Omalu Bennet I, Macurdy Krystle M, Koehler Steven A, Nnebe-Agumadu Uche H, Shakir Abdulrezzak M, Rozin Leon, Wecht Cyril H
Allegheny County Coroner's Office, 542 Fourth Avenue, 15219, Pittsburgh, PA,
Forensic Sci Med Pathol. 2005 Jun;1(2):125-37. doi: 10.1385/FSMP:1:2:125.
Suicide has assumed epidemic proportions and constitutes a major public health issue throughout the United States. Suicide remains one of the top eight leading causes of death, accounting for approximately 30,000 deaths annually. The understanding and prevention of suicide requires a multidisciplinary approach that involves psychosocial and medical specialties starting with a forensic analysis of the characteristics of suicide. The aim of this 10-year (1990-1999) retrospective study was threefold: first, to examine the forensic epidemiological characteristics of suicides examined by the Allegheny County Coroner's Office; second, to describe emerging epidemiological patterns of suicide; and finally, to make recommendations for preventive measures. A total of 1447 suicides were identified, with 1164 males (80%) and 283 females (20%) resulting in a male to female ratio of 4:1. The race distribution comprised 90% whites, 9% blacks, and 1% other races. The age of suicide victims ranged from 13 to 96 years old with a peak within the 31- to 40-year-old age group, which represented 24.5% of all suicides. Overall, 40% of the victims were single and more blacks than whites were single. The greatest number of suicides occurred in July, with the least in December. Suicides most frequently occurred between 9:01 AM and 3:00 PM. Suicide notes were present in 29% of all suicides. Firearm injuries, hanging, and drug overdose were the leading methods of suicide. Use of firearms was the leading method of suicide among both sexes. Female drug overdose deaths outnumbered male drug overdose deaths. The 10 most common overdose drugs were all central nervous system depressants, with amitriptyline being the most common prescription overdose drug. Based on reported antecedent trends in suicides, we make two recommendations regarding suicide prevention: (1) physicians should be educated to replace the prescription of older and more toxic antidepressants such as amitriptyline with newer and less toxic antidepressants such as serotonin reuptake inhibitors; and (2) firearms should be made inaccessible to individuals with risk factors for suicide, especially in the home.
自杀已呈流行态势，成为美国全国性的重大公共卫生问题。自杀仍是八大主要死因之一，每年约造成30000人死亡。理解和预防自杀需要采取多学科方法，这涉及心理社会和医学专业领域，首先要对自杀特征进行法医分析。这项为期10年（1990 - 1999年）的回顾性研究有三个目的：第一，研究阿勒格尼县验尸官办公室所调查自杀案例的法医流行病学特征；第二，描述自杀出现的流行病学新趋势；最后，提出预防措施建议。共识别出1447起自杀案例，其中男性1164例（80%），女性283例（20%），男女比例为4:1。种族分布为90%白人、9%黑人、1%其他种族。自杀受害者年龄在13岁至96岁之间，31岁至40岁年龄组为高峰，占所有自杀案例的24.5%。总体而言，40%的受害者为单身，黑人单身者多于白人。自杀案例数量最多发生在7月，最少在12月。自杀最常发生在上午9:01至下午3:00之间。29%的自杀案例留有遗书。火器伤、上吊和药物过量是主要的自杀方式。使用火器是男女最主要的自杀方式。女性药物过量死亡人数超过男性。10种最常见的过量药物均为中枢神经系统抑制剂，其中阿米替林是最常见的处方过量药物。基于报告的自杀既往趋势，我们就自杀预防提出两条建议：（1）应对医生进行教育，用新型低毒抗抑郁药如5-羟色胺再摄取抑制剂取代阿米替林等旧型高毒抗抑郁药的处方；（2）应使有自杀风险因素的人无法获取火器，尤其是在家中。
