Department of Epidemiology, West Virginia University, Morgantown, West Virginia, United States of America.
Injury Control Research Center, West Virginia University, Morgantown, West Virginia, United States of America.
PLoS One. 2018 Jan 10;13(1):e0190200. doi: 10.1371/journal.pone.0190200. eCollection 2018.
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.
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.
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.
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.
缺乏确凿的心理学和精神病学证据可能会阻碍美国对药物中毒自杀的检测。我们评估了自杀遗书和精神病史在药物中毒与枪支（枪击伤）加吊颈/窒息（其他两种主要的、但明显暴力的方法）导致的自杀分类中的相对重要性。
本观察性多水平（个体/县）、多变量研究采用广义线性混合模型（GLMM）分析了 2011 年至 2013 年期间参加国家暴力死亡报告系统的 17 个州 15 岁及以上人群中的所有自杀和未确定意图死亡的情况，这些情况可能被视为自杀。结局指标为自杀相对于未确定分类的相对比值，根据人口统计学、诱发因素和调查特征进行调整。
不到三分之一的自杀者和四分之一的未确定死因者有自杀遗书、自杀未遂或情感障碍的记录。药物中毒病例的差距大于枪击/吊颈病例。与药物中毒病例相比，枪击/吊颈病例更有可能被归类为自杀（调整后的比值比[OR]，41.14；95%置信区间[CI]，34.43-49.15），有自杀遗书（OR，33.90；95%CI，26.11-44.05）、自杀未遂（OR，2.42；95%CI，2.11-2.77）或抑郁（OR，1.61；95%CI，1.38-1.88）或双相障碍（OR，1.41；95%CI，1.10-1.81）的病例更有可能被归类为自杀。按机制/原因分层后，自杀遗书与药物中毒病例自杀分类之间的关联更为强烈（OR，45.43；95%CI，31.06-66.58）。自杀未遂（OR，2.64；95%CI，2.19-3.18）和抑郁（OR，1.48；95%CI，1.17-1.87）与药物中毒病例的自杀分类相关，但与枪击/吊颈病例无关。
如果没有心理学/精神病学证据来帮助确定死因分类，美国的药物中毒自杀可能会被严重漏报。这些发现对监测、病因理解和预防自杀和药物死亡都有不利影响。
