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Preventing Suicide Among Veterans and Other Vulnerable Groups

Experts on suicide, particularly among veterans, led a wide-ranging conversation about risk factors and effective interventions at an event hosted by UCLA Luskin Social Welfare. Professor Mark S. Kaplan shared insights from his extensive research of at-risk populations with the gathering of students and social workers. “What many vulnerable young veterans returning from places like Afghanistan and Iraq needed more than anything else was not a psychiatrist but a social worker, somebody who could help them with that transition into civilian life, somebody who could help them with their family and their community,” he said. “It was really a challenge of reintegration that mattered most; it wasn’t a psychiatric problem.” The Nov. 6, 2018, panel included Susan Pindack, a social worker with the Veterans Affairs Greater Los Angeles Healthcare System; Sam Coleman, a lecturer at Cal State Long Beach and coordinator of the Veterans for Peace PTSD Working Group; and Carolyn Levitan, director of the crisis line at Didi Hirsch Mental Health Services’ Suicide Prevention Center. The panel’s broad experience led to an expansive discussion that touched on Civil War fighters who took their own lives, firearm use among female soldiers, the role of pain management in preventing suicide and the impact of the Netflix series “13 Reasons Why.” Students from the Mental Health Caucus at UCLA, one of several event co-sponsors, led a question-and-answer session after the panel presentations. — Mary Braswell

View a Flickr album from the event here.


 

 

Kaplan to Advise CDC on Prevention of Violence and Injuries

The U.S. Department of Health and Human Services has named UCLA Luskin Professor of Social Welfare Mark S. Kaplan to a board of experts on the prevention of violence and injuries. Kaplan will serve a four-year term on the Board of Scientific Counselors for the National Center for Injury Prevention and Control, a branch of the Centers for Disease Control and Prevention. The CDC reports that 214,000 people die from injury every year in the United States, and millions who survive an injury face lifelong mental, physical and financial problems. The board will advise the federal agencies on a variety of research areas to help set priorities and improve public health. “This is an incredible career achievement,” Social Welfare chair Laura Abrams said of the appointment. Kaplan’s research has focused on understanding suicide risk factors among veterans, seniors and other vulnerable populations. The CDC reports that suicide is one of just three leading causes of death that are on the rise. Members of the Board of Scientific Counselors represent several disciplines and include epidemiologists, statisticians, trauma surgeons, behavioral scientists, health economists, political scientists and criminologists.

Kaplan Discusses CDC Report About Suicide Rates Rising Across U.S. 

New CDC figures documenting the growing rate of suicide may not reflect the full scope of the problem, said Mark S. Kaplan, professor of social welfare at UCLA Luskin. Many suicides are actually classified as ”accidental deaths,” Kaplan, a noted suicide prevention researcher, told WebMD. “Some are classified as unintentional self-injury when, in fact, if you take a closer look, they look more like suicide,” he said. “The true incidence of suicide is unknown.” Kaplan said the Great Recession from 2007 to 2009 contributed to what he terms ”deaths of despair” by suicide. Some people, he said, never recovered economically.


 

The Connection Between Poverty, Inequality and Firearm Violence UCLA Luskin’s Mark Kaplan explains how circumstances in U.S. urban centers go hand in hand with gun violence

By Stan Paul

A fatal gunshot wound. This is a slide that Mark Kaplan, professor of Social Welfare at the UCLA Luskin School of Public Affairs, shows early in his presentation on gun violence.

As he recites annual gun death statistics in the United States, the vivid and unsettling scene serves as a backdrop.

“This might have been a suicide, this might have been a homicide; we’re not exactly sure. All I can tell you is that it was a fatal gunshot wound,” said Kaplan who spoke on “Poverty, Inequality and Firearm Violence,” Jan. 26, 2017 at the Luskin School as part of the Public Child Welfare Seminar series.

“The reason for putting this up is because quite often the discussion about guns is sanitized.” Kaplan explained, “We often treat the issue of gun violence as an abstraction but when you talk to people who are working in emergency departments, when you talk to coroners and medical centers, this is what people tell you. This is the net effect of guns.”

Across the nation, that net effect amounts to more than 33,000 similar scenes recorded each year on average, and more than 36,000 for 2015, Kaplan reported as the latest available data. What stands out for Kaplan is that two-thirds are suicides, his area of research. Kaplan, who holds adjunct appointments in psychiatry at the Oregon Health & Science University and in epidemiology and community medicine at the University of Ottawa, focuses on using population-wide data to understand suicide risk factors and firearm violence among vulnerable populations.

“So, the problem of gun violence in this country is primarily a suicide problem, less so a homicide problem,” said Kaplan to the audience, which included future social workers who are students in the master of social welfare (MSW) program. While recognizing the spike in gun deaths in cities such as Chicago – more than 50 in January in that city alone — Kaplan said that over the past 10-15 years there has been an overall national decline in the rate of gun deaths.

Kaplan said gun ownership in the U.S. is at more than 300 million and growing, and the death rate is only part of the story. He pointed out that for all of the recorded deaths by guns, there were more than 81,000 people – more than 200 per day – injured nationwide by guns in 2014.

“There are a lot of individuals who are shot, who survive, who wind up in emergency departments, are hospitalized and often disabled for life.”

A relationship exists between the high rate of guns and gun ownership and the number of homicides, suicides and injuries. Kaplan said that work is needed “on the ground” in America’s cities, such as limiting access to guns that would “go a long way to reducing some of the fatalities that we’re experiencing both in the homicide and suicide.”

He pointed to the work of one of his doctoral students that showed almost 90 percent of suicides involved guns in some parts of the country. California is an exception, according to Kaplan, who credited the state’s stringent gun control measures.

“California is an outlier. There aren’t many states like us,” he noted, suggesting that California could serve as a role model for the rest of the country. Unfortunately, two-thirds of states fall into the quadrant with both high rates of gun violence and lax restrictions on gun ownership, he said. “We are a gun-toting, gun-culture nation, and that’s going to make things a little bit challenging.”

The U.S. stands out among industrialized nations, Kaplan said. Gun homicides in the U.S. are 25 times higher than the average of other high-income countries. Factors such as poverty and inequality are contributing factors, he said.

“You all hear about poverty, but inequality is another measure of economic well-being. And there is a strong correlation between homicide per million and income inequality,” said Kaplan, pointing out that countries that are most equal have the lowest rates of gun-related homicides.

In terms of race and ethnicity, Kaplan said that 77 percent of white gun deaths in the U.S. are suicides, while less than 1 in 5 (19 percent) is a homicide. The figures are nearly opposite for African Americans, for which only 14 percent are suicides.

African American males in the 20-29 age group have the highest risk (89 per 100,000) in terms of the firearm homicide rate, a figure that is comparable with Honduras (90.4 murders per 100,000 people).

“In many ways we look like what some developing or Third World countries are experiencing,” Kaplan said.

Citing recent scholarship published by the Brookings Institution, he said that people who witness gun violence are also at increased risk for a variety mental health issues that can manifest as post traumatic stress disorder (PTSD), depression, poor academic performance, substance abuse, risky sexual behavior, delinquency and violent behavior – a “constellation of interconnected pathologies.”

Cities such as Los Angeles and New York have been stereotyped as “dangerous big cities,” Kaplan said, but both have benefitted from gun control measures. “Look how well we do in Los Angeles. New York is another place where the homicide rate has declined quite dramatically in the past 10-15, maybe 20, years.”

In contrast, Philadelphia today still has a high homicide rate, he said. And Texas, which has some of the least restrictive gun law on the books (with both Dallas and Houston appearing close to the bottom), has among the highest rates of gun deaths in the United States.

UCLA Luskin’s Mark Kaplan talks about a spike in gun violence in Chicago, a topic that has been much discussed by President Donald Trump and others. Photo by Stan Paul

Kaplan, who was born in Chicago, spoke about that city’s spike in murders in the past few years – nearly 300 shootings this January. One of Kaplan’s slides showed a recent tweet by President Trump about gun homicides in Chicago.

“We don’t know what [Trump] is going to do, but he is reacting to something legitimate” that is not occurring randomly, Kaplan said in reference to the accuracy of the numbers.

“You can approach this problem as a criminal justice problem … or approach it as a public health or social welfare or social justice problem, and that’s was missing in the discussion,” Kaplan said. Social inequality and income inequality are to some extent fueling the gun violence epidemic in Chicago, he noted.

Over the long term, however, little has really changed in Chicago, which has concentrated areas of poverty and racial segregation. Some areas are 90 percent African American. “Neighborhoods still look the same way as they did 10, 15, 20, maybe even 30, years ago. Chicago is a very divided city socio-economically,” Kaplan said.

The addition of guns increases violence. “The more guns, the more lethal the assault. When guns are absent, people are more likely to survive an assault,” said Kaplan. “If we could just tamp down the levels of gun ownership, that might – might – be the first step in trying to reduce the rate of gun violence.”

Compared to other leading causes of death in the U.S., the national investment in trying to understand and prevent gun deaths “pales by comparison” to what is spent on other causes of death and other major health problems, he said. A prohibition in the United States related to research on firearms doesn’t help.

“There is so much we need to know,” Kaplan said. “That’s what depresses me and keep me up at night.”

 

 

 

 

Studying the Link Between Poverty and Suicides New research shows that poverty may have a greater effect on suicide rates than do unemployment or foreclosures

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Mark S. Kaplan

County-level suicide rates in the United States had a strong positive relationship with county poverty rates, while no relationships were found between county measures of unemployment or foreclosures when poverty rates were controlled, according to a new study from the Alcohol Research Group (ARG), a program of the Public Health Institute, in collaboration with the UCLA Luskin School of Public Affairs, Oregon Health and Science University, Prevention Research Center and the Centre for Addiction and Mental Health in Toronto.

The study, published in the American Journal of Preventive Medicine, analyzed data over a six-year period from 2005 to 2011 that includes the major U.S. economic downturn from 2007 to 2009. The study also found that for men 45 to 64 years old, the proportion of alcohol-related suicides and poverty rates were positively associated. This working-age group was a key demographic in rising suicide rates during the recession.

This is the first study to try to unravel how different features of such a downturn affect suicide rates and alcohol-related suicides in particular. It is also the first study to suggest that unemployment’s role may not be as significant as poverty.

“Our finding suggests that the consequences of unemployment were more important than being unemployed during this period,” said ARG senior scientist and lead author William C. Kerr. “These results are consistent with what we see in countries that have strong unemployment support systems — where being out of a job doesn’t increase your risk for suicide.”

Poverty was also found to mediate unemployment’s effect on suicide rates, which suggests that policies should focus directly on reducing poverty as well as on supporting people who are unemployed.

“The analysis also draws attention to the importance of targeting suicide prevention efforts in economically disadvantaged communities and incorporating alcohol control policies, abuse prevention and treatment for alcohol misuse into such efforts,” said Mark S. Kaplan, co-author and professor in UCLA Luskin’s Department of Social Welfare.

“County-level poverty rates reflect what’s happening at an individual and family level as well as across the entire area,” Kerr added. “It speaks to a lack of resources for people who are struggling. It’s possible that some people were already at a breaking point when the recession hit — it’s difficult to know for sure. But the results do tell us that we need better mechanisms in place to help the people who need it the most.”

The study analyzed data from 16 states included in the National Violent Death Reporting System during the study period. This system links data from coroner/medical examiner records, police reports, death certificates and crime laboratories.

Support for this paper was provided by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health under award number R01 AA021791.