Abstract
This study examines aspects of prediction of suicide and death of undetermined intent. We investigated all consecutive, autopsied patients between 1993 and 1997 who had been in contact with the Addiction Centre in Malmö from 1968 onwards. The staff was asked, shortly after autopsy but before they knew of the manner of death, if they thought the patient had committed suicide. The case records were blindly evaluated, and toxicological autopsy findings for alcohol in blood samples investigated. The specificity of prediction was 83% and significantly more often correct than the sensitivity, which was only 45% for suicide and for suicide/death of undetermined intent (93% versus 39%). Suicidal communication was more often considered non-serious before death of undetermined intent than before suicide. The former could be predicted by ideation but not by suicide attempt reported in case records, unlike suicide, which was predicted by both. The undetermined group also showed higher levels of alcohol in the blood at autopsy. We concluded that more serious clinical investigation of suicidal feelings, which may be hidden and not taken seriously, and treatment of alcohol use disorders with active follow-up appear urgent in the efforts to prevent suicide.
Highlights
IntroductionSuicide is a major health problem, with more than 800,000 people killing themselves every year [1]
Suicide is a major health problem, with more than 800,000 people killing themselves every year [1].The prediction of accomplished suicide in order to prevent it is urgent but difficult
Suicide predicted by staff and ‘intent not considered serious’ were compared for suicides and death of undetermined intent (Table 3)
Summary
Suicide is a major health problem, with more than 800,000 people killing themselves every year [1]. The prediction of accomplished suicide in order to prevent it is urgent but difficult. Different rating scales have been developed, such as the Scale of Suicidal Ideation (SSI) [2], the Suicidal Intent Scale (SIS) [3], and the Sad Persons Scale [4]. A recent review of the predictive value for future suicide attempts has not been encouraging [5], with the conclusion that none of the known rating scales reached a sensitivity of 80%, nor was a specificity of 50% reached. Clinical judgement as a complement to rating scales was strongly recommended. Typical scales for suicide prediction can be less effective when a respondent has alcohol or other substance use disorders, so additional clinical judgement is warranted
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