Deaths Of Undetermined Intent Research Articles

Involvement of propranolol in suicides: cross-sectional study using coroner-reported data.

Propranolol is a beta-blocker medication indicated mostly for heart rhythm conditions and for physical symptoms of anxiety. Prescriptions for propranolol in the UK have increased since 2008. Recently, there have been concerns about the involvement of propranolol in intentional poisonings, but such deaths are not routinely reported. Therefore, use of coroner-reported and toxicology data enables unique investigation into the scale of involvement of propranolol in suicide. To describe the extent to which propranolol is involved in suicides, including patterns over time and characteristics of people whose suicide involved propranolol compared with other suicides. Data were derived from the National Programme on Substance Use Mortality (NPSUM). All suicides and deaths of undetermined intent between 2010 and 2021 in England, Wales and Northern Ireland were extracted, and a subset was identified where propranolol was involved in death. There were 4473 suicides of which 297 (6.6%) involved propranolol, with the proportion involving propranolol nearly quadrupling during the study period (3.4% v. 12.3%). Compared with all other suicides, a greater proportion of propranolol suicides were in women (56.6% v. 37.1%) and in people with diagnoses of depression (39.1% v. 27.1%) and anxiety (22.2% v. 8.6%). When suicide involved propranolol, an antidepressant was detected at post-mortem in 81.8% of deaths, most commonly a selective serotonin reuptake inhibitor (SSRIs) (51.5%), and most often citalopram (24.6%). A small number, but increasing proportion, of suicides reported to the NPSUM involve propranolol. Vigilance to the combined toxicity profile of medicines used alongside propranolol may be pertinent.

Surveillance for Violent Deaths — National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020

Surveillance for Violent Deaths — National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020

Taking responsibility for mental health in the workplace

In PracticeVolume 45, Issue 4 p. 245-246 Opinion Taking responsibility for mental health in the workplace Glen Cousquer, Glen CousquerSearch for more papers by this author Glen Cousquer, Glen CousquerSearch for more papers by this author First published: 05 May 2023 https://doi.org/10.1002/inpr.315Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References BRSCIC, M., CONTIERO, B., SCHIANCHI, A. & MAROGNA, C. (2021) Challenging suicide, burnout, and depression among veterinary practitioners and students: text mining and topics modelling analysis of the scientific literature. BMC Veterinary Research 17, 294 HANH, T. N. (2015) Silence: the power of quiet in a world full of noise. Rider HSE (2022) Protecting people and places. HSE strategy 2022 to 2032. https://bit.ly/43MHP5U. Accessed 20 April 2023 HÜBL, T. & SHRIDHARE, L. (2022) The ‘Tender Narrator’ who sees beyond time: a framework for trauma integration and healing. Journal of Awareness-Based Systems Change 2, 9– 27 MACY, J. & BROWN, M. (2021) Coming Back to Life: The Updated Guide to the Work That Reconnects. New Society Publishers MATÉ, G. (2022) The myth of normal: trauma, illness and healing in a toxic culture. Penguin Random House WATERS, S. & PALMER, H. (2021) Work-related suicide: a qualitative analysis of recent cases with recommendations for reform. https://bit.ly/3mIsYch. Accessed 20 April 2023 WHO (2021) 1 in 100 deaths is by suicide. https://bit.ly/3AhOCqV. Accessed 20 April 2023 WITTE, T. K., SPITZER, E. G., EDWARDS, N., FOWLER, K. A. & NETT, R. J. (2019) Suicides and deaths of undetermined intent among veterinary professionals from 2003 through 2014. Journal of the American Veterinary Medical Association 255, 595– 608 Volume45, Issue4May 2023Pages 245-246 ReferencesRelatedInformation

Genetic differences between suicide deaths and deaths of undetermined intent.

Few, if any, prior studies have considered whether undetermined intent (UDI) deaths and suicide deaths differ with respect to genetic liability for suicidal behavior or psychopathology. The authors used Swedish national registry data to identify suicide deaths (N=31,835) and UDI deaths (N=10,623); sociodemographic covariates; and registrations for psychopathology. Family genetic risk scores (FGRS) were derived for each form of psychopathology. The authors used LASSO models to assess genetic and phenotypic differences across outcomes. In the multivariate LASSO regressions, higher FGRS for major depression, bipolar disorder, and suicide death were associated with lower odds of UDI relative to unambiguous suicide (OR=0.91-0.95), while those for alcohol and drug use disorders, ADHD, and criminal behavior were associated with higher odds of UDI relative to unambiguous suicide (OR=1.04-1.12). When the corresponding phenotypic registration status for these outcomes was included in a subsequent model, the associations were attenuated and of small magnitude, but many remained different from OR=1. Aggregate genetic differences between unambiguous suicide decedents and UDI deaths are small, particularly when accounting for psychiatric comorbidity, but in some cases, statistically significant. These findings suggest that different analytic treatment of UDI deaths may be warranted depending on the research question. Replication in other samples, and using molecular genetic data, is necessary.

Unanticipated Changes in Drug Overdose Death Rates in Canada During the Opioid Crisis.

Escalating drug overdose death rates in Canada are of ever-increasing concern. To better understand the extent of this health threat, we obtained mortality statistics and population figures for the years 2000 to 2020, and examined rates of overdose deaths, coded (using ICD-10) as accidental, suicide or “undetermined intent.” The drug deemed as primarily responsible for the death was categorized as opioid, non-opioid, or unspecified. Age patterns of drug deaths were graphed. Joinpoint analysis was used to test the significance of changes in death rates. Accidental opioid and stimulant overdose death rates in Canada have climbed faster since 2011, though not as high as corresponding US rates. Unknown cause death rates have increased. However, opioid and non-opioid suicide rates have decreased significantly since 2011, and there have been fewer drug deaths of undetermined intent. Increased attention to the possibility that some suicides are being misclassified is warranted.

Caring for Carers: Veterinarians Struggle With MH Issues

Caring for Carers: Veterinarians Struggle With MH Issues

Surveillance for Violent Deaths - National Violent Death Reporting System, 42 States, the District of Columbia, and Puerto Rico, 2019.

Surveillance for Violent Deaths - National Violent Death Reporting System, 42 States, the District of Columbia, and Puerto Rico, 2019.

Suicide, Homicide, and Other Violent Deaths Among People Experiencing Homelessness in the United States: A Cross-sectional Study.

Limited information exists about violent deaths among people experiencing homelessness (PEH) across the United States. Using data from a national reporting system, we describe characteristics of suicides, homicides, and other deaths classified as violent among PEH in the United States. We obtained data on demographic characteristics, mechanisms of injury, and circumstances surrounding violent deaths from January 1, 2016, through December 31, 2018, in 31 states from the National Violent Death Reporting System. Of 122 113 violent deaths in 31 states during 2016-2018, 1757 (1.4%) occurred among PEH and 3952 (3.2%) occurred among people for whom homelessness status was unknown or missing. Of all violent deaths among PEH, 878 were suicides (1.1% of all suicides), 458 were homicides (1.6% of all homicides), 352 were of undetermined intent (2.8% of all deaths of undetermined intent), and 59 were the result of legal interventions (3.8% of all deaths due to legal interventions). Hanging/suffocation/strangulation was the most common mechanism of suicide among PEH (44.4%), followed by deaths due to firearms (21.6%). Firearms were the most common mechanism of homicide deaths among PEH (48.0%). Black PEH were more likely to die by homicide than by suicide, and White PEH were more likely to die by suicide than by homicide. Among the 843 suicide victims for whom additional information was known, 345 (40.9%) had a history of suicidal thoughts or plans, 245 (29.1%) had disclosed intent to die by suicide, and 183 (21.7%) were receiving treatment for a mental health condition. Efforts to reduce mortality and improve health outcomes among PEH should consider the high rates of violent deaths in this population.

Using natural language processing to improve suicide classification requires consideration of race.

To improve the accuracy of classification of deaths of undetermined intent and to examine racial differences in misclassification. We used natural language processing and statistical text analysis on restricted-access case narratives of suicides, homicides, and undetermined deaths in 37 states collected from the National Violent Death Reporting System (NVDRS) (2017). We fit separate race-specific classification models to predict suicide among undetermined cases using data from known homicide cases (true negatives) and known suicide cases (true positives). A classifier trained on an all-race dataset predicts less than half of these cases as suicide. Importantly, our analysis yields an estimated suicide rate for the Black population comparable with the typical detection rate for the White population, indicating that misclassification excess is endemic for Black suicide. This problem may be mitigated by using race-specific data. Our findings, based on the statistical text analysis, also reveal systematic differences in the phrases identified as most predictive of suicide. This study highlights the need to understand the reasons underlying suicide rate differences and for further testing of strategies to reduce misclassification, particularly among people of color.

Surveillance for Violent Deaths - National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018.

Surveillance for Violent Deaths - National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018.

Sociodemographic Analysis of Suicide Rates Among Older Adults Living in Ecuador: 1997-2019.

Background: Despite most suicides occurring in low-and-middle-income countries (LAMICs), limited reports on suicide rates in older adults among LAMICs are available. In Ecuador, high suicide rates have been reported among adolescents. Little is known about the epidemiology of suicides among older adults in Ecuador.Aim: To examine the sociodemographic characteristics of suicides among older adults living in Ecuador from 1997 to 2019.Methods: An observational study was conducted using Ecuador's National Institute of Census and Statistics database from 1997 to 2019 in Ecuadorians aged 60 and older. International Classification of Diseases 10th Revision (ICD-10) (X60-X84)-reported suicide deaths were included in addition to deaths of events of undetermined intent (Y21-Y33). Sex, age, ethnicity, educational level, and method of suicide were analyzed. Annual suicide rates were calculated per 100,000 by age, sex, and method. To examine the trends in rates of suicide, Joinpoint analysis using Poisson log-linear regression was used.Results: Suicide rates of female older adults remained relatively stable between 1997 and 2019 with an average annual percentage increase of 2.4%, while the male rates increased between 2002 and 2009, 2014 and 2016, and maintained relatively stable within the past 3 years (2017–2019). The annual age-adjusted male suicide rate was 29.8 per 100,000, while the female suicide rate was 5.26 per 100,000 during the study period. When adding deaths of undetermined intent, the annual male rate was 60.5 per 100,000, while the same rate was 14.3 for women. The most common suicide method was hanging (55.7%) followed by self-poisoning (26.0%). The highest suicide numbers were reported in urban districts, men, and those with lower education status.Conclusion: This study contributes to building the baseline for further studies on suicide rates of older adults in Ecuador. Results highlight priority areas of suicide prevention. By examining suicide trends over 23 years, findings can help inform policy and future interventions targeting suicide prevention.

Surveillance for Violent Deaths - National Violent Death Reporting System, 34 States, Four California Counties, the District of Columbia, and Puerto Rico, 2017.

Surveillance for Violent Deaths - National Violent Death Reporting System, 34 States, Four California Counties, the District of Columbia, and Puerto Rico, 2017.

Surveillance for Violent Deaths - National Violent Death Reporting System, 32 States, 2016.

Surveillance for Violent Deaths - National Violent Death Reporting System, 32 States, 2016.

Suicides and deaths of undetermined intent among veterinary professionals from 2003 through 2014.

To analyze data for death of veterinary professionals and veterinary students, with manner of death characterized as suicide or undetermined intent from 2003 through 2014. Death records for 202 veterinary professionals and veterinary students. Decedents employed as veterinarians, veterinary technicians or technologists, or veterinary assistants or laboratory animal caretakers and veterinary students who died by suicide or of undetermined intent were identified through retrospective review of National Violent Death Reporting System records. Standardized mortality ratios (SMRs) and 95% confidence intervals were calculated, and mechanisms and circumstances of death were compared among veterinary occupational groups. 197 veterinary professionals and 5 veterinary students had deaths by suicide or of undetermined intent. Among decedents employed at the time of death, SMRs for suicide of male and female veterinarians (1.6 and 2.4, respectively) and male and female veterinary technicians or technologists (5.0 and 2.3, respectively) were significantly greater than those for the general US population, whereas SMRs for suicide of male and female veterinary assistants or laboratory animal caretakers were not. Poisoning was the most common mechanism of death among veterinarians; the drug most commonly used was pentobarbital. For most (13/18) veterinarians who died of pentobarbital poisoning, the death-related injury occurred at home. When decedents with pentobarbital poisoning were excluded from analyses, SMRs for suicide of male and female veterinarians, but not veterinary technicians or technologists, did not differ significantly from results for the general population. Results suggested higher SMRs for suicide among veterinarians might be attributable to pentobarbital access. Improving administrative controls for pentobarbital might be a promising suicide prevention strategy among veterinarians; however, different strategies are likely needed for veterinary technicians or technologists.

Suicides and Deaths of Undetermined Intent by Poisoning: Reexamination of Classification Differences by Race/Ethnicity and State

This study examined differences by race/ethnicity and state in poisoning deaths of undetermined intent (UnD) versus suicide classification and the potential impact of state variations on UnD rates for Blacks and Hispanics. We used data from the 2005–2015 U.S. National Violent Death Reporting System (N = 29,567 aged 15+) and weighted coarsened exact matching. The odds of UnD classification were 7–10 times higher in the 5 highest UnD states (Kentucky, Maryland, Michigan, Utah, and Rhode Island) than in other states. Blacks in these 5 states had twice the odds of Whites of being classified as UnDs than suicides, but had lower odds in other states. Other significant UnD classification factors were opioid and cocaine positive toxicologies.

"Armed juvenicide": youth homicides and firearms in Latin America

This article analyzes the impact of firearms in the homicides of young people in Latin America today. A cross-sectional descriptive epidemiological study was carried out based on data from the Pan American Health Organization. There were 14,427 deaths due to assaults with firearms in young people, that is, a rate of 14.3 per 100,000 young people for the year 2014 in Latin America. Thus, 80% of all homicides in young people between 10 to 19 years of age in the region were committed with firearms. This especially affects young males, with a rate of 26.5 per 100,000 deaths due to assault with firearms, although it should not be overlooked that the deaths among women are largely femicides. In addition, 1,828 deaths of undetermined intent with firearms (especially in Argentina and Venezuela) and 284 deaths with firearms in legal interventions (showing higher policy lethality among young people) were registered. The corrected rate is therefore 16.4 young people killed by others with firearms per 100,000 youth in Latin America. The need for gun control and disarmament policies, de-stigmatization campaigns and youth development programs is discussed, in order to reduce the current conditions that foster and invisibilize the so-called "armed juvenicide" in Latin America.

Analysis of the quality of information on mortality by homicide from deaths with undetermined intent. Bahia, Brazil, from 2002-2013.

To identify patterns in the spatial distribution of homicide death rates, considering the proportion of deaths of undetermined intent in the municipalities of the State of Bahia, from 2002 to 2013. An ecological study was carried out, using data from the Mortality Information System (SIM). Theproportional mortality of undetermined intent on the total external causes and the homicide rate were analyzed in several municipalities of Bahia and considering the Health Macro-regions (HMRs). A-non-random mortality distribution pattern was observed, according to the overall Moran index, which was clearer in the 2005-2007, 2008-2010 and 2011-2013 triennia. The highest proportions of undetermined deaths, ≥ 50%, were concentrated in the State's Western region. On the other hand, the highest homicide rates were observed in the Far South, South and East regions - coastal municipalities. The same municipalities and regions identified with low homicide rates concomitantly presented high proportions of undetermined deaths, and conversely, where there were high rates, there was also a low proportion of undetermined death. Therefore,it is essential to take into account the quality of information about the underlying cause.

Poisoning deaths among late-middle aged and older adults: comparison between suicides and deaths of undetermined intent

Given the rapid increase in prescription and illicit drug poisoning deaths in the 50+ age group, we examined precipitating/risk factors and toxicology results associated with poisoning deaths classified as suicides compared to intent-undetermined death (UnD) among decedents aged 50+. Data were from the 2005-2015 US National Violent Death Reporting System (N = 15,453). χ2 tests and multinomial logistic regression models were used to compare three groups of decedents: suicide decedent who left a suicide note, suicide decedent who did not leave a note, and UnD cases. Compared to suicide decedents without a note (37.7% of the sample), those with a note (29.4%) were more likely to have been depressed and had physical health problems and other life stressors, while UnD cases (32.9%) were less likely to have had mental health problems and other life stressors but more likely to have had substance use and health problems. UnD cases were also more likely to be opioid (RRR = 2.65, 95% CI = 2.42-2.90) and cocaine (RRR = 2.59, 95% CI = 2.09-3.21) positive but less likely to be antidepressant positive. Blacks were more than twice as likely as non-Hispanic Whites to be UnDs. Results from separate regression models in the highest UnD states (Maryland and Utah) and in states other than Maryland/Utah were similar. Many UnDs may be more correctly classified as unintentional overdose deaths. Along with more accurate determination processes for intent/manner of death, substance use treatment and approaches to curbing opioid and other drug use problems are needed to prevent intentional and unintentional poisoning deaths.

Surveillance for Violent Deaths - National Violent Death Reporting System, 27 States, 2015.

Surveillance for Violent Deaths - National Violent Death Reporting System, 27 States, 2015.

Surveillance for Violent Deaths - National Violent Death Reporting System, 18 States, 2014.

Problem/ConditionIn 2014, approximately 59,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC’s National Violent Death Reporting System (NVDRS) regarding violent deaths from 18 U.S. states for 2014. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics.Reporting Period Covered2014.Description of SystemNVDRS collects data from participating states regarding violent deaths. Data are obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 18 states that collected statewide data for 2014 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) into a single incident.ResultsFor 2014, a total of 22,098 fatal incidents involving 22,618 deaths were captured by NVDRS in the 18 states included in this report. The majority of deaths were suicides (65.6%), followed by homicides (22.5%), deaths of undetermined intent (10.0%), deaths involving legal intervention (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1%). The term “legal intervention” is a classification incorporated into the International Classification of Diseases, Tenth Revision (ICD-10) and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement. Suicides occurred at higher rates among males, non-Hispanic American Indian/Alaska Natives (AI/AN), non-Hispanic whites, persons aged 45–54 years, and males aged ≥75 years. Suicides were preceded primarily by a mental health, intimate partner, substance abuse, or physical health problem or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged <1 year and 15–44 years; rates were highest among non-Hispanic black and AI/AN males. Homicides primarily were precipitated by arguments and interpersonal conflicts, occurrence in conjunction with another crime, or related to intimate partner violence (particularly for females). When the relationship between a homicide victim and a suspected perpetrator was known, it was most often either an acquaintance/friend or an intimate partner. Legal intervention death rates were highest among males and persons aged 20–44 years; rates were highest among non-Hispanic black males and Hispanic males. Precipitating factors for the majority of legal intervention deaths were alleged criminal activity in progress, the victim reportedly using a weapon in the incident, a mental health or substance abuse problem, an argument or conflict, or a recent crisis. Deaths of undetermined intent occurred more frequently among males, particularly non-Hispanic black and AI/AN males, and persons aged 30–54 years. Substance abuse, mental health problems, physical health problems, and a recent crisis were the most common circumstances preceding deaths of undetermined intent. Unintentional firearm deaths were more frequent among males, non-Hispanic whites, and persons aged 10–24 years; these deaths most often occurred while the shooter was playing with a firearm and were most often precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded.InterpretationThis report provides a detailed summary of data from NVDRS for 2014. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected persons aged <65 years, males, and certain minority populations. The primary precipitating factors for homicides and suicides were intimate partner problems, interpersonal conflicts, mental health and substance abuse problems, and recent crises.Public Health ActionNVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths. For example, North Carolina VDRS data were used to improve case ascertainment of pregnancy-associated suicides, Wisconsin VDRS data were used to develop the statewide suicide prevention strategy, and Colorado VDRS data were used to develop programs and prevention strategies for suicide among veterans. The continued development and expansion of NVDRS to include all U.S. states, territories, and the District of Columbia are essential to public health efforts to reduce the impact of violence.