Clinical Prediction of Suicide and Undetermined Death: A Pseudo-Prospective Clinical and Medico-Legal Study of Substance Abusers

Brådvik, Louise; Berglund, Mats; Frank, Arne; Löwenhielm, Peter

doi:10.3390/ijerph14030310

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…Gov, 2017) (Quello et al, 2005) (Hasin et al, 2002) and within this study, correlations were found between substances being present on toxicology and a diagnosis of depression. These results are consistent with studies that have identified that drugs increased the likelihood of accidents, suicides and homicides (Aharonovich et al, 2002;Brådvik et al, 2017;Kamali et al, 2000;Ortíz-Gómez et al, 2014) impulsivity and decreased rational thinking. (Ortíz-Gómez et al, 2014;WHO, 2017) There was a higher proportion of individuals with a diagnosis of depression who specifically had a history of taking Cocaine and Opiates.…”

Section: Discussionsupporting

confidence: 91%

The role of depression in unnatural death: A case-based retrospective study

Gilchrist

Sadler

2019

Journal of Affective Disorders

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Background: Depression affects the life of millions around the globe and perhaps also the manner of death. This study examined the role of depression in specific causes of unnatural death whether there was a relationship between unnatural death and depression and whether alcohol and substance use affect this relationship, in one locality in Scotland. Methods: The research used a retrospective case-based study approach to analyse 168 cases, quantifying data reported in mortuary files to allow for quantitative statistical analysis of associations and differences amongst the variables. Results: A diagnosis of depression was associated with a higher likelihood of unnatural death, specifically from due to suicide, drugs or homicide. A diagnosis of substance abuse was associated with a diagnosis of depression and with an increased likelihood of death due to suicide or drugs. A diagnosis of alcohol abuse was associated with a reduced likelihood of a diagnosis of depression but was associated with an increased likelihood of suicide.Limitations: This study relied on a small sample from one locality in Scotland which limited the ability to generalise the results and the retrospective case-based design also limited the potential for checking data accuracy or to consider temporal relationships, which limited the ability to interpret causality. Conclusions: This study found that there was a relationship between depression and unnatural death, which was mediated by alcohol and substance use. The importance of this study lies within the recognition of these relationships which identified the complexities of these relationships but suggested that some unnatural deaths within this population could be prevented.

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Section: Discussionsupporting

confidence: 91%

The role of depression in unnatural death: A case-based retrospective study

Gilchrist

Sadler

2019

Journal of Affective Disorders

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“…Alcohol at levels above 1‰ was also associated with an increased risk of self-inflicted death. This level of alcohol has also been found in suicide victims with a brittle/sensitive personality [ 44 ] and high levels of alcohol were also related to suicide among patients with suicidal ideation in a previous study on the present sample [ 38 ], both indicating disinhibition of suicidal impulses. Furthermore, there were equal rates of positive blood sampling in poisoning and violent suicides and deaths of undetermined intent and also similar rates of detection of high alcohol levels (above 1‰), regardless of violent method.…”

Section: Discussionsupporting

confidence: 80%

“…The sample has been presented in a previous study on unnatural death and drugs used in life, concluding that number of substances used in life is related to an increased risk of death of undetermined intent and heroin overdoses, but not suicide [ 37 ]. A more recent study on the same sample showed that suicidal communication was more often considered non-serious before death of undetermined intent than before suicide, and that the undetermined group also showed higher levels of alcohol in blood at autopsy [ 38 ]. The sample does not reflect the substance use pattern of today, but the physical and psychological effects we intended to study remain the same.…”

Section: Introductionmentioning

confidence: 99%

From Substance Use Disorders in Life to Autopsy Findings: A Combined Case-Record and Medico-Legal Study

Brådvik

Löwenhielm

Frank

et al. 2019

IJERPH

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Objectives: Several studies have shown mortality and suicide risk in substance use disorders, and autopsy findings with respect to the used substances. However, there seems to be a gap in the knowledge about substances misused in life and at death at the within-person level. Methods: All consecutive, autopsied patients during 1993 to 1997, who had been in contact with the Addiction Centre in Malmö from 1968, were investigated (365 subjects). Drug misuse in the long-term course noted in case records was related to autopsy findings. Self-inflicted death (suicide/undetermined suicide/accidental overdose) was compared with natural death. Results: Benzodiazepine misuse was associated with a high risk of autopsy findings of the substance in suicide and death of undetermined intent. It was also associated among non-misusers, but less so. An alcohol level above 1‰ was found more often in self-inflicted death. Prescription opioids at autopsy were mainly found in self-inflicted death among non-misusers. Heroin misuse was related to overdose. Central nervous system stimulants (CNS-S) and cannabis were rarely found in self-inflicted death among previous misusers. The overlap between depression in life and antidepressants at death was low. Conclusions: Benzodiazepines and alcohol seem to disinhibit suicidal tendencies. Suicide risk among users of cannabis and CNS-S may be related to other risk factors than acute use. Implications for suicide prevention are discussed.

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Pattern of intentional drowning mortality: a total population retrospective cohort study in Australia, 2006–2014

et al. 2019

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Background While a downward trend in unintentional drowning deaths in Australia has been observed, little is known about intentional drowning mortality. Limited information on intentional drowning death impedes the planning, implementation, and evaluation of prevention strategies. This study aims to describe rates of intentional fatal drowning in Australia and compare these to other categories of drowning. Methods Data were sourced from the Australian Bureau of Statistics (ABS) over a 9-year period (2006–2014). Rates and trends of intentional drowning were compared with unintentional, water-transport related and undetermined intent drowning. Rates of intentional drowning deaths across gender, age groups, states/territories, remoteness of residence and First Peoples of Australia were calculated. Relative risk (RR) (95% confidence interval [CI]) was calculated, and chi-square tests of independence were performed ( p < 0.05). Results The crude mortality rate for intentional drowning deaths in Australia over the study period was 0.23/100000, lower than unintentional drowning (0.89/100000). Males were 1.6 (CI: 1.4–2.0) times more likely than females to intentionally drown, however females made up a significantly larger proportion of intentional drowning deaths (38.2%) compared to unintentional deaths (22.4%) (χ 2 = 47.3; df = 1; p < 0.05). A significant linear association between age group and intentional drowning was observed (χ 2 = 131.3; p < 0.05), with individuals aged 75 years and over 32.6 times more likely to intentionally drown. Non-Indigenous peoples were 4.1 times more likely to intentionally drown in comparison to First Peoples of Australia. Residents of Inner Regional, Outer Regional, and Major Cities were 4.2 times (CI: 0.6–30.0), 4.1 times (CI: 0.6–29.9), and 4.0 times (CI: 0.6–28.6) more likely to intentionally drown, respectively, compared with residents of Very Remote areas. Conclusions This study adds to the limited evidence currently available about intentional drowning rates and trends in Australia. Being male, of older age groups, non-Indigenous, residing in Inner and Outer Regional areas, and Major Cities were risk factors for intentional drowning deaths. Improving data collection systems and furthering understanding of the risk factors of intentional drowning, as well as the development, implementation, and evaluation of prevention programmes, are required to reduce the risk of intentional drowning death in Australia.

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Clinical Prediction of Suicide and Undetermined Death: A Pseudo-Prospective Clinical and Medico-Legal Study of Substance Abusers

Cited by 3 publications

References 33 publications

The role of depression in unnatural death: A case-based retrospective study

The role of depression in unnatural death: A case-based retrospective study

From Substance Use Disorders in Life to Autopsy Findings: A Combined Case-Record and Medico-Legal Study

Pattern of intentional drowning mortality: a total population retrospective cohort study in Australia, 2006–2014

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