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      Comparative Analysis of Suicide, Accidental, and Undetermined Cause of Death Classification

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          Abstract

          Suicide determination is not standardized across medical examiners, and many suspected suicides are later classified as accidental or undetermined. The present study investigated patterns between these three groups using a medical examiner database and 633 structured interviews with next of kin. There were similarities across all three classification groups, including rates of mental illness and psychiatric symptoms. Those classified suicide were more likely to be male, to have died in a violent fashion, and have a stronger family history of suicide. Chronic pain was very common across all three groups, but significantly higher in the accidental and undetermined groups.

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          Absolute risk of suicide after first hospital contact in mental disorder.

          Merete Nordentoft, Preben Mortensen, Merete Nordentoft (2011)
          Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up. To estimate, in a national cohort, the absolute risk of suicide within 36 years after the first psychiatric contact. Prospective study of incident cases followed up for as long as 36 years. Median follow-up was 18 years. Individual data drawn from Danish longitudinal registers. A total of 176,347 persons born from January 1, 1955, through December 31, 1991, were followed up from their first contact with secondary mental health services after 15 years of age until death, emigration, disappearance, or the end of 2006. For each participant, 5 matched control individuals were included. Absolute risk of suicide in percentage of individuals up to 36 years after the first contact. Among men, the absolute risk of suicide (95% confidence interval [CI]) was highest for bipolar disorder, (7.77%; 6.01%-10.05%), followed by unipolar affective disorder (6.67%; 5.72%-7.78%) and schizophrenia (6.55%; 5.85%-7.34%). Among women, the highest risk was found among women with schizophrenia (4.91%; 95% CI, 4.03%-5.98%), followed by bipolar disorder (4.78%; 3.48%-6.56%). In the nonpsychiatric population, the risk was 0.72% (95% CI, 0.61%-0.86%) for men and 0.26% (0.20%-0.35%) for women. Comorbid substance abuse and comorbid unipolar affective disorder significantly increased the risk. The co-occurrence of deliberate self-harm increased the risk approximately 2-fold. Men with bipolar disorder and deliberate self-harm had the highest risk (17.08%; 95% CI, 11.19%-26.07%). This is the first analysis of the absolute risk of suicide in a total national cohort of individuals followed up from the first psychiatric contact, and it represents, to our knowledge, the hitherto largest sample with the longest and most complete follow-up. Our estimates are lower than those most often cited, but they are still substantial and indicate the continuous need for prevention of suicide among people with mental disorders.
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            Main predictions of the interpersonal-psychological theory of suicidal behavior: empirical tests in two samples of young adults.

            Thomas Joiner, T. Witte, J Ribeiro … (2009)
            The interpersonal-psychological theory of suicidal behavior (T. E. Joiner, 2005) makes 2 overarching predictions: (a) that perceptions of burdening others and of social alienation combine to instill the desire for death and (b) that individuals will not act on the desire for death unless they have developed the capability to do so. This capability develops through exposure and thus habituation to painful and/or fearsome experiences and is posited by the theory to be necessary for overcoming powerful self-preservation pressures. Two studies tested these predictions. In Study 1, the interaction of (low) family social support (cf. social alienation or low belonging) and feeling that one does not matter (cf. perceived burdensomeness) predicted current suicidal ideation, beyond depression indices. In Study 2, the 3-way interaction among a measure of low belonging, a measure of perceived burdensomeness, and lifetime number of suicide attempts (viewed as a strong predictor of the level of acquired capability for suicide) predicted current suicide attempt (vs. ideation) among a clinical sample of suicidal young adults, again beyond depression indices and other key covariates. Implications for the understanding, treatment, and prevention of suicidal behavior are discussed.
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              Genetics of suicide: a systematic review of twin studies.

              Martin Voracek, Lisa Loibl (2006)
              Convergent evidence from a multitude of research designs (adoption, family, genomescan, geographical, immigrant, molecular genetic, surname, and twin studies of suicide) suggests genetic contributions to suicide risk. The present account provides a comprehensive and up-to-date review of the twin studies on this topic. A total of 32 studies (19 case reports, 5 twin register-based studies, 4 population-based epidemiological studies, 4 studies of surviving co-twins) located through extensive literature search strategies are summarized and discussed here. This literature corpus was published between 1812 and 2006 in six languages and reports data from 13 countries. A meta-analysis of all register-based studies and all case reports aggregated shows that concordance for completed suicide is significantly more frequent among monozygotic than dizygotic twin pairs. The results of co-twin studies rule out exclusively psychosocially based explanations of this pattern. Population-based epidemiological studies demonstrate a significant contribution of additive genetic factors (heritability estimates: 30-55%) to the broader phenotype of suicidal behavior (suicide thoughts, plans and attempts) that largely overlaps for different types of suicidal behavior and is largely independent of the inheritance of psychiatric disorders. Nonshared environmental effects (i.e. personal experiences) also contribute substantially to the risk of suicidal behavior, whereas effects of shared (family) environment do not. The totality of evidence from twin studies of suicide strongly suggests genetic contributions to liability for suicidal behavior. To further research progress in this area, an extensive discussion of design limitations, shortcomings of the literature and further points is provided, including sources of bias, gaps in the literature, errors in previous reviews, age and sex effects and twin-singleton differences in suicide risk, and notes from a history-of-science view.
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                Author and article information

                Journal
                Title: Suicide and Life-Threatening Behavior
                Abbreviated Title: Suicide & Life Threat Behav
                Publisher: Wiley
                ISSN (Print): 0363-0234
                ISSN (Electronic): 1943-278X
                Publication date Created: June 2014
                Publication date (Electronic): February 20 2014
                Publication date (Print): June 2014
                Volume: 44
                Issue: 3
                Pages: 304-316
                Affiliations
                [1 ] Mental Illness Research, Education and Clinical Center (MIRECC) Veterans Integrated Service Network 19 (VISN 19) George E. Whalen Department of Veterans Affairs Medical Center Salt Lake City UT USA
                [2 ] Department of Psychiatry University of Utah School of Medicine Salt Lake City UT USA
                [3 ] Brain Institute University of Utah Salt Lake City UT USA
                [4 ] Utah Office of the Medical Examiner Salt Lake City UT USA
                [5 ] Department of Educational Psychology University of Utah Salt Lake City UT USA
                [6 ] Department of Pathology University of Utah School of Medicine Salt Lake City UT USA
                Article
                DOI: 10.1111/sltb.12079
                PubMed ID: 25057525
                SO-VID: 276f77a5-7414-4042-8f3f-324bf4d2772e
                Copyright © © 2014
                License:

                http://onlinelibrary.wiley.com/termsAndConditions#vor

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