Confronting Death From Drug Self-Intoxication (DDSI): Prevention Through a Better Definition

Rockett, Ian Richard Hildreth; Smith, Gordon S.; Caine, Eric D.; Kapusta, Nestor D.; Hanzlick, Randy; Larkin, Gregory Luke; Naylor, Charles; Nolte, Kurt B.; Miller, Ted R.; Putnam, Sandra L.; Leo, Diego De; Kleinig, John; Stack, Steven; Todd, Knox H.; Fraser, David W.

doi:10.2105/ajph.2014.302244

Cited by 63 publications

(69 citation statements)

References 64 publications

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“…Deaths due to suicide (regardless of cause, including suicide by poisoning) and drug overdoses (unintentional poisonings and poisonings of undetermined intent) were categorized broadly as deaths from “self-harm” for the purposes of this study, as it is often difficult for the coroner and Colorado Maternal Mortality Review Committee (a panel of experts including obstetrician–gynecologists, perinatologists, substance use disorder experts, injury prevention experts, psychiatrists and a coroner) to accurately classify these deaths by intent even after reviewing all available documentation. 7,8 This approach was also supported by prior literature demonstrating an over-classification of overdoses as accidental rather than suicide. 7 Cases of overdoses are not classified as suicide by a medical examiner or coroner unless there is clear evidence indicating an intention to take one's own life and deliberate means.…”

Section: Methodssupporting

confidence: 53%

“…7,8 This approach was also supported by prior literature demonstrating an over-classification of overdoses as accidental rather than suicide. 7 Cases of overdoses are not classified as suicide by a medical examiner or coroner unless there is clear evidence indicating an intention to take one's own life and deliberate means. Often this must be corroborated by other evidence of suicide such as a suicide note, known suicidal ideations, or a prior attempt.…”

Section: Methodssupporting

confidence: 53%

“…Often this must be corroborated by other evidence of suicide such as a suicide note, known suicidal ideations, or a prior attempt. 7 When cases of maternal death by accidental overdose are reviewed by mental and behavioral health experts on the Colorado Maternal Mortality Review Committee, it is often concluded that the death may have been intentional despite a documented manner of death of accidental. Thus, these outcomes were combined for the purposes of this study.…”

Section: Methodsmentioning

confidence: 99%

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Maternal Deaths From Suicide and Overdose in Colorado, 2004–2012

Metz

Rovner

Hoffman

et al. 2016

Obstetrics &Amp; Gynecology

163

100

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Objective To ascertain demographic and clinical characteristics of maternal deaths from self-harm (accidental overdose or suicide) in order to identify opportunities for prevention. Methods We report a case series of pregnancy-associated deaths due to self-harm in the state of Colorado between 2004 and 2012. Self-harm deaths were identified from several sources, including death certificates. Birth and death certificates along with coroner, prenatal care and delivery hospitalization records were abstracted. Descriptive analyses were performed. For context, we describe demographic characteristics of women with a maternal death from self-harm and all women with live births in Colorado. Results Among the 211 total maternal deaths in Colorado over the study interval, 30% (n=63) resulted from self-harm. The pregnancy-associated death ratio from overdose was 5.0 (95% CI 3.4, 7.2) per 100,000 live births and from suicide 4.6 (95% CI 3.0, 6.6) per 100,000 live births. Detailed records were obtained for 94% (n=59) of women with deaths from self-harm. Deaths were equally distributed throughout the first postpartum year (mean 6.21 ± 3.3 months postpartum) with only 6 maternal deaths during pregnancy. Seventeen percent (n=10) had a known substance use disorder. Prior psychiatric diagnoses were documented in 54% (n=32) and prior suicide attempts in 10% (n=6). While half (n=27) of the women with deaths from self-harm were noted to be taking psycho-pharmacotherapy at conception, 48% of them discontinued the medications during pregnancy. Fifty women had toxicology testing available; pharmaceutical opioids were the most common drug identified (n=21). Conclusion Self-harm was the most common cause of pregnancy-associated mortality with most deaths occurring in the postpartum period. A four-pronged educational and program building effort to include women, providers, health care systems, and both governments and organizations at the community and national level may allow for a reduction in maternal deaths.

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Section: Methodssupporting

confidence: 53%

Section: Methodssupporting

confidence: 53%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Maternal Deaths From Suicide and Overdose in Colorado, 2004–2012

Metz

Rovner

Hoffman

et al. 2016

Obstetrics &Amp; Gynecology

163

100

View full text Add to dashboard Cite

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“…A similar result that there were several differences between suicide and undetermined intent (foremost unintentional poisonings) were also found in Sweden [41]. Recently, some studies have paid attention to the misclassification of underdetermined poisonings deaths [42, 43]. A new death classification about the suicide and undetermined intent may be helpful for us to better understand suicide behavior.…”

Section: Discussionmentioning

confidence: 67%

Characteristics of Chinese rural young suicides: Who did not have a strong intent to die

Sun¹,

Zhang²

2015

Comprehensive Psychiatry

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Background In exploration of the risk factors of the Chinese rural young suicide, previous researchers found low prevalence of mental problems, high degree of impulsivity, and great proportion of lethal pesticide consumption. It noticed that some of the young suicides in rural China did not intend to die from the suicidal behavior which was only instrumentally used for certain gains. Aims This study aims to look into the characteristics of those young suicides who did not really intend to die and compare them with those young suicides who had a strong intent to die. Methods Subjects were 386 suicides aged 15-34 years in the rural areas of three provinces in China. The data were obtained by psychological autopsy method. The degree of suicidal intent of the subjects was evaluated by the first 8 items of Beck’s Suicide Intent Scale (SIS). Results It was found that those suicides who had a strong intent of death were more likely to have higher age, more years of education, live alone, and suffer mental disease. On the other hand, the low intent suicides were more likely to have pesticides at home and to be impulsive. In other words, pesticides and impulsivity killed some Chinese rural young men and women who did not really want to die by suicide. Conclusion Findings of the study may be translated into practical measures in suicide prevention in China as well as elsewhere in the world.

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“…7 Thus, the label of “accident” has served as the default determination when definitive proximal evidence remains uncertain. 8 …”

mentioning

confidence: 99%

Self-injury Mortality in the United States in the Early 21st Century

et al. 2016

Self Cite

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IMPORTANCE Fatal self-injury in the United States associated with deliberate behaviors is seriously underestimated owing to misclassification of poisoning suicides and mischaracterization of most drug poisoning deaths as “accidents” on death certificates. OBJECTIVE To compare national trends and patterns of self-injury mortality (SIM) with mortality from 3 proximally ranked top 10 causes of death: diabetes, influenza and pneumonia, and kidney disease. DATA, SETTING, AND PARTICIPANTS Underlying cause-of-death data from 1999 to 2014 were extracted for this observational study from death certificate data in the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research online databases. Linear time trends were compared by negative binomial regression with a log link function. Self-injury mortality was defined as a composite of suicides by any method and estimated deaths from drug self-intoxication whose manner was an “accident” or was undetermined. MAIN OUTCOMES AND MEASURES Mortality rates and ratios, cumulative mortality in individuals younger than 55 years, and years of life lost in 2014. RESULTS There were an estimated 40 289 self-injury deaths in 1999 and 76 227 in 2014. Females comprised 8923 (22.1%) of the deaths in 1999 and 21 950 (28.8%) of the 76 227 deaths in 2014. The estimated crude rate for SIM increased 65%between 1999 and 2014, from 14.4 to 23.9 deaths per 100 000 persons (rate ratio, 1.03; 95%CI, 1.03–1.04; P < .001). The SIM rate continuously exceeded the kidney disease mortality rate and surpassed the influenza and pneumonia mortality rate by 2006. By 2014, the SIM rate converged with the diabetes mortality rate. Additionally, the SIM rate was 1.8-fold higher than the suicide rate in 2014 vs 1.4-fold higher in 1999. The male-to-female ratio for SIM decreased from 3.7 in 1999 to 2.6 in 2014 (male by year: rate ratio, 0.98; 95%CI, 0.97–0.98; P < .001). By 2014, SIM accounted for 32.2 and 36.6 years of life lost for male and female decedents, respectively, compared with 15.8 and 17.3 years from diabetes, 15.0 and 16.6 years from influenza and pneumonia, and 14.5 and 16.2 years from kidney disease. CONCLUSIONS AND RELEVANCE The burgeoning SIM rate has converged with the mortality rate for diabetes, but there is a 6-fold differential in the proportion of SIM vs diabetes deaths involving people younger than 55 years and SIM is increasingly affecting women relative to men. Accurately characterizing, measuring, and monitoring this major clinical and public health challenge will be essential for developing a comprehensive etiologic understanding and evaluating preventive and therapeutic interventions

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Confronting Death From Drug Self-Intoxication (DDSI): Prevention Through a Better Definition

Cited by 63 publications

References 64 publications

Maternal Deaths From Suicide and Overdose in Colorado, 2004–2012

Maternal Deaths From Suicide and Overdose in Colorado, 2004–2012

Characteristics of Chinese rural young suicides: Who did not have a strong intent to die

Self-injury Mortality in the United States in the Early 21st Century

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