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Akron Univ. School of Law

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Friday, August 5, 2005

JAMA Law and Mental Health Articles

The August 3, 2005 issue of JAMA (the Journal of the American Medical Association), contains three articles at the law-and-mental-health interface.

In "Criminal Records of Homicide Offenders" (JAMA 2005;294:598-601), Philip J. Cook and colleagues set out to answer two questions: (1) Do adults with a criminal record have a higher likelihood of committing a homicide? (2) If so, by how much would a hypothetical intervention program directed toward this group lower society’s overall rate of homicide, if the program could reduce the group’s homicide commission rate to the risk level of adults without criminal records? Using a case-control analysis and data from Illinois arrests and felony convictions, the authors concluded that persons arrested for homicide were 10 times more likely to have a prior felony conviction than the general population. The authors calculated that the hypothetical intervention might reduce the homicide rate by 31 percent. Here is a link to the article’s abstract:

http://jama.ama-assn.org/cgi/content/abstract/294/5/598

A second article (JAMA 2005;294:563-570) compares a specific type of psychotherapy with "usual care" in preventing future suicide attempts. This form of treatment, called "cognitive therapy," was developed by psychiatrist Aaron T. Beck, M.D. (one of the article’s coauthors), and has proven effective for treating many psychiatric conditions, including depression. In this study of persons who had recently attempted suicide, patients in the experimental group underwent ten sessions of cognitive therapy. In these sessions, therapists and patients tried to identify thoughts, images, and beliefs that occurred just before the suicide attempt; then, therapists helped patients develop thinking and behavior strategies to cope more effectively with stressors. Patients who received cognitive therapy had lower likelihoods of subsequent suicide attempts and less depression than patients in the usual-care group. Here’ a link to the article’s abstract:

http://jama.ama-assn.org/cgi/content/full/294/5/563

Finally, in an editorial (JAMA 2005;294:623-624), Drs. Thomas Cole and Richard Glass point out that in the U.S., "suicide and homicide are the fourth and fifth leading causes of death for persons" 10-60 years old. Studies show that most persons who attempt or succeed in committing suicide have a diagnosable mental disorder. Although most people who have mental illness are not violent, scientific investigations over the last 15 years confirm that having certain types of psychiatric disorders and mental symptoms increase a person’s statistical risk of acting violently. On the basis of the issue’s two other articles and several other published studies, Drs. Cole and Glass believe that "[i]Identifying persons at risk of violence to themselves or others and offering or compelling them to receive mental health treatment services is warranted." They acknowledge, however, that this would raise concerns about confidentiality and discrimination, and that many pe! ople who n eed psychiatric care

http://jama.ama-assn.org/cgi/content/full/294/5/623

Dr. Douglas Mossman is reponsible for this excellent post.  He can be reached at douglas.mossman@wright.edu  [bm]

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