CHAPEL HILL -- White women in North Carolina commit suicide at nearly three times the rate of minority women across the state, a new University of North Carolina at Chapel Hill study shows. No one knows why.

Some say black women, for example, may have a larger circle of nearby family members and friends to help them through trying times, but study leader Dr. Carol Runyan says she prefers not to speculate.

Runyan directs the UNC Injury Prevention Research Center and is professor of health behavior and health education at the UNC School of Public Health. Her study is one of the largest of its kind ever conducted. The key finding was that not enough information is available through reports by law enforcement officials and the state’s medical examiner system to fully understand the problem, she said.

"We found that medical examiner records varied in completeness," Runyan said. "Law enforcement interviews frequently did not yield information about the factors we had hoped to examine, probably because the investigations were conducted primarily to rule out homicide."

A report on the study appears in the current issue of Injury Prevention, a quarterly professional journal. Besides Runyan, authors are Dr. Kathryn E. Moracco, former research assistant professor of maternal and child health; Lisa Dulli, graduate research assistant; and Dr. John Butts, N.C. chief medical examiner and clinical professor of pathology and laboratory medicine at the UNC School of Medicine.

The team focused on suicides among women age 15 and older from 1989 through 1993 as identified by the Office of the Chief Medical Examiner. They reviewed all case files and tried to interview investigating law enforcement officials for all 177 cases in 1993, completing 135 interviews.

Examination of the 882 suicides meeting the study definition showed a fluctuating age-adjusted suicide rate of between 5.53 and 7.26 per 100,000 women. Women under age 45 were proportionally more likely than older ones to have recently broken up with an intimate partner.

Women's suicide patterns seem to vary by age group, suggesting the possible need for prevention programs targeted to specific populations, Runyan said. Consistent with prior research, a history of mental illness and previous suicidal thoughts and attempts were risk factors for suicide.

"One of the factors we were looking for was a prior history of domestic violence," she said. "While the numbers were not large, we did find that interpersonal conflict preceded some of the events (17.7 percent) and of these, 76 percent were with current or former intimate partners. However, it is important to realize that these analyses are all looking backwards."

But many more depressed people and people who have conflicts are not suicidal, Runyan said, and future research needs to try to disentangle what can help identify risk factors and prevent suicides through public health and mental health approaches.

More than 40 percent of the deaths involved handguns, more than 21 percent resulted from taking prescription drugs, more than 13 percent involved other guns and almost 10 percent resulted from carbon monoxide poisoning, researchers found.

"The high proportion of cases involving firearms, particularly handguns, and the occurrence of suicides in the home environment signals the need for greater attention to gun storage practices in the home," Runyan wrote.

"The main thing that is important about this study is learning what is and isn't available in the data sources that we examined," she said. "While they were not designed to look specifically at suicide -- particularly the law enforcement data -- it would be desirable if they would provide more information that could help guide prevention efforts."

The researchers recommend that investigating units adopt a standard protocol for investigations that would include gathering more details of each suicide. Consideration also should be given to organizing a formal suicide fatality review process similar to the review process for child fatalities.

Almost 6,000 U.S. women ages 15 and older take their own lives annually, making suicide the second leading cause of injury death among women, earlier research showed. The risk of suicide was five times greater in homes where the victim had ready access to a gun, according to one study.

Grants from the National Center for Injury Prevention and Control supported the research.

By DAVID WILLIAMSON UNC News Services University of North Carolina at Chapel Hill

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