CHICAGO—Substance use and homelessness are factors associated with death among street youth in Montreal, according to a study in the August 4 issue of JAMA, the Journal of the American Medical Association, a theme issue on Violence and Human Rights.

"In Canada and the United States, street youth are generally 25 years or younger, and approximately a third of them are girls," the authors provide as background information in the article. "They are homeless or, more frequently, they live in highly unstable residential conditions." These youth "frequently engage in high-risk behaviors such as prostitution and substance abuse, including injection drug use. They are increasingly recognized as population at risk for a wide range of physical and mental health problems."

Elise Roy, M.D., M.Sc., from Direction de Sante Publique de Montreal, Canada, and colleagues recruited 1,013 youth from January 1995 to September 2000. Participants were interviewed twice a year. They were eligible for follow-up until they reached 30 years of age or until they reported in four consecutive study questionnaires that they were not using services from street youth organizations and not homeless. The average age of the participants when the study started was 19.9 years.

"Twenty-six youth died during follow-up for a mortality rate of 921 per 100,000 person-years," the authors report. "The observed causes of death were as follows: suicide (13), overdose (8), unintentional injury (2), fulminant hepatitis A (1), heart disease (1); 1 was unidentified." In further analysis the authors found, HIV infection, daily alcohol use in the last month, homelessness in the last 6 months, drug injection in the last 6 months and being male were identified as independent predictors of mortality.

"The mortality rate of 921 per 100,000 person-years observed in our study participants is extremely high, exceeding 11 times the rate observed among youth in the general population," the authors state.

CHICAGO—Exposure to trauma and mental health symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) are prevalent among people in Afghanistan but, often go untreated because of lack of resources and mental health care professionals, according to two studies in the August 4 issue of JAMA, the Journal of the American Medical Association, a theme issue on Violence and Human Rights.

According to background information: "More than two decades of war and conflict and three years of drought have led to widespread human suffering and substantial population displacement in Afghanistan. The country's infrastructure has been destroyed or degraded and vital human resources have been depleted." The researchers note that mental health facilities in Afghanistan are non-existent or in poor condition.

Barbara Lopes Cardozo, M.D., M.P.H., from the Centers for Disease Control and Prevention, Atlanta, and colleagues, conducted a nationally representative survey of 799 Afghan adult household members (699 nondisabled and 100 disabled respondents) aged 15 years or older from July to September 2002 to assess respondents exposure to trauma during the previous 10 years, mental health symptoms, resources for emotional support, and disability. The researchers defined the term disability "as any restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being."

"A total of 407 respondents (62 percent) reported experiencing at least four trauma events during the past 10 years," the authors found. "The most common trauma events experienced by the respondents were lack of food and water (56.1 percent) for nondisabled persons and lack of shelter (69.7 percent) for disabled persons.

The prevalence of respondents with symptoms of depression was 67.7 percent and 71.7 percent, and symptoms of anxiety 72.2 percent and 84.6 percent for nondisabled and disabled respondents, respectively. The prevalence of symptoms of PTSD was similar for both groups (nondisabled, 42.1 percent and disabled, 42.2 percent). Women had significantly poorer mental health status than men did. Respondents who were disabled had significantly lower social functioning and poorer mental health status than those who were nondisabled. Feelings of hatred were high (84 percent of nondisabled and 81 percent of disabled respondents). Coping mechanisms included religious and spiritual practices; focusing on basic needs, such as higher income, better housing, and more food; and seeking medical assistance."

CHICAGO—Laws intended to keep guns from youth often referred to as child access prevention or CAP laws are associated with a reduction in suicide rates among youth aged 14 to 17 years, according to a study in the August 4 issue of JAMA, the Journal of the American Medical Association, a theme issue on Violence and Human Rights.

"Suicide is the third leading cause of death among youth aged 10 to 19 years in the United States, accounting for 1,883 deaths in 2001," the authors provide as background information in the article. "Firearms were used in approximately half of suicides within this age group in 2001; however, as recently as 1994, 7 of every 10 suicides among teenagers involved firearms." The authors note that as of 2001, "18 states had some form of CAP law that makes it a crime to store firearms in a manner that allows them to be easily accessed by children and adolescents. Most require gun owners to lock up their guns."

Daniel W. Webster, Sc.D., M.P.H., from the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues, analyzed data on suicide rates among U.S. youth aged 14 through 20 years from 1976 to 2001. The researchers used models to estimate the association between state and federal youth-focused firearm laws mandating a minimum age for the purchase or possession of handguns and state CAP laws requiring safe storage of firearms on suicide rates among youth.

"There were 63,954 suicides among youth aged 14 through 20 years during the 1976-2001 study period, 39,655 (62 percent) of which were committed with firearms," the authors found. "Minimum purchase-age and possession-age laws were not associated with statistically significant reductions in suicide rates among youth aged 14 through 20 years. State CAP laws were associated with a 8.3 percent decrease in suicide rates among 14- to 17-year olds. The annual rate of suicide in this age group in states with CAP laws was 5.97 per 100,000 population rather than the projected 6.51."

The authors report that CAP laws were also associated with a significant reduction in suicides among youth aged 18 through 20 years, however the association was similar for firearm and nonfirearm suicides.

The authors write that "assuming that the observed association is causal, we estimate that the 18 CAP laws implemented prior to 2002 have prevented 333 suicides among youth aged 14 to 17 years from the time that Florida implemented the nation's first CAP law (October 1989) through 2001. In 2001 alone, we estimate that there were 35 fewer suicides among this group in the 18 states with CAP laws than would have been expected without the laws."

DEPRESSION, ANXIETY, POST-TRAUMATIC STRESS DISORDER AND FEELINGS OF HATRED HIGH AMONG AFGHAN PEOPLE