Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history
© 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 int...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Journal Article |
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Public Library of Science
2018
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| Online Access: | http://hdl.handle.net/20.500.11937/68854 |
| _version_ | 1848761906445156352 |
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| author | 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. |
| author_facet | 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. |
| author_sort | Rockett, I. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | © 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. |
| first_indexed | 2025-11-14T10:39:07Z |
| format | Journal Article |
| id | curtin-20.500.11937-68854 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T10:39:07Z |
| publishDate | 2018 |
| publisher | Public Library of Science |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-688542018-09-20T05:45:13Z Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history 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. © 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. 2018 Journal Article http://hdl.handle.net/20.500.11937/68854 10.1371/journal.pone.0190200 Public Library of Science fulltext |
| spellingShingle | 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. Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history |
| title | Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history |
| title_full | Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history |
| title_fullStr | Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history |
| title_full_unstemmed | Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history |
| title_short | Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history |
| title_sort | discerning suicide in drug intoxication deaths: paucity and primacy of suicide notes and psychiatric history |
| url | http://hdl.handle.net/20.500.11937/68854 |