Franck Maria Cristina, Monteiro Maristela Goldnadel, Limberger Renata Pereira
Instituto-Geral de Perícias do Rio Grande do Sul (IGP-RS), Departamento de Perícias Laboratoriais Porto Alegre (RS) Brasil Instituto-Geral de Perícias do Rio Grande do Sul (IGP-RS), Departamento de Perícias Laboratoriais, Porto Alegre (RS), Brasil.
Pan American Health Organization (PAHO), Noncommunicable Diseases and Mental Health Washington, D.C. Estados Unidos Pan American Health Organization (PAHO), Noncommunicable Diseases and Mental Health, Washington, D.C., Estados Unidos.
Rev Panam Salud Publica. 2021 Mar 12;45:e28. doi: 10.26633/RPSP.2021.28. eCollection 2021.
To describe the toxicology of suicide cases recorded in the state of Rio Grande do Sul, Brazil, from 2017 to 2019.
The present descriptive, cross-sectional study examined all the medico-legal reports and police records related to suicide deaths in the state. Multiple correspondence analyses were performed along with independent logistic regression models having ethanol, anxiolytic and antidepressant drugs, illicit drugs, and non-medical substances as dependent variables.
Ethanol was investigated in 2 978 samples, with positive results in 28.5%. The odds of a positive ethanol finding were 0.5 time higher (95%CI: 1.1; 2.2) for suicides occurring at night, 1.0 (95%CI: 1.4; 2.9) time higher for suicides occurring on weekends, and 0.9 (95%CI: 1.3; 2.7) time higher in individuals with a prior criminal record. Investigation of psychotropic drugs (2 900 samples) was positive in 30.4% samples. Anxiolytics were the most common medication detected, with 1.5 (95%CI: 1.6; 4.1) time higher odds of occurrence in women and 0.8 time higher odds (95%CI: 1.2; 2.7) for suicides occurring in the fall-winter. The odds of detecting illicit drugs (n = 338) were 4.1 times higher (95%CI: 1.9; 14.4) in the regions of Pelotas (south of the state) vs. Passo Fundo (north), and 1.2 (95%CI: 1.3; 3.6) time higher in cases with positive ethanol results, without significant difference between adolescents and adults.
Despite the lack of evidence on causality, the present results support a link between suicide and several psychoactive drugs. Medico-legal experts should be guided regarding the need to perform toxicological tests in all suicide cases.
描述2017年至2019年巴西南里奥格兰德州记录的自杀案例的毒理学情况。
本描述性横断面研究检查了该州所有与自杀死亡相关的法医报告和警方记录。进行了多重对应分析，并建立了以乙醇、抗焦虑和抗抑郁药物、非法药物及非医疗物质为因变量的独立逻辑回归模型。
对2978份样本进行了乙醇检测，阳性率为28.5%。夜间发生自杀时乙醇检测呈阳性的几率高0.5倍（95%置信区间：1.1；2.2），周末发生自杀时高1.0倍（95%置信区间：1.4；2.9），有前科者高0.9倍（95%置信区间：1.3；2.7）。对精神药物（2900份样本）的检测阳性率为30.4%。检测到的最常见药物是抗焦虑药，女性出现几率高1.5倍（95%置信区间：1.6；4.1），秋冬季节发生自杀时高0.8倍（95%置信区间：1.2；2.7）。佩洛塔斯地区（该州南部）非法药物检测呈阳性的几率（n = 338）比帕索丰杜地区（北部）高4.1倍（95%置信区间：1.9；14.4），乙醇检测结果呈阳性的案例中高1.2倍（95%置信区间：1.3；3.6），青少年和成年人之间无显著差异。
尽管缺乏因果关系的证据，但目前的结果支持自杀与几种精神活性药物之间存在联系。应指导法医专家在所有自杀案例中进行毒理学检测的必要性。
