Observational studyPloS one2018
Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history.
Observational study in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers.
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Who cites it
51 citing papers in PubMed.
- Study protocol for a randomized trial examining a peer grief support approach for people grieving drug overdose deaths.Addiction science & clinical practice · 2026Trial
- Links between suicidal intent, polysubstance use, and medical treatment after non-fatal opioid overdose.Drug and alcohol dependence · 2020Trial
- Association between undetermined intent death classification and county death investigation system for drug poisoning deaths in nine US jurisdictions.Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention · 2026Article
- Suicide and Drug Overdose Mortality Among Washington State Workers: A Stratified Analysis by Industry, Occupation, Sex, and Race/Ethnicity, 2014-2023.International journal of environmental research and public health · 2026Article
- Comparison of suicide rates in the USA and Australia between 1921 and 2020: major shifts in youth and elderly suicide rates over a century.BJPsych open · 2025Article
- Racial/ethnic inequality in homelessness and drug overdose deaths in US States.Social psychiatry and psychiatric epidemiology · 2025Article
- Factors Associated with Attempted Suicide Among Emergency Department Patients with Nonfatal Opioid Overdose.Substance use & misuse · 2025Observational
- Randomized Pilot of a Clinical Decision Support Tool to Increase Suicide Screening for at-Risk Primary Care Patients With Opioid Use Disorder.AJPM focus · 2024Article
- Autopsy rates and the misclassification of suicide and accident deaths.European journal of epidemiology · 2024Article
- Trends in Drug Overdose Deaths by Intent and Drug Categories, United States, 1999‒2022.American journal of public health · 2024Article
- Share of Adult Suicides After Recent Jail Release.JAMA network open · 2024Article
- [Social determinants of health: alternative explanatory proposal to the biomedical approach to suicidal behavior].Revista de salud publica (Bogota, Colombia) · 2024Article
- High dimensional predictions of suicide risk in 4.2 million US Veterans using ensemble transfer learning.Scientific reports · 2024Article
- The temporal association between suicide and comorbid mental disorders in people treated for substance use disorders: a National registry study.Addiction science & clinical practice · 2023Article
- Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System.Drug safety · 2023Article
- Escalating costs of self-injury mortality in the 21st century United States: an interstate observational study.BMC public health · 2023Observational
- Physical Health Problems as a Suicide Precipitant: Associations With Other Risk Factors and Suicide Methods in Three Age Groups of Older Decedents.Innovation in aging · 2023Article
- Detection of Suicide Clusters using Small-Area Geographic Data from the Virginia Violent Death Reporting System, 2010 - 2015.Virginia journal of public health · 2023Article
- Job loss, financial strain, and housing problems as suicide precipitants: Associations with other life stressors.SSM - population health · 2022Article
- Achieving health equity in US suicides: a narrative review and commentary.BMC public health · 2022Review
Corrections and comments
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Authors and funding
16 authors.
Funding
Abstract
objectiveA paucity of corroborative psychological and psychiatric evidence may be inhibiting detection of drug intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by drug intoxication versus firearm (gunshot wound) plus hanging/suffocation-the other two major, but overtly violent methods.
methodsThis observational multilevel (individual/county), multivariable study employed a generalized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System throughout 2011-2013. The outcome measure was relative odds of suicide versus undetermined classification, adjusted for demographics, precipitating circumstances, and investigation characteristics.
resultsA suicide note, prior suicide attempt, or affective disorder was documented in less than one-third of suicides and one-quarter of undetermined deaths. The prevalence gaps were larger among drug intoxication cases than gunshot/hanging cases. The latter were more likely than intoxication cases to be classified as suicide versus undetermined manner of death (adjusted odds ratio [OR], 41.14; 95% CI, 34.43-49.15), as were cases documenting a suicide note (OR, 33.90; 95% CI, 26.11-44.05), prior suicide attempt (OR, 2.42; 95% CI, 2.11-2.77), or depression (OR, 1.61; 95% CI, 1.38 to 1.88), or bipolar disorder (OR, 1.41; 95% CI, 1.10-1.81). Stratification by mechanism/cause intensified the association between a note and suicide classification for intoxication cases (OR, 45.43; 95% CI, 31.06-66.58). Prior suicide attempt (OR, 2.64; 95% CI, 2.19-3.18) and depression (OR, 1.48; 95% CI, 1.17-1.87) were associated with suicide classification in intoxication but not gunshot/hanging cases.
conclusionsWithout psychological/psychiatric evidence contributing to manner of death classification, suicide by drug intoxication in the US is likely profoundly under-reported. Findings harbor adverse implications for surveillance, etiologic understanding, and prevention of suicides and drug deaths.
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