT IYES PARENT FRIEND COL PCT FAMILY LOVER TOT PCT I 1 [ 2 I 3 0 I 49 [ 102 I 69 I 2 2 . 3 [ 46 . 4 I 31 .4 I 18.2 [ 55 . 4 I 11.4 I 4 . 6 [ 9 .6 I 6 . 5 1 I 164 [ 59 I 424 I 25 . 3 [ 9.1 I 65 . 5 I 6 1 . 0 [ 32 . 1 I 7 0 . 0 I 15.5 [ 5 .6 I 4 0 . 0 2 I 51 [ 18 I 107 I 2 9 . 0 [ 10. 2 I 60 .8 I 19 .0 t 9 .8 I 17.7 I 4 . 8 [ 1.7 I 10. 1 3 I 5 [ 5 I 6 I 3 1 . 3 t 31 .3 I 37 .5 I 1.9 t 2 .7 I 1.0 I 0 . 5 [ 0 . 5 I 0 . 6 COLUMN 269 184 606 TOTAL 25 .4 17.4 57 . 2 ROW TOTAL 220 20.8 647 61.1 176 16.6 16 1 .5 1059 100.0 2 OUT OF 12 ( 16.7%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 . MINIMUM EXPECTED CELL FREOUENCY = 2 .780 RAW CHI SOUARE = 175.68050 WITH 6 DEGREES OF FREEDOM. SIGNIFICANCE = O . O CRAMER'S V = 0 .28800 CONTINGENCY COEFFICIENT = 0.37721 LAMBDA (ASYMMETRIC) = 0 .10437 WITH AGE DEPENDENT. = 0 .07285 WITH DIRECTED DEPENDENT. LAMBDA (SYMMETRIC) = 0 .08786 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.07292 WITH AGE DEPENDENT. = 0 .07423 WITH DIRECTED DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .07357 K E N D A L L ' S TAU B = 0 .10545 SIGNIFICANCE (2 -TAILED) = 0.0002 K E N D A L L ' S TAU C = 0 .08963 SIGNIFICANCE (2 -TAILED) = 0.0002 GAMMA = 0 .17097 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .0002 SOMERS'S D (ASYMMETRIC) = 0.10341 WITH AGE DEPENDENT. = 0 .10753 WITH'DIRECTED DEPENDENT. SOMERS'S D (SYMMETRIC) = 0 .10543 ETA = 0 .27305 WITH AGE DEPENDENT. = 0 .14856 WITH DIRECTED DEPENDENT. PEARSON'S R = 0 .07038 SIGNIFICANCE = 0 .0110 NUMBER OF MISSING OBSERVATIONS = 4299 * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * A G E <AGE> BY COMMUN <PRIOR COMMUNICATION> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 COMMUN COUNT ROW PCT I NO YES ROW COL PCT TOTAL TOT PCT I 1 I 2 AGE -I 0 I 1 195 I 58 I 1253 <LO- 19> I 95 .4 I 4 . 6 I 23 .4 I 23 . 7 I 18.8 I 22 . 3 I 1 . 1 1 I 2891 I 187 I 3078 <20- 39> I 9 3 . 9 I 6 . 1 I 57 .5 I 57 . 3 I 60 . 5 I 5 4 . 0 I 3 .5 2 I 856 I 58 I 914 <40- 64> I 93 . 7 I 6 . 3 I 17.1 I 17 .0 I 18.8 I 16 .0 I 1 . 1 - -I 3 I 102 I 6 I 108 <65- HI> I 94 .4 I 5 .6 I 2 . 0 I 2 . 0 I 1 .9 I 1.9 I 0 . 1 - -I COLUMN 5044 309 5353 TOTAL 9 4 . 2 5 .8 100.0 3 DEGREES OF FREEDOM. RAW CHI SOUARE = 4 .09339 WITH CRAMER'S V = 0 .02765 CONTINGENCY COEFFICIENT = 0.02764 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00038 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00063 K E N D A L L ' S TAU B = 0 .02263 SIGNIFICANCE (2 -TAILED) = 0 .0848 K E N D A L L ' S TAU C = 0 .01142 SIGNIFICANCE (2 -TAILED) = 0 .0848 GAMMA = 0 .09105 SIGNIFICANCE ( 2 - T A I L E D ) = SOMERS'S D (ASYMMETRIC) = 0.05248 WITH AGE SOMERS'S D (SYMMETRIC) = 0 .01646 ETA = 0 .02195 WITH AGE DEPENDENT. PEARSON'S R = 0 .02197 SIGNIFICANCE = 0 .0540 SIGNIFICANCE DEPENDENT. .0848 DEPENDENT. 0 . 0 DEPENDENT. 0 . 2516 WITH COMMUN DEPENDENT. 0.00181 WITH COMMUN DEPENDENT. 0 .00976 WITH COMMUN DEPENDENT. 0 .02770 WITH COMMUN DEPENDENT. NUMBER OF MISSING OBSERVATIONS = 5 * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY CHILDREN <HAVE CHILDREN> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 CHILDREN COUNT ROW PCT I NO YES ROW COL PCT TOTAL TOT PCT I 1 I 2 AGE I 0 I 1213 I 41 I 1254 <LO- 19> I 96 . 7 I 3 .3 I 23 . 4 I 27 .9 I 4.1 I 22 .6 I 0 .8 1 I 2485 I 597 I 3082 <20- 39> I 8 0 . 6 I 19.4 I 57 . 5 I 57 . 1 I 59 .4 I 46 . 4 I 11.1 2 I 587 I 327 I 914 <40- 64> I 64 .2 I 35 . 8 I 17.1 I 13.5 I 32 .5 I 11 .0 I 6.1 3 I 68 I 40 I 108 <65- HI> I 6 3 . 0 I 37 .0 I 2 . 0 I 1.6 I 4 . 0 I 1.3 I 0 .7 COLUMN 4353 1005 5358 TOTAL 81 .2 18.8 100.0 SIGNIFICANCE = 0 . 0 = 0 . 0 WITH CHILDREN DEPENDENT. DEPENDENT. = 0 .08640 WITH CHILDREN DEPENDENT. = 0 .18616 WITH CHILDREN DEPENDENT. WITH CHILDREN DEPENDENT. RAW CHI SOUARE = 395.56836 WITH 3 DEGREES OF FREEDOM. CRAMER'S V = 0.27171 CONTINGENCY COEFFICIENT = 0.26221 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .04016 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.05484 K E N D A L L ' S TAU B = 0 .25788 SIGNIFICANCE (2 -TAILED) = 0 .0 K E N D A L L ' S TAU C = 0 .21775 SIGNIFICANCE (2 -TA ILED) = 0 .0 GAMMA = 0 .59044 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .0 SOMERS'S D (ASYMMETRIC) = 0 .35723 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = 0.24477 ETA = 0 .26731 WITH AGE DEPENDENT. = 0.27172 PEARSON'S R = 0.26731 SIGNIFICANCE = 0.OOOO * * * * * * * * * * * * * * * * C R 0 S S T A 3 U L A T I 0 N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY DEPENDEN <DRUG DEPENDENT> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 DEPENDEN COUNT ROW PCT COL PCT TOT PCT AGE <L0-19> <20-39> <40-64> <65-HI> COLUMN TOTAL NO 1 1 148 9 1 . 7 2 5 . 6 2 1 . 5 2540 82 .9 5 6 . 6 4 7 . 6 705 77 .6 15.7 13.2 97 8 9 . 8 2 . 2 1 . 8 4490 84 . 2 YES I 2 I 104 I 8 .3 I 12.3 I 2 . 0 I 525 I 17.1 I 62 . 3 I 9 .8 I 203 I 22 . 4 I 24 . 1 I 3 .8 I 1 1 I 10.2 I 1.3 I 0 .2 843 15.8 ROW TOTAL 1252 23 . 5 3065 5 7 . 5 908 17.0 108 2 . 0 5333 100.0 RAW CHI SOUARE = 88 .77960 WITH 3 DEGREES OF FREEDOM. CRAMER'S V = 0 .12902 CONTINGENCY COEFFICIENT = 0.12796 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.00862 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.01214 K E N D A L L ' S TAU B = 0 .10894 SIGNIFICANCE (2 -TA ILED) = 0 . 0 K E N D A L L ' S TAU C = 0 .08599 SIGNIFICANCE (2 -TA ILED) = 0 . 0 GAMMA = 0 .27942 SIGNIFICANCE ( 2 - T A I L E D ) = 0 . 0 SOMERS'S D (ASYMMETRIC) = 0.16152 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = 0 .10100 ETA = 0 .10419 WITH AGE DEPENDENT. = 0 .12903 PEARSON'S R = 0 .10419 SIGNIFICANCE = 0 .0000 SIGNIFICANCE = 0 .0000 = 0 .0 WITH DEPENDEN DEPENDENT. DEPENDENT. = 0.02051 WITH DEPENDEN DEPENDENT. = 0 .07347 WITH DEPENDEN DEPENDENT. WITH DEPENDEN DEPENDENT. NUMBER OF MISSING OBSERVATIONS = 25 * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY ILLNESS <PAST ILLNESS> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 ILLNESS COUNT AGE <LO-19> <20-39> <40-64> <65-HI> ROW PCT KNO> <YES> ROW COL PCT TOTAL TOT PCT I 1 I 2 0 I 1205 I 49 I 1254 I 96 . 1 I 3 . 9 I 23 .4 I 2 4 . 5 I 11.1 I 22 . 5 I 0 . 9 1 I 2859 I 223 I 3082 I 9 2 . 8 I 7.2 I 57 . 5 I 58 . 1 I 50 .7 I 53 .4 I 4 . 2 2 I 777 I 136 I 913 I 8 5 . 1 I 14.9 I 17.0 I 15.8 I 30 .9 I 14.5 I 2 . 5 3 I 76 I 32 I 108 I 70 .4 I 29 .6 I 2 . 0 I 1.5 I 7 .3 I 1.4 I 0 .6 COLUMN 4917 440 5357 TOTAL 91 .8 8 . 2 100.0 3 DEGREES OF FREEDOM. SIGNIFICANCE 0 . 0 DEPENDENT. 0 . 0 RAW CHI SOUARE = 154.53534 WITH CRAMER'S V = 0 .16985 CONTINGENCY COEFFICIENT = 0 .16745 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .01150 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .01806 K E N D A L L ' S TAU B = 0 .13939 SIGNIFICANCE (2 -TA ILED) = 0 . 0 K E N D A L L ' S TAU C = 0 .08278 SIGNIFICANCE (2 -TAILED) = 0 . 0 GAMMA = 0 .43708 SIGNIFICANCE ( 2 - T A I L E D ) = 0 . 0 SOMERS'S D (ASYMMETRIC) = 0.27451 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = 0.11254 ETA = 0 .15749 WITH AGE DEPENDENT. = 0.16986 WITH ILLNESS DEPENDENT PEARSON'S R = 0 .15750 SIGNIFICANCE = O.OOOO WITH ILLNESS DEPENDENT. 0 .04205 WITH ILLNESS DEPENDENT. = 0 .07078 WITH ILLNESS DEPENDENT. NUMBER OF MISSING OBSERVATIONS = 1 co o * * * * * * * * * * * * * * + * * * C R 0 S AGE <AGE> * * * * * * * * * * * * * * * * * * * * * * * ACCIDENT COUNT ROW PCT KNO> <YES> ROW COL PCT TOTAL TOT PCT I 1 I 2 I AGE 0 I 1240 I 14 I 1254 <L0-19> I 98.9 I 1.1 I 23.4 I 23.7 I 12.1 I I 23 . 1 I 0.3 1 1 I 3016 I 66 I 3082 <20-39> I 97 .9 I 2.1 I 57 . 5 I 57 .5 I 56.9 I I 56 . 3 I 1.2 1 2 I 884 I 30 I 914 <40-G4> I 96 . 7 I 3.3 I 17.1 I 16.9 I 25.9 I I 16.5 I 0.6 1 3 I 102 I 6 I 108 <65-HI> I 94 .4 I 5.6 I 2.0 I 1.9 I 5.2 I I 1.9 I 0.1 1 COLUMN 5242 1 16 5358 TOTAL 97 .8 2 . 2 100.0 1 OUT OF 8 ( 12.5%) OF THE VALID CELLS * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 \ T I 0 N O F BY ACCIDENT <ACCIDENT> * * * * * * * * * * * * * * * * * * * * SIGNIFICANCE = 0.0 DEPENDENT. MINIMUM EXPECTED CELL FREOUENCY = 2.338 RAW CHI SOUARE = 17.76573 WITH 3 DEGREES OF FREEDOM. CRAMER'S V = 0.05758 CONTINGENCY COEFFICIENT = 0.05749 LAMBDA (ASYMMETRIC) = 0.0 WITH AGE DEPENDENT. LAMBDA (SYMMETRIC) = O.O UNCERTAINTY COEFFICIENT (ASYMMETRIC) - 0.00150 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.00272 KENDALL'S TAU B = 0.05143 SIGNIFICANCE (2-TAILED) = 0.0001 KENDALL'S TAU C = O.01619 SIGNIFICANCE (2-TAILED) = 0.0001 GAMMA = 0.31876 SIGNIFICANCE (2-TAILED) = 0.0001 SOMERS'S D (ASYMMETRIC) = 0.19109 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = 0.02581 ETA = 0.05652 WITH AGE DEPENDENT. = 0.05784 WITH ACCIDENT DEPENDENT. PEARSON'S R = 0.05652 SIGNIFICANCE = 0.OOOO 0.0005 WITH ACCIDENT DEPENDENT. = 0.01491 WITH ACCIDENT DEPENDENT. 0.01384 WITH ACCIDENT DEPENDENT. 00 * * * * AGE * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * <AGE> BY VIOLENCE <FAMILY VIOLENCE> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 VIOLENCE COUNT ROW PCT KNO> <YES> ROW COL PCT TOTAL TOT PCT I 1 [ 2 AGE 0 I 1 170 t 83 I 1253 <LO- 19> I 93 .4 [ 6 .6 I 23 .4 I 23 .6 [ 2 1 . 0 I 21 .8 [ 1.5 1 I 2825 [ 257 I 3082 <20- 39> I 9 1 . 7 [ 8 . 3 I 57 . 5 I 56 . 9 [ 6 4 . 9 I 52 .7 [ 4 . 8 2 I 860 [ 54 I 914 <40- G4> I 94 . 1 [ 5 .9 I 17.1 I 17.3 [ 13.6 I 16.1 [ 1.0 3 I 106 [ 2 I 108 <65- HI> I 98 . 1 [ 1.9 I 2 . 0 I 2.1 [ 0 . 5 I 2 . 0 t 0 . 0 COLUMN 4961 396 5357 TOTAL 92 .6 7 . 4 100.0 RAW CHI SOUARE = 12.89671 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0049 CRAMER'S V = 0 .04907 CONTINGENCY COEFFICIENT = 0.04901 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 WITH VIOLENCE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00134 WITH AGE DEPENDENT. = 0 .00528 WITH VIOLENCE DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00214 KENDALL 'S TAU B = - 0 . 0 1 0 4 7 SIGNIFICANCE (2 -TA ILED) = 0 .4298 KENDALL 'S TAU C = - 0 . 0 0 5 9 3 SIGNIFICANCE (2 -TA ILED) = 0 .4298 GAMMA = - 0 . 0 3 8 8 3 SIGNIFICANCE ( 2 - T A I L E D ) = 0.4298 SOMERS'S D (ASYMMETRIC) = -0 .02164 WITH AGE DEPENDENT. = -0 .00507 WITH VIOLENCE DEPENDENT. SOMERS'S D (SYMMETRIC) = -0 .00821 ETA = 0 .01632 WITH AGE DEPENDENT. = 0 .04915 WITH VIOLENCE DEPENDENT. PEARSON'S R =-0 .01630 SIGNIFICANCE = 0 .1164 NUMBER OF MISSING OBSERVATIONS = 1 * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY DEATH <DEATH OF SIG OTHER> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * . * * * * * * * * * * PAGE 1 OF 1 DEATH COUNT ROW PCT KNO> <YES> ROW COL PCT TOTAL TOT PCT I 1 I 2 AGE -I 0 I 1200 I 54 I 1254 <L0-19> I 95 . 7 I 4 . 3 I 23 .4 I 23 .9 I 16.2 I 22 .4 I 1.0 1 I 2906 I 175 I 3081 <20-39> I 94 . 3 I 5 .7 I ' 57 .5 I 57 .9 I 52 . 4 I 54 . 3 I 3 . 3 2 I 832 I 81 I 913 <40-G4> I 91.1 I 8 . 9 I 17.0 I 16.6 I 24 . 3 I 15.5 I 1.5 3 ' I 84 I 24 I 108 <65-HI> I 77 .8 I 22 .2 I 2 . 0 I 1.7 I 7 .2 _ I 1.6 I 0 . 4 COLUMN 5022 334 5356 TOTAL 93 .8 6 .2 100.0 67 .66769 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE RAW CHI SOUARE = CRAMER'S V = 0 .11240 CONTINGENCY COEFFICIENT = 0 .11170 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00448 WITH AGE DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00732 KENDALL 'S TAU B = 0 .07667 SIGNIFICANCE (2 -TAILED) = 0 . 0 KENDALL 'S TAU C = 0 .04010 SIGNIFICANCE (2 -TAILED) = 0 . 0 GAMMA = 0 .27799 SIGNIFICANCE ( 2 - T A I L E D ) = 0 . 0 SOMERS'S D (ASYMMETRIC) = 0 .17146 WITH AGE DEPENDENT. SOMERS'S D (SYMMETRIC) = 0 .05715 ETA = 0 .09182 WITH AGE DEPENDENT. = 0.11246 WITH DEATH PEARSON'S R = 0 .09182 SIGNIFICANCE = 0 .0000 0 . OOOO WITH DEATH DEPENDENT. 0 .01993 WITH DEATH DEPENDENT. 0 .03429 WITH DEATH DEPENDENT. DEPENDENT. NUMBER OF MISSING OBSERVATIONS = 2 CO CO * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY ATTEMPTS <PRIOR ATTEMPTS> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 ATTEMPTS AGE <LO-19> <20-39> <40-64> <65-HI> COUNT ROW PCT KNO> <YES> ROW COL PCT TOTAL TOT PCT I 1 I 2 0 I 1069 I 185 I 1254 I 8 5 . 2 I 14.8 I 23.4 I 25 .6 I 15.7 I 2 0 . 0 I 3 .5 1 I 2316 I 766 I 3082 I 75 . 1 I 24 .9 I 57 . 5 I 55 .4 I 6 4 . 9 I 43 .2 I 14.3 2 I 700 I 214 I 914 I 76 . 6 I 23 . 4 I 17.1 I 16.8 I 18.1 I 13.1 I 4 . 0 3 I 92 I 15 I 107 I 8 6 . 0 I 14 .0 I 2 . 0 I 2 .2 I 1.3 I 1.7 I 0 . 3 COLUMN 4177 1 180 5357 TOTAL 78 .0 22 .0 100.0 RAW CHI SOUARE = 57 .99309 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0000 CRAMER' S V = O.10405 CONTINGENCY COEFFICIENT = 0 .10349 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 WITH ATTEMPTS DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00555 WITH AGE DEPENDENT. = 0 .01093 WITH ATTEMPTS DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00737 KENDALL 'S TAU B = 0 .06270 SIGNIFICANCE (2 -TAILED) = 0 .0000 KENDALL 'S TAU C = 0 .05620 SIGNIFICANCE (2 -TAILED) = 0 .0000 GAMMA = 0 .14369 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .0000 SOMERS'S D (ASYMMETRIC) = 0 .08180 WITH AGE DEPENDENT. = 0 .04806 WITH ATTEMPTS DEPENDENT. SOMERS'S D (SYMMETRIC) = 0 .06054 ETA = 0 .05618 WITH AGE DEPENDENT. = 0 .10405 WITH ATTEMPTS DEPENDENT. PEARSON'S R = 0 .05617 SIGNIFICANCE = 0 .0000 NUMBER OF MISSING OBSERVATIONS = 1 * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY PRIOTYPE <PRIOR CONTACT TYPE> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 PRIOTYPE AGE <L0-19> <20-39> <40-64> <65-HI> COUNT ROW PCT I NO SERVICE ROW COL PCT ISERVICE TOTAL TOT PCT I 1 I 2 0 I 33 I 62 [ 95 I 34 . 7 I 65 . 3 [ 12.5 I 11 .0 I 13.4 I 4 . 3 I 8.1 1 I 200 I 309 [ 509 I 39 . 3 I 6 0 . 7 [ 66 . 8 I 66 . 7 I 6 6 . 9 I 26 . 2 I 40 .6 2 I 63 I 84 [ 147 I 4 2 . 9 I 57 . 1 [ 19.3 I 2 1 . 0 I 18.2 I 8 .3 I 11 .0 3 I 4 I 7 [ 1 1 I 36 .4 I 6 3 . 6 [ 1.4 I 1.3 I 1.5 I 0 . 5 I 0 . 9 COLUMN 300 462 762 TOTAL 39 . 4 6 0 . 6 100.0 1 OUT OF 8 ( 12.5%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 . MINIMUM EXPECTED CELL FREOUENCY = 4.331 RAW CHI SOUARE = 1.64611 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .6490 CRAMER'S V = 0 .04648 CONTINGENCY COEFFICIENT = 0.04643 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 . 0 WITH PRIOTYPE DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00120 WITH AGE DEPENDENT. = 0 .00162 WITH PRIOTYPE DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00137 KENDALL 'S TAU B = - 0 . 0 4 0 5 2 SIGNIFICANCE (2 -TA ILED) = 0 .2550 KENDALL 'S TAU C = - 0 . 0 3 9 6 2 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .2550 GAMMA = - 0 . 0 8 2 8 4 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .2550 SOMERS'S D (ASYMMETRIC) = -0 .04150 WITH AGE DEPENDENT. = - 0 .03956 WITH PRIOTYPE DEPENDENT. SOMERS'S D (SYMMETRIC) = -0 .04051 ETA = 0 .03937 WITH AGE DEPENDENT. = 0 .04648 WITH PRIOTYPE DEPENDENT. PEARSON'S R =-0.03937 SIGNIFICANCE = 0 .1389 NUMBER OF MISSING OBSERVATIONS = 4596 * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGE <AGE> BY CONTYPE <CONTACT TYPE> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 CONTYPE COUNT ROW PCT I NO SERVICE ROW COL PCT ISERVICE TOTAL TOT PCT I 1 I 2 AGE -I 0 I 407 I 842 [ 1249 <LO- 19> I 32 .6 I 67 .4 [ 23 .4 I 19.1 I 26 . 1 I 7 .6 I T 15.7 1 I 1279 1 I 1798 [ 3077 <20- 39> I 4 1.6 I 58 .4 [ 57 . 5 I 60 . 1 I 55 .8 I 2 3 . 9 I 33 .6 2 I 392 I 522 [ 914 <40- 64> I 4 2 . 9 I 57 . 1 [ 17.1 I 18.4 I 16 . 2 I 7 .3 I 9 .8 3 I 49 I 58 [ 107 <65- HI> I 45 .8 I 54 . 2 [ 2 . 0 I 2 .3 I 1 .8 I 0 . 9 I T 1 . 1 COLUMN 2127 1 3220 5347 TOTAL 39 .8 60 . 2 100.0 3 DEGREES OF FREEDOM. SIGNIFICANCE DEPENDENT. RAW CHI SOUARE = 36.38458 WITH CRAMER'S V = 0 .08249 CONTINGENCY COEFFICIENT = 0.08221 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE LAMBDA (SYMMETRIC) = O .O UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00333 WITH AGE UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00405 K E N D A L L ' S TAU B = -0 .07062 SIGNIFICANCE (2 -TAILED) = 0 K E N D A L L ' S TAU C = - 0 .07476 SIGNIFICANCE (2 -TAILED) = 0 GAMMA = -0 .13361 SIGNIFICANCE ( 2 - T A I L E D ) = SOMERS'S D (ASYMMETRIC) = -0 .07802 WITH AGE SOMERS'S D (SYMMETRIC) = -0 .07028 ETA = 0 .07204 WITH AGE DEPENDENT. PEARSON'S R =-0.07202 SIGNIFICANCE = 0 .0000 0 .0 DEPENDENT. = 0 . 0 DEPENDENT. 0 . OOOO WITH CONTYPE DEPENDENT. = 0 .00515 WITH CONTYPE DEPENDENT. = - 0 .06393 WITH CONTYPE DEPENDENT. 0 .08248 WITH CONTYPE DEPENDENT. NUMBER OF MISSING OBSERVATIONS = 11 CO CTi * * * * AGE * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * <AGE> BY REASON <REASON FOR ASSESS> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 REASON AGE <LO-19> <20-39> <40-64> <65-HI> COUNT ROW PCT IUNABLE REFUSAL AGENCIES OTHER ROW COL PCT ICONTACT KIN-PROF INVOLVED TOTAL TOT PCT I 1 I 2 [ 3 4 0 I 154 I 115 t 1 10 55 I 434 I 3 5 . 5 I 26 . 5 t 25 .3 ] 12.7 I 19.3 I 15 .0 I 28 .6 [ 28.1 ] 12.7 I G . 8 I 5.1 [ 4 . 9 2.4 1 I 700 I 208 [ 200 I 240 I 1348 I 5 1 . 9 I 15.4 [ 14.8 ] 17.8 I 59 .8 I 68 . 1 I 51 .7 [ 51 .2 ] 55 . 4 I 31.1 I 9 .2 [ 8 .9 1 10.6 2 I 162 I 73 t 68 1 117 I 420 I 3 8 . 6 I 17.4 t 16.2 27 .9 I 18.6 I 15.8 I 18.2 [ 17.4 ] 27 .0 I 7 .2 I 3 .2 [ 3 .0 ] 5.2 3 I 12 I 6 t 13 ] 21 I 52 I 23 . 1 I 11.5 t 2 5 . 0 1 40. 4 I 2 .3 I 1.2 I 1.5 [ 3 .3 1 4.8 I 0 . 5 I 0 . 3 [ 0 . 6 ] 0 .9 COLUMN 1028 402 391 433 2254 TOTAL 4 5 . 6 17.8 17.3 19.2 100.0 RAW CHI SOUARE = 118.25435 WITH 9 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0000 CRAMER'S V = 0 .13224 CONTINGENCY COEFFICIENT = 0.22327 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGE DEPENDENT. = 0 .00734 WITH REASON DEPENDENT. LAMBDA (SYMMETRIC) * 0 .00422 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .02436 WITH AGE DEPENDENT. = 0 .01940 WITH REASON DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .02160 K E N D A L L ' S TAU B = 0 .04696 SIGNIFICANCE (2 -TAILED) = 0 .0113 K E N D A L L ' S TAU C = 0 .03936 SIGNIFICANCE (2 -TA ILED) = 0.0113 GAMMA = 0 .07242 SIGNIFICANCE (2 -TA ILED) = 0 .0113 SOMERS'S D (ASYMMETRIC) = 0 .04258 WITH AGE DEPENDENT. = 0 .05178 WITH REASON DEPENDENT. SOMERS'S D (SYMMETRIC) = 0.04673 ETA = 0 .15453 WITH AGE DEPENDENT. = 0.14884 WITH REASON DEPENDENT. PEARSON'S R = 0 .08291 SIGNIFICANCE = 0 .0000 NUMBER OF MISSING OBSERVATIONS = 3104 CO 1 8 8 A P P E N D I X D * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGELEVEL BY SEX • <SEX> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 SEX AGELEVEL COUNT I ROW PCT IFEMALE MALE ROW COL PCT I TOTAL TOT PCT I 1 I 2 1 I 46 I 23 I 69 74> I 66 . 7 I 33 .3 I 6 3 . 9 I 6 3 . 9 I 6 3 . 9 I 4 2 . 6 I 21 .3 - I - -I 2 I 26 I 13 I 39 99> I 6 6 . 7 I 33 . 3 I 36. 1 I 36 . 1 I 36 . 1 I 24. 1 I 12.0 - I - -I COLUMN 72 36 .108 TOTAL 66 . 7 33 . 3 100.0 WITH 1 DEGREE OF FREEDOM. WITH 1 DEGREE OF FREEDOM. SIGNIFICANCE = SIGNIFICANCE = 1 . OOOO 1 . OOOO WITH SEX CORRECTED CHI SOUARE = 0 . 0 RAW CHI SOUARE = 0 . 0 PHI = 0 . 0 CONTINGENCY COEFFICIENT = 0 . 0 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGELEVEL DEPENDENT. = 0 . 0 LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00000 WITH AGELEVEL DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00000 K E N D A L L ' S TAU B = 0 . 0 SIGNIFICANCE (2 -TA ILED) = 0 .8325 K E N D A L L ' S TAU C = 0 . 0 SIGNIFICANCE (2 -TA ILED) = 0 .8325 GAMMA = 0 . 0 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .8325 SOMERS'S D (ASYMMETRIC) = 0 . 0 WITH AGELEVEL DEPENDENT. = 0 . 0 WITH SEX SOMERS'S D (SYMMETRIC) = 0 . 0 ETA = 0 . 0 WITH AGELEVEL DEPENDENT. = 0 .0 WITH SEX DEPENDENT. PEARSON'S R = 0 . 0 SIGNIFICANCE = 0 .5000 DEPENDENT. = 0 .00000 WITH SEX DEPENDENT. DEPENDENT. NUMBER OF MISSING OBSERVATIONS = 5250 CO VD * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGELEVEL BY MARITAL <MARITAL STATUS> * * * * * * * * * * * * * * * * * * * * * * * * * + * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 COUNT ROW PCT COL PCT MARITAL I I SINGLE I MARRIED WIDOWED DIV-SEP ROW TOTAL TOT PCT I 1 I 2 I 3 4 I AGELEVEL 1 I 3 I 21 I 17 9 I 50 <65 TO 74> I 6 0 I 42 .0 I 34 .0 I 18 0 I 63 . 3 I 33 3 I 7 0 . 0 I 54 .8 I 100 0 I I 3 8 I 26 .6 I 21 .5 I 1 1 4 I 2 I 6 I 9 I 14 0 I 29 <75 TO 99> I 20 7 I 3 1 . 0 I 48 . 3 I 0 0 I 36 .7 I GG 7 I 3 0 . 0 I 45 . 2 I 0 0 I I 7 6 I 11.4 I 17.7 I 0 0 I - I - - I - - I - -I COLUMN 9 30 31 9 79 TOTAL 1 1 4 38 .0 39 .2 1 1 4 100. O 2 OUT OF 8 ( 25.0%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5 . 0 . MINIMUM EXPECTED CELL FREOUENCY = 3.304 RAW CHI SOUARE = 10.23098 WITH 3 DEGREES OF FREEDOM. SIGNIFICANCE = 0 .0167 CRAMER'S V = 0 .35987 CONTINGENCY COEFFICIENT = 0.33861 LAMBDA (ASYMMETRIC) = 0 .10345 WITH AGELEVEL DEPENDENT. = 0 .08333 WITH MARITAL DEPENDENT. LAMBDA (SYMMETRIC) = 0.09091 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.12587 WITH AGELEVEL DEPENDENT. = 0 .06729 WITH MARITAL DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .08770 KENDALL 'S TAU B = -0 .15954 SIGNIFICANCE (2 -TAILED) = 0 .1500 KENDALL 'S TAU C = -0 .17882 SIGNIFICANCE (2 -TAILED) = 0 .1500 GAMMA = -0 .27761 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .1500 SOMERS'S D (ASYMMETRIC) = - 0 . 1 3 2 2 9 WITH AGELEVEL DEPENDENT. = -0 .19241 WITH MARITAL DEPENDENT. SOMERS'S D (SYMMETRIC) = - 0 . 1 5 6 7 9 ETA = 0 .35987 WITH AGELEVEL DEPENDENT. = 0.20895 WITH MARITAL DEPENDENT. PEARSON'S R =-0.20894 SIGNIFICANCE = 0 .0323 NUMBER OF MISSING OBSERVATIONS = 5279 O * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGELEVEL BY METHOD <METHOD OF ATTEMPT> • • • i t * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 METHOD COUNT ROW PCT ISELF-INJ SELF-POI OTHER COL PCT IURY SON ROW TOTAL TOT PCT I 1 I 2 ] 3 AGELEVEL - I - - I -1 I 8 I 59 ] 1 I 68 <65 TO 74> I 1 1 .8 I 86.8 ] 1 5 I 64 . 2 I 6 1 .5 I 65.6 ] 33 3 I 7 . 5 I 55.7 ] 0 9 - I - - I -2 I 5 I 31 1 2 I 38 <75 TO 99> I 13 . 2 I 81.6 ] 5 3 I 35 . 8 I 38 .5 I 34.4 ] 66 7 I 4 . 7 I 29. 2 ] 1 9 - I - - I -COLUMN 13 90 3 106 TOTAL 12 . 3 84.9 2 8 100.0 3 OUT OF 6 ( 50.0%) OF THE VALID CELLS HAVE EXPECTED CELL FREOUENCY LESS THAN 5.0. MINIMUM EXPECTED CELL FREOUENCY = 1.075 RAW CHI SOUARE = 1.35470 WITH 2 DEGREES OF FREEDOM. SIGNIFICANCE = 0.5080 CRAMER'S V = 0.11305 CONTINGENCY COEFFICIENT = 0.11233 LAMBDA (ASYMMETRIC) = 0.02632 WITH AGELEVEL DEPENDENT. = 0.0 WITH METHOD DEPENDENT. LAMBDA (SYMMETRIC) = 0.01852 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.00931 WITH AGELEVEL DEPENDENT. = 0.01222 WITH METHOD DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0.01057 KENDALL'S TAU B = 0.02609 SIGNIFICANCE (2-TAILED) = 0.8967 KENDALL'S TAU C = 0.01816 SIGNIFICANCE (2-TAILED) = 0.8967 GAMMA = 0.07153 SIGNIFICANCE (2-TAILED) = 0.8967 SOMERS'S D (ASYMMETRIC) = 0.03448 WITH AGELEVEL DEPENDENT. = 0.01974 WITH METHOD DEPENDENT. SOMERS'S D (SYMMETRIC) = 0.02510 ETA = 0.11305 WITH AGELEVEL DEPENDENT. = 0.03055 WITH METHOD DEPENDENT. PEARSON'S R = 0.03053 SIGNIFICANCE = 0.3780 NUMBER OF MISSING OBSERVATIONS = 5252 VD * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGELEVEL BY PLANNED <PLANNED TO DIE> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 PLANNED COUNT AGELEVEL ROW PCT I NO YES ROW COL PCT TOTAL TOT PCT I 1 I 2 1 I 52 I 17 I 69 74> I 75 .4 I 24 .6 I 6 3 . 9 I 64 . 2 I 6 3 . 0 I 48 . 1 I 15.7 2 I 29 I 10 I 39 99> I 74 . 4 I 25 .6 I 36 . 1 I 35 .8 I 37 .0 I 26 .9 I 9 . 3 COLUMN 81 27 108 TOTAL 75 .0 25 .0 100.0 SIGNIFICANCE SIGNIFICANCE = 0 OOOO 9079 = O.O CORRECTED CHI SOUARE = 0 .0 WITH 1 DEGREE OF FREEDOM. RAW CHI SOUARE = 0.01338 WITH 1 DEGREE OF FREEDOM. PHI = 0 . 0 1 1 1 3 CONTINGENCY COEFFICIENT = 0 .01113 LAMBDA (ASYMMETRIC) = 0 . 0 WITH AGELEVEL DEPENDENT. LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00009 WITH AGELEVEL DEPENDENT UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00010 K E N D A L L ' S TAU B = 0 .01113 SIGNIFICANCE (2 -TA ILED) = 0 .9083 K E N D A L L ' S TAU C = 0 .00926 SIGNIFICANCE (2 -TAILED) = 0 .9083 GAMMA = 0 .02665 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .9083 SOMERS'S D (ASYMMETRIC) = 0 .01235 WITH AGELEVEL DEPENDENT. SOMERS'S D (SYMMETRIC) = 0 .01107 ETA = 0 .01110 WITH AGELEVEL DEPENDENT. = 0.01112 WITH PLANNED DEPENDENT PEARSON'S R = 0 .01113 SIGNIFICANCE = 0 .4545 WITH PLANNED DEPENDENT. 0.00011 WITH PLANNED DEPENDENT. 0 .01003 WITH PLANNED DEPENDENT. NUMBER OF MISSING OBSERVATIONS = 5250 KD t o AGELEVEL C R O S S T A B U L A T BY I 0 N PRIOR 0 F <PRIOR ATTEMPT> PAGE 1 OF 1 PRIOR COUNT ROW PCT I NO YES ROW COL PCT I TOTAL TOT PCT I 1 I 2 AGELEVEL - I - - -I 1 I 59 I 10 I 69 <65 TO 74> I 85 . 5 I 14 . 5 I 64 .5 I 64 . 1 I 66 . 7 I 55 . 1 I 9 . 3 - I - - -I 2 I 33 I 5 I 38 <75 TO 99> I 86 .8 I 13 . 2 I 35 .5 I 35 .9 I 33 . 3 I 30 .8 I 4 . 7 - I - - -I COLUMN 92 15 107 TOTAL 86 .0 14 .0 100.0 0 .0 WITH 1 DEGREE OF FREEDOM. 0 .03623 WITH 1 DEGREE OF FREEDOM. SIGNIFICANCE SIGNIFICANCE 0 .01840 WITH AGELEVEL DEPENDENT. 0 . 0 CORRECTED CHI SOUARE = RAW CHI SOUARE = PHI = 0 . 0 1 8 4 0 CONTINGENCY COEFFICIENT = LAMBDA (ASYMMETRIC) = 0 . 0 LAMBDA (SYMMETRIC) = O .O UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0.00026 WITH AGELEVEL DEPENDENT. UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00032 K E N D A L L ' S TAU B = - 0 . 0 1 8 4 0 SIGNIFICANCE (2 -TAILED) = 0 .9202 K E N D A L L ' S TAU C = -0 .01223 SIGNIFICANCE (2 -TA ILED) = 0 .9202 GAMMA = - 0 . 0 5 6 0 0 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .9202 SOMERS'S D (ASYMMETRIC) = -0 .02536 WITH AGELEVEL DEPENDENT. = -SOMERS'S D (SYMMETRIC) = -0 .01749 ETA = 0 .01839 WITH AGELEVEL DEPENDENT. = 0 .01836 WITH PRIOR PEARSON'S R =-0 .01840 SIGNIFICANCE = 0.4254 1 . OOOO 0.8491 WITH PRIOR DEPENDENT. 0 .00042 WITH PRIOR DEPENDENT. 0 .01335 WITH PRIOR DEPENDENT. DEPENDENT. NUMBER OF MISSING OBSERVATIONS = 5251 KD * * * * * * * * * * * * * * * * * * C R O S S T A B U L A T I O N O F * * * * * * * * * * * * * * * * * * AGELEVEL BY CONTYPE <CONTACT TYPE> * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PAGE 1 OF 1 COUNT ROW PCT COL PCT TOT PCT CONTYPE I INO SERVI ICE AGELEVEL 1 <65 TO 74> <75 TO 99> COLUMN TOTAL 1 SOME VICE SER 33 ] 36 I 69 47 .8 ] 52 . 2 I 64 . 5 67 . 3 ] 62 . 1 30 .8 ] 3 3 . 6 16 ] 22 I 38 42 . 1 ] 5 7 . 9 I 35 . 5 32 . 7 ] 37 . 9 15 .0 1 20 .6 49 58 107 45 .8 54 . 2 100.0 ROW TOTAL .05487 WITH AGELEVEL DEPENDENT. = 0 . 0 CORRECTED CHI SOUARE = 0 .13372 WITH 1 DEGREE OF FREEDOM. SIGNIFICANCE RAW CHI SOUARE = 0.32308 WITH 1 DEGREE OF FREEDOM. SIGNIFICANCE PHI = 0 .05495 CONTINGENCY COEFFICIENT = LAMBDA (ASYMMETRIC) = 0 . 0 LAMBDA (SYMMETRIC) = 0 . 0 UNCERTAINTY COEFFICIENT (ASYMMETRIC) = 0 .00233 WITH AGELEVEL DEPENDENT UNCERTAINTY COEFFICIENT (SYMMETRIC) = 0 .00226 K E N D A L L ' S TAU B = 0 .05495 SIGNIFICANCE (2 -TAILED) = 0 .7159 K E N D A L L ' S TAU C = 0.05241 SIGNIFICANCE (2 -TAILED) = 0 .7159 GAMMA = 0.11521 SIGNIFICANCE ( 2 - T A I L E D ) = 0 .7159 SOMERS'S D (ASYMMETRIC) = 0 .05278 WITH AGELEVEL DEPENDENT. SOMERS'S D (SYMMETRIC) = 0 .05490 ETA = O.05495 WITH AGELEVEL DEPENDENT. = 0 .05495 WITH CONTYPE PEARSON'S R = 0 .05495 SIGNIFICANCE = 0 .2870 0 .7146 0 .5698 WITH CONTYPE DEPENDENT. 0 .00219 WITH CONTYPE DEPENDENT. 0.05721 WITH CONTYPE DEPENDENT. DEPENDENT. NUMBER OF MISSING OBSERVATIONS 5251 VO 

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