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    Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history

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    Access Status
    Open access
    Authors
    Rockett, I.
    Caine, E.
    Connery, H.
    D'Onofrio, G.
    Gunnell, D.
    Miller, Ted
    Nolte, K.
    Kaplan, M.
    Kapusta, N.
    Lilly, C.
    Nelson, L.
    Putnam, S.
    Stack, S.
    Värnik, P.
    Webster, L.
    Jia, H.
    Date
    2018
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Rockett, I. and Caine, E. and Connery, H. and D'Onofrio, G. and Gunnell, D. and Miller, T. and Nolte, K. et al. 2018. Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history. PLoS ONE. 13 (1): 0190200.
    Source Title
    PLoS ONE
    DOI
    10.1371/journal.pone.0190200
    ISSN
    1932-6203
    School
    School of Public Health
    URI
    http://hdl.handle.net/20.500.11937/68854
    Collection
    • Curtin Research Publications
    Abstract

    © 2018 Rockett et al. Objective A paucity of corroborative psychological and psychiatric evidence may be inhibiting detection of drug intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by drug intoxication versus firearm (gunshot wound) plus hanging/suffocation—the other two major, but overtly violent methods. Methods This observational multilevel (individual/county), multivariable study employed a generalized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System throughout 2011–2013. The outcome measure was relative odds of suicide versus undetermined classification, adjusted for demographics, precipitating circumstances, and investigation characteristics. Results A suicide note, prior suicide attempt, or affective disorder was documented in less than one-third of suicides and one-quarter of undetermined deaths. The prevalence gaps were larger among drug intoxication cases than gunshot/hanging cases. The latter were more likely than intoxication cases to be classified as suicide versus undetermined manner of death (adjusted odds ratio [OR], 41.14; 95% CI, 34.43–49.15), as were cases documenting a suicide note (OR, 33.90; 95% CI, 26.11–44.05), prior suicide attempt (OR, 2.42; 95% CI, 2.11–2.77), or depression (OR, 1.61; 95% CI, 1.38 to 1.88), or bipolar disorder (OR, 1.41; 95% CI, 1.10–1.81). Stratification by mechanism/cause intensified the association between a note and suicide classification for intoxication cases (OR, 45.43; 95% CI, 31.06–66.58). Prior suicide attempt (OR, 2.64; 95% CI, 2.19–3.18) and depression (OR, 1.48; 95% CI, 1.17–1.87) were associated with suicide classification in intoxication but not gunshot/hanging cases. Conclusions Without psychological/psychiatric evidence contributing to manner of death classification, suicide by drug intoxication in the US is likely profoundly under-reported. Findings harbor adverse implications for surveillance, etiologic understanding, and prevention of suicides and drug deaths.

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    • Method overtness, forensic autopsy, and the evidentiary suicide note: A multilevel national violent death reporting system analysis
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      © 2018 Rockett et al. Objective Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary ...
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      Importance: Fatal self-injury in the United States associated with deliberate behaviors is seriously underestimated owing to misclassification of poisoning suicides and mischaracterization of most drug poisoning deaths ...
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