Wray Matt, Miller Matthew, Gurvey Jill, Carroll Joanna, Kawachi Ichiro
Department of Sociology, Temple University, Philadelphia, PA 19122, USA.
Soc Sci Med. 2008 Dec;67(11):1882-8. doi: 10.1016/j.socscimed.2008.09.002. Epub 2008 Oct 18.
Residents of Las Vegas, Nevada have much higher suicide rates than residents of other metropolitan counties in the USA. Whether the risk of suicide among visitors to Las Vegas is also significantly elevated has been difficult to assess because person-time denominator information is not available. We used a case-control design to examine the association between exposure to Las Vegas and risk of suicide expressed as mortality odds ratios. We conceptualized four different types of potential suicide risk with respect to Las Vegas: (1) risk of suicide among usual residents of Las Vegas ("chronic risk"), (2) risk of suicide among temporary visitors to Las Vegas ("acute risk"), (3) risk of suicide among Las Vegas residents visiting elsewhere ("leaving Las Vegas risk"), and (4) risk of suicide among travelers in general ("traveler risk"). Controlling for age, gender, marital status, and year effects, the odds of suicide among Las Vegas residents was at least 50% greater than among residents elsewhere in each of the three decades we observed. Visitors to Las Vegas were at double the risk compared to those who stayed in their home county. Leaving Las Vegas was associated with a greater than 20% reduction in risk for suicide. Traveling to Las Vegas is associated with a twofold increase in risk compared to traveling elsewhere. We discuss three possible theoretical frameworks to help explain our observed results: ecological effects, whereby social factors unique to Las Vegas, or uniquely amplified in Las Vegas, result in increased risk to both residents and visitors; selection effects whereby those predisposed to suicide disproportionately choose Las Vegas to reside in and visit; and contagion effects, whereby high numbers of suicides tend to lead to even greater numbers over time, as people emulate the suicides of others. We compare our empirical evidence for each of the effects with existing sociological and historical scholarship on Las Vegas.
美国内华达州拉斯维加斯市居民的自杀率远高于美国其他大都市县的居民。由于无法获取人时分母信息，很难评估前往拉斯维加斯的游客的自杀风险是否也显著升高。我们采用病例对照设计，以死亡比值比来检验接触拉斯维加斯与自杀风险之间的关联。我们针对拉斯维加斯概念化了四种不同类型的潜在自杀风险：（1）拉斯维加斯常住居民的自杀风险（“慢性风险”），（2）拉斯维加斯临时游客的自杀风险（“急性风险”），（3）前往其他地方的拉斯维加斯居民的自杀风险（“离开拉斯维加斯风险”），以及（4）一般旅行者的自杀风险（“旅行者风险”）。在控制年龄、性别、婚姻状况和年份效应后，在我们观察的三个十年中，拉斯维加斯居民自杀的几率比其他地方的居民至少高出50%。与留在本县的人相比，前往拉斯维加斯的游客自杀风险翻倍。离开拉斯维加斯与自杀风险降低20%以上相关。与前往其他地方相比，前往拉斯维加斯的旅行与风险增加两倍相关。我们讨论了三种可能的理论框架来帮助解释我们观察到的结果：生态效应，即拉斯维加斯独有的或在拉斯维加斯独特放大的社会因素导致居民和游客的风险增加；选择效应，即那些易患自杀症的人不成比例地选择居住和前往拉斯维加斯；以及传染效应，即随着时间的推移，大量自杀事件往往会导致更多自杀事件，因为人们会模仿他人的自杀行为。我们将每种效应的实证证据与现有的关于拉斯维加斯的社会学和历史学术研究进行了比较。
