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Roza TH, Marchionatti LE, Gosmann NP, do Canto GC, Machado PV, Massuda R, Passos IC, Kessler FHP, Magalhães PVDS, Telles LEDB. Characteristics of deaths by suicide in postmortem studies in Brazil: A systematic review and meta-analysis. Suicide Life Threat Behav 2023; 53:1086-1107. [PMID: 37864416 DOI: 10.1111/sltb.13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/16/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Suicide is one of the leading causes of death, with a trend for its increase in Brazil in past decades. This study aimed to review the characteristics of suicides in Brazilian postmortem studies. METHODS Studies investigating suicide deaths in Brazil, and based on autopsy or psychological autopsy were included. Proportions were pooled across studies with the use of random and fixed effects models. RESULTS 6777 references were retrieved from six databases (searches up to January, 2023), and 45 studies included. In autopsy studies (k = 37, n = 16,231), substance use at toxicological analysis was found in 36.42% of cases (95% CI: 30.05-43.32), previous suicide attempts in 23.92% (95% CI: 6.73-57.78). In psychological autopsy studies (k = 8, n = 139), previous suicide attempts were reported in 28.09% (95% CI: 19.74-38.28), psychiatric conditions/symptoms in 90.67% (95% CI: 67.79-97.82), family history of suicidality in 21.33% (95% CI: 13.5-32.03). Most suicide deaths were reported in males and took place at the victim's home, hanging was the most frequent suicide method. Included studies presented significant limitations in quality assessment. CONCLUSION Future studies should present more robust methodology, including bigger samples, the use of controls, and validated methodology.
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Affiliation(s)
- Thiago Henrique Roza
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Lauro Estivalete Marchionatti
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Natan Pereira Gosmann
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Section of Negative Affect and Social Processes, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Anxiety Disorders Outpatient Program, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Gustavo Cambraia do Canto
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Patrícia Vasconcelos Machado
- Seção de Perícias Psíquicas (Forensic Psychological and Psychiatric Examination Unit), Departamento-Médico Legal (Institute of Legal Medicine), Instituto-Geral de Perícias (General Crime Scene Investigation Institute), Porto Alegre, Brazil
| | - Raffael Massuda
- Department of Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Ives Cavalcante Passos
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Felix Henrique Paim Kessler
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Pedro Vieira da Silva Magalhães
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lisieux Elaine de Borba Telles
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Ilic M, Ilic I. Trends in suicide by hanging, strangulation, and suffocation in Serbia, 1991-2020: A joinpoint regression and age-period-cohort analysis. World J Psychiatry 2022; 12:505-520. [PMID: 35433320 PMCID: PMC8968500 DOI: 10.5498/wjp.v12.i3.505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/18/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hanging is one of the most commonly used methods for suicide in both sexes worldwide. In a number of countries, hanging mortality has increased over the last decades. Nevertheless, there is a scarcity of studies that have explored the patterns and trends for mortality of suicide by hanging on global, regional and national levels, as most evaluations are limited to certain populations.
AIM To assess the trends of suicide mortality by hanging, strangulation, and suffocation in Serbia, from 1991 to 2020.
METHODS This nationwide study, with epidemiological descriptive study design, was carried out based on official data. The age-standardized rates (ASRs, expressed per 100000 persons) were calculated by direct standardization, using the World Standard Population. Mortality trends from suicide by hanging were assessed using the joinpoint regression analysis: The average annual percent change (AAPC) with the corresponding 95% confidence interval (95%CI) was calculated. Age-period-cohort analysis was performed to address the possible underlying reasons for the observed suicide trends.
RESULTS Over the 30-year period studied, there were 24340 deaths by hanging (17750 males and 6590 females) in Serbia. In 2020, the ASR of deaths by hanging was 4.5 per 100000 persons in both sexes together (7.6 in males vs 1.7 in females). The trends of suicide mortality by hanging decreased significantly between 1991 and 2020 in both males (AAPC = -1.7% per year; 95%CI: -2.0 to -1.4) and females (AAPC = - 3.5% per year; 95%CI: -3.9 to -3.1). Mortality rates of suicide by hanging had a continuously decreasing tendency in both sexes together in all age groups: The only exception was among males in 40-49 age group, with an increasing trend of suicide by hanging from 1991 to 2011 (by +0.3% per year).
CONCLUSION The trends in suicide mortality by hanging have been decreasing in Serbia in the last three decades in both sexes, but this was more pronounced in women than in men. Despite the decreasing trends observed in mortality of suicide by hanging, further research is needed for better clarification of trends and help in suicide prevention in the future.
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Affiliation(s)
- Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
| | - Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
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Male depressive traits in relation to violent suicides or suicide attempts: A systematic review. J Affect Disord 2020; 262:55-61. [PMID: 31707247 DOI: 10.1016/j.jad.2019.10.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/09/2019] [Accepted: 10/28/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Male sex is a consistently reported risk factor for violent suicide. It has been suggested that this association may be driven by so-called male depression - as operationalized by the Gotland Male Depression Scale (GMDS). The aim of this systematic review was to investigate if males dying by or attempting suicide with violent methods, display symptoms compatible with male depression. METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search of PubMed, Embase and PsycINFO was performed using search terms covering: male sex, violent suicide/suicide attempt, and symptoms of male depression from the GMDS. Subsequently, a qualitative synthesis of studies meeting predefined inclusion criteria was carried out. RESULTS A total of 28 studies reporting on 91,933 violent suicides and 113 violent suicide attempts were included in the qualitative synthesis. The suicide/suicide attempt methods reported in these studies were predominantly shooting, hanging or drowning. The only two symptoms from the GMDS that was reported in relation to violent suicides/suicide attempts was overconsumption of alcohol or drugs and suicide attempts in the biological family. No studies had systematically assessed suicide victims or attempters for symptoms of male depression. LIMITATIONS Publication-, selection-, and information biases may have affected this review. CONCLUSIONS Symptoms of male depression are rarely reported in relation to violent suicides/suicide attempts. The most likely explanation for this finding is that there has been little focus on this potential association. Future studies should address this void.
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Franck MC, Sgaravatti ÂM, Scolmeister D, Fassina V, Bettoni CC, Jardim FR, Nunes CC, Morales AF, Limberger RP. Suicide and associated factors across life span. JORNAL BRASILEIRO DE PSIQUIATRIA 2020. [DOI: 10.1590/0047-2085000000254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To assess the epidemiological and toxicological profile of all suicide victims in 2017 in Rio Grande do Sul, Brazil. Methods The victims were classified by gender, age, parental absence, city, suicide form, death context, and toxicological results, using the police occurrences and the reports issued by the Instituto-Geral de Perícias do RS. Multiple correspondence analysis and the Cochran-Mantel-Haenszel X 2 test were used to evaluate associations between the parameters studied. Results There were 1,284 suicides (11.3 cases/100,000 inhabitants) in RS in 2017, 80% of which were men and 46% were young and old. Porto Alegre had the highest number of victims and the region of the Vale do Rio Pardo, the highest rate (20.8 cases/100,000 inhabitants). The hanging was the most used medium and the depression, the most mentioned context in the occurrences. The presence of ethanol was observed in 30% of the samples analyzed, with an adult male profile associated with the presence of other psychotropic substances, whose class was most frequently detected with anxiolytics. The nitrite was the most detected poison among the samples sent for this purpose. There was an association between parental absence and young people, between suicidal intoxication method and women and among young people and the presence of illicit compounds. Conclusion Mortality due to suicide continues to increase in RS, which, historically, has the highest Brazilian index. The information obtained in this study supports new research, promoting awareness raising, guidance to health services and the elaboration of more preventive public policies.
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Affiliation(s)
- Maria Cristina Franck
- Universidade Federal do Rio Grande do Sul, Brasil; Instituto-Geral de Perícias do Rio Grande do Sul, Brasil
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Gravensteen IK, Ekeberg Ø, Thiblin I, Helweg-Larsen K, Hem E, Rogde S, Tøllefsen IM. Psychoactive substances in natural and unnatural deaths in Norway and Sweden - a study on victims of suicide and accidents compared with natural deaths in psychiatric patients. BMC Psychiatry 2019; 19:33. [PMID: 30658618 PMCID: PMC6339417 DOI: 10.1186/s12888-019-2015-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The extent of post-mortem detection of specific psychoactive drugs may differ between countries, and may greatly influence the national death register's classification of manner and cause of death. The main objective of the present study was to analyse the magnitude and pattern of post-mortem detection of various psychoactive substances by the manner of death (suicide, accidental, undetermined and natural death with a psychiatric diagnosis) in Norway and Sweden. METHODS The Cause of Death Registers in Norway and Sweden provided data on 600 deaths in 2008 from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of death and 200 as natural deaths in individuals with a diagnosis of mental disorder as the underlying cause of death. We examined death certificates and forensic reports including toxicological analyses. RESULTS The detection of psychoactive substances was commonly reported in suicides (66 and 74% in Norway and Sweden respectively), accidents (85 and 66%), undetermined manner of deaths (80% in the Swedish dataset) and in natural deaths with a psychiatric diagnosis (50 and 53%). Ethanol was the most commonly reported substance in the three manners of death, except from opioids being more common in accidental deaths in the Norwegian dataset. In cases of suicide by poisoning, benzodiazepines and z-drugs were the most common substances in both countries. Heroin or morphine was the most commonly reported substance in cases of accidental death by poisoning in the Norwegian dataset, while other opioids dominated the Swedish dataset. Anti-depressants were found in 22% of the suicide cases in the Norwegian dataset and in 29% of suicide cases in the Swedish dataset. CONCLUSIONS Psychoactive substances were detected in 66 and 74% of suicides and in 85 and 66% of accidental deaths in the Norwegian and Swedish datasets, respectively. Apart from a higher detection rate of heroin in deaths by accident in Norway than in Sweden, the pattern of detected psychoactive substances was similar in the two countries. Assessment of a suicidal motive may be hampered by the common use of psychoactive substances in suicide victims.
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Affiliation(s)
- Ida Kathrine Gravensteen
- 0000 0004 0389 8485grid.55325.34Department of Forensic Sciences, Oslo University Hospital, Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Øivind Ekeberg
- 0000 0004 1936 8921grid.5510.1Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1111 Blindern, N-0317 Oslo, Norway ,0000 0004 0389 8485grid.55325.34Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Ingemar Thiblin
- 0000 0004 1936 9457grid.8993.bDepartment of Surgical Sciences, Uppsala University, Box 256, 751 05 Uppsala, Sweden
| | - Karin Helweg-Larsen
- 0000 0001 0674 042Xgrid.5254.6Department of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Erlend Hem
- 0000 0004 1936 8921grid.5510.1Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1111 Blindern, N-0317 Oslo, Norway ,0000 0004 0389 8485grid.55325.34Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Sidsel Rogde
- 0000 0004 0389 8485grid.55325.34Department of Forensic Sciences, Oslo University Hospital, Box 4950 Nydalen, N-0424 Oslo, Norway ,0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, University of Oslo, Box 1072 Blindern, N- 0316 Oslo, Norway
| | - Ingvild Maria Tøllefsen
- Division of Medicine, Department of Acute Medicine, Oslo University Hospital Ullevaal, Box 4950 Nydalen, N-0424, Oslo, Norway.
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Vadysinghe AN, Sivasubramanium M. Anesthetized by chloroform before hanging. Forensic Sci Med Pathol 2018; 14:381-385. [PMID: 29658097 DOI: 10.1007/s12024-018-9974-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 12/01/2022]
Abstract
We present a unique case of suicidal hanging. The deceased was a 31-year-old male who was found hanging from a tree in a dense thicket, with his lower limbs in contact with the ground (partial suspension). There was an apparatus similar to a facial mask placed around his nose and mouth. A strong chemical smell was emanating from the apparatus, which was identified as chloroform (Formyl trichloride/CHCl3). A ligature with a soft cloth beneath it was around his neck. A ligature mark was present around the neck. The decedent's blood alcohol levels were 112 mg/dl. The blood and stomach contents were negative for chloroform. A complete death investigation, including scene investigation and complete autopsy examination, confirmed the cause of death as hanging. The manner of death was suicide. This case highlights how the deceased had used several methods whilst committing suicide to minimize pain, including the inhalation of chloroform, which would have also resulted in the inability to engage in protective actions during the act.
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Affiliation(s)
- Amal Nishantha Vadysinghe
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka.
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Characteristics of completed suicide in different blood alcohol concentrations in Korea. Forensic Sci Int 2017; 281:37-43. [DOI: 10.1016/j.forsciint.2017.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/08/2017] [Accepted: 10/11/2017] [Indexed: 11/19/2022]
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Gonçalves REM, Ponce JDC, Leyton V. Alcohol use by suicide victims in the city of Sao Paulo, Brazil, 2011-2015. J Forensic Leg Med 2017; 53:68-72. [PMID: 29197754 DOI: 10.1016/j.jflm.2017.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 11/02/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
Excessive alcohol consumption is a serious public health issue, because drunkenness affects critical judgment and self-control which could trigger violent and self-harm behavior, with thus a potential association between alcohol consumption and suicide deaths. The objective of the present study was to assess the association between alcohol consumption and suicide deaths in the city of Sao Paulo, Brazil, from 2011 to 2015, and its relationship with socio-demographic characteristics of the victims and the circumstances of the suicide. A cross-sectional retrospective study was conducted by collection of data from 1,700 suicide victims subjected to examination of blood alcohol concentration (BAC) from toxicology reports from the Institute of Legal Medicine of the State of Sao Paulo, Brazil. Alcohol was detected in blood samples of 30.2% of the victims and mean BAC levels were 1.73 ± 0.08 g/L. The mean age of the victims was 39.90 ± 0.75 years. The majority of the victims were male (74.6%) and the prevalence of positive BAC was higher amongst men (34.7%) than women (17.1%), p<0.05. The majority of the victims were white skinned (64.7%), but there was a higher proportion of victims with positive BAC among mulatto and black individuals, p<0.05. Hanging was the most prevalent suicide method in the sample (48.7%) and amongst men (55.4%), but amongst women it was jumping from a height (35%), p < 0.05.
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Affiliation(s)
- Raphael Eduardo Marques Gonçalves
- University of Sao Paulo Medical School, Department of Legal Medicine, Avenida Doutor Arnaldo, 455, CEP 01246-903, Sao Paulo, SP, Brazil.
| | - Júlio de Carvalho Ponce
- University of Sao Paulo Medical School, Department of Preventive Medicine, Avenida Doutor Arnaldo, 455, CEP 01246-903, Sao Paulo, SP, Brazil.
| | - Vilma Leyton
- University of Sao Paulo Medical School, Department of Legal Medicine, Avenida Doutor Arnaldo, 455, CEP 01246-903, Sao Paulo, SP, Brazil.
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Sumarokov YA, Brenn T, Kudryavtsev AV, Sidorenkov O, Nilssen O. Alcohol and suicide in the Nenets Autonomous Okrug and Arkhangelsk Oblast, Russia. Int J Circumpolar Health 2016; 75:30965. [PMID: 27452190 PMCID: PMC4958908 DOI: 10.3402/ijch.v75.30965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND High suicide rates in the Russian North are coupled with high alcohol consumption in the described populations. OBJECTIVE To investigate the potential role of alcohol consumption on suicides in the Nenets Autonomous Okrug (NAO) in 2002-2012 and to compare this information with corresponding data from the neighboring Arkhangelsk Oblast (AO). DESIGN Retrospective population-based mortality study. METHODS Data from autopsy reports were used to identify 252 cases of suicide in the NAO and 1,198 cases in the AO in the period 2002-2012. Postmortem blood alcohol content (BAC) was available for 228 cases in the NAO and 1,185 cases in the AO. BAC as well as other selected variables were compared between the NAO and the AO among women and men, different age groups, ethnic groups, and selected variables of suicide. RESULTS Alcohol was present in the blood of 74.1% of male and 82.9% of female suicide cases in the NAO, which was significantly higher than the proportions found in the AO (59.3% of male and 46.6% female cases). BAC<1.0‰ and between 2.0 and 3.0‰ were more frequently found among suicide cases in the NAO than those in the AO. CONCLUSIONS Our findings specify that alcohol drinking may be an essential risk factor for suicide in the NAO, and that this factor may be of greater importance in the indigenous population of the NAO than among Russians in the AO.
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Affiliation(s)
- Yury A Sumarokov
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- International School of Public Health, Northern State Medical University, Arkhangelsk, Russia; @mail.ru
| | - Tormod Brenn
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Alexander V Kudryavtsev
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- International School of Public Health, Northern State Medical University, Arkhangelsk, Russia
| | - Oleg Sidorenkov
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Odd Nilssen
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
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San Nicolas A, Lemos N. Toxicology findings in cases of hanging in the City and County of San Francisco over the 3-year period from 2011 to 2013. Forensic Sci Int 2015; 255:146-55. [DOI: 10.1016/j.forsciint.2015.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/21/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
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Kaplan MS, Huguet N, McFarland BH, Caetano R, Conner KR, Giesbrecht N, Nolte KB. Use of alcohol before suicide in the United States. Ann Epidemiol 2014; 24:588-592.e1-2. [PMID: 24953567 DOI: 10.1016/j.annepidem.2014.05.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/22/2014] [Accepted: 05/16/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE Few studies have compared acute use of alcohol in suicide decedents with that in a nonsuicide group. This study provides the first national analysis of acute use of alcohol before suicide compared with an estimate of acute use of alcohol in a living sample. METHODS Pooled 2003-2011 National Violent Death Reporting System data were used to estimate the prevalence of postmortem blood alcohol content positivity (blood alcohol content >0.0 g/dL) and intoxication (blood alcohol content ≥0.08 g/dL). Population estimates of comparable use of alcohol (within the past 48 hours) were based on the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS Compared with the living sample, male and female suicide decedents showed, respectively, a 1.83-fold (95% confidence interval [CI], 1.73-1.93) and 2.40-fold (95% CI, 2.24-2.57) increased risk of alcohol ingestion before their death after age, race/ethnicity, and chronic alcohol problems were controlled. Furthermore, male and female decedents exhibited, respectively, a 6.18-fold (95% CI, 5.57-6.86) and a 10.04-fold (95% CI, 8.67-11.64) increased risk of being intoxicated before their death after confounders were considered. CONCLUSIONS The findings underscore the crucial need to include among the essential components of suicide prevention policies programs that minimize the use of alcohol, particularly drinking to intoxication.
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Affiliation(s)
- Mark S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA.
| | - Nathalie Huguet
- Center for Public Health Studies, School of Community Health, College of Urban & Public Affairs, Portland State University, Portland, OR
| | | | - Raul Caetano
- The University of Texas School of Public Health, Dallas Regional Campus, Dallas
| | - Kenneth R Conner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY; VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY
| | - Norman Giesbrecht
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kurt B Nolte
- Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque
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Zupanc T, Agius M, Paska AV, Pregelj P. Blood alcohol concentration of suicide victims by partial hanging. J Forensic Leg Med 2013; 20:976-979. [PMID: 24237803 DOI: 10.1016/j.jflm.2013.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 09/11/2013] [Accepted: 09/16/2013] [Indexed: 11/18/2022]
Abstract
During the investigated period, 2000-2007, 4249 suicides were reported in Slovenia, and 1061 autopsies of suicide deaths from the central, northwestern, and southwestern parts of Slovenia were conducted at the Institute of Forensic Medicine in Ljubljana. To identify a possible role of alcohol use in the selection of suicide method blood samples were collected during medicolegal autopsies of suicide victims in order to establish their blood alcohol concentration (BAC) level at the time of death. The study group consisted of 844 suicide victims that used violent suicide methods and 174 suicide victims that used non-violent suicide methods. Out of the group with violent suicide methods 184 (21.8%) suicide victims by partial hanging and 112 (13.3%) suicide victims by complete hanging were identified. The average age was higher in the group of suicide victims by partial hanging than in the group of suicide victims by complete hanging (p < 0.001; T = 3653; df = 294). The mean BAC was higher (T = 1.604; df = 278; p < 0.05) in the group of suicide victims by partial hanging (0.57 g/kg; SD ± 0.92) than in the group of suicide victims by complete hanging (0.40 g/kg; SD ± 0.82). The proportion of BAC positive suicide victims with blood alcohol concentration above 0.1 g/kg at the time of death was higher in the group of suicide victims who used non-violent suicide methods in comparison to the group of suicide victims who used violent suicide methods (p < 0.001; χ(2) = 14.988, df = 1). Partial hanging was almost twice as common as complete hanging. Higher BAC in the group of suicide victims by partial hanging and more BAC positive suicide victims in the group who died by non-violent suicide methods could give indications about the role of alcohol in the selection of suicide method.
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Affiliation(s)
- Tomaž Zupanc
- Institute of Forensic Medicine, Faculty of Medicine, University of Ljubljana, Korytkova ulica 2, SI-1000 Ljubljana, Slovenia
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Toxicology findings in suicides: concentrations of ethanol and other drugs in femoral blood in victims of hanging and poisoning in relation to age and gender of the deceased. J Forensic Leg Med 2013; 20:842-7. [PMID: 24112333 DOI: 10.1016/j.jflm.2013.06.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/19/2013] [Accepted: 06/30/2013] [Indexed: 02/04/2023]
Abstract
Over-consumption of alcohol and/or abuse of other drugs are closely linked to attempted or completed suicides. In this retrospective 10-year study (2001-2010), we compared the toxicology findings in hanging suicides (n = 4551) with drug poisoning (intoxication) suicides (n = 2468). The mean age of hanging deaths was 49 ± 19 y (±SD) and 80% were male, compared with a mean age of 52 ± 17 y and 47% males for the intoxication deaths. Poly-drug use was more common in poisoning suicides with an average of 3.6 drugs/case compared with 1.8 drugs/case in hangings. Moreover, 31% of hangings were negative for alcohol and/or drugs. Alcohol was detected (>0.20 g/L) in femoral blood in 30% of hanging suicides (mean 1.39 g/L) and 36% of drug poisonings (mean 1.39 g/L). The median BACs did not depend on the person's age or gender (p > 0.05). Ethanol, paracetamol, citalopram, diazepam, propiomazine, alimemazine and zopiclone were amongst the top-ten drugs detected in both methods of suicide. With the exception of ethanol, the concentrations of drugs in blood were considerably higher in the poisoning deaths, as might be expected. Regardless of the method of suicide, antidepressants and/or antipsychotics were common findings, which could implicate mental health as a significant suicide risk factor.
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Hilal A, Çekin N, Gülmen MK, Yıldırım KÇ. Adana’da Otopsileri Yapılan Ası ve Bağla Boğma Olgularının Boyun Bulguları. ACTA ACUST UNITED AC 2011. [DOI: 10.17986/blm.2011161719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Boyun bölgesine uygulanan mekanik kuvvetlere bağlı ölümlerle adli tıp uygulamalarında sıklıkla karşılaşılmaktadır. Bunlar arasında, en sık karşılaşılan adli ölüm olgu grubunu asılar oluşturmaktadır. Sık olmamakla birlikte bağla boğma olguları ile karşılaşılmaktadır. Bu çalışma adli tıp uzmanlarının sıklıkla karşılaştıkları ası ve bağla boğma olgularında ki boyun lezyonlanmn çeşitliliğini ve sıklığını göstermek, bunları literatür bilgileri ile tartışmak içinyapıldı. Adli Tıp Kurumu Adana Grup Başkanlığında otopsileri yapılan olgulara ait 2008-2009 yıllan kayıtları retrospektif olarak incelendi. 2726 olgu içerisinde boyun bölgesine mekanik kuvvet uygulanması (ası ve bağla boğma) sonucu öldüğü saptanan 159'u ası, 11 i bağla boğma olan 170 (%6.2) olgu çalışma kapsamına alındı. Olguların 104'ü (%61.2) erkek 66'sınm kadın olduğu, çalışma kapsamındaki toplam olguların %93.5'ini asıların, 6.5%'ini ise bağla boğmaların oluşturduğu, asıların tümünün intihar, bağla boğmaların ise cinayet olduğu görüldü. Olguların yaş aralıklarına bakıldığında 4 ile 86yaş arasında, en çok olgunun 37 (%21.7) ile 21-30 yaş aralığında olduğu, 32 olgunun 11 -20 yaş aralığında olduğu, 0-10 yaş aralığında ki iki olgunun kız çocuğu olduğu, bununda bağla boğma sonucu öldürüldüğü saptandı. Asıların 121'nin tipik lokalizasyonlu, 38'nin atipik lokalizasyonlu ası olduğu görüldü. Ası ve bağla boğmalarda 43(%25.3) olguda troid kıkırdakda kırık olduğu, 25(%14.7) olguda ise hyoid kemik kmğı olduğu, 11(%6.5) olgu da ise hem hyoid kemik hem de troid kıkırdakta birlikte kırık olduğu saptandı. 7 olguda servikal vertebrada kırık veya dislokasyon olduğu görüldü. Troid kıkırdak, hyoid kemik ve servikal vertebralarda bulgu veren olguların toplam 86(%50.6) olduğu görüldü.Anahtar kelimeler: Ası, bağla boğma, boyna bası, otopsi, adli tıp.
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