Method overtness, forensic autopsy, and the evidentiary suicide note: A multilevel National Violent Death Reporting System analysis

Autor: Steven Stack, Haomiao Jia, Hilary S. Connery, Christa L. Lilly, Lewis S. Nelson, Sandra L. Putnam, Ian R. H. Rockett, Ted R. Miller, Eric D. Caine, Paul S. Nestadt, Kurt B. Nolte
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Suicide note
Social Sciences
lcsh:Medicine
Pathology and Laboratory Medicine
Toxicology
Suicide prevention
0302 clinical medicine
Epidemiology
Medicine and Health Sciences
Public and Occupational Health
030212 general & internal medicine
Registries
Young adult
lcsh:Science
Forensic Pathology
Multidisciplinary
Poisoning
Traumatic Injury Risk Factors
Middle Aged
16. Peace & justice
Clinical Laboratory Sciences
3. Good health
Suicide
Multilevel Analysis
Engineering and Technology
Female
Autopsy
Weapons
Research Article
Adult
medicine.medical_specialty
Forensic pathology
Firearms
Adolescent
Substance-Related Disorders
Intoxication
Equipment
Surgical and Invasive Medical Procedures
Drug overdose
03 medical and health sciences
Forensic Toxicology
Asphyxia
Young Adult
Signs and Symptoms
Diagnostic Medicine
Mental Health and Psychiatry
medicine
Humans
Psychiatry
Forensics
Aged
business.industry
lcsh:R
Forensic toxicology
Biology and Life Sciences
Odds ratio
medicine.disease
United States
030227 psychiatry
Anatomical Pathology
Law and Legal Sciences
Wounds
Gunshot
lcsh:Q
Drug Overdose
business
Zdroj: PLoS ONE, Vol 13, Iss 5, p e0197805 (2018)
PLoS ONE
ISSN: 1932-6203
Popis: Objective Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by drug-intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note. Methods This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States National Violent Death Reporting System throughout 2011–2013, the study population comprised registered suicides, aged 15 years and older. Decedents totaled 32,151. The outcome measure was relative odds of an authenticated suicide note. Results An authenticated suicide note was documented in 31% of the suicide cases. Inspection of the full multivariable model showed a suicide note was more likely to manifest among drug intoxication (adjusted odds ratio [OR], 1.70; 95% CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm suicides, the referent. Respective excesses were larger when there was no autopsy or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95% CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62, 95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation suicides did not differ from the firearm referent given an autopsy. Conclusions Suicide requires substantial affirmative evidence to establish manner of death, and affirmation of drug intoxication suicides appears to demand an especially high burden of proof. Findings and their implications argue for more stringent investigative standards, better training, and more resources to support comprehensive and accurate case ascertainment, as the foundation for developing evidence-based suicide prevention initiatives.
Databáze: OpenAIRE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje