National Violent Death Reporting System Research Articles

A Comparison of Suicides and Undetermined Deaths by Poisoning among Women: An Analysis of the National Violent Death Reporting System

The study compared the prevalence of common suicide risk factors between poisoning deaths classified as injuries of undetermined intent or suicides among women. Data were derived from the 2003–10 National Violent Death Reporting System. Multiple logistic regression assessed the factors associated with 799 undetermined deaths (relative to 3,233 suicides). Female decedents with lower education, a substance use problem, and a health problem were more likely to be classified as undetermined death. Older women, those with an intimate partner problem, financial problem, depressed mood, mental health problem, attempted suicide, and disclosed intent to die were less likely to be classified as undetermined death. The present study raises the possibility that many (perhaps most) undetermined female poisoning deaths are suicides.

Use of alcohol before suicide in the United States

PurposeFew studies have compared acute use of alcohol in suicide decedents with that in a nonsuicide group. This study provides the first national analysis of acute use of alcohol before suicide compared with an estimate of acute use of alcohol in a living sample. MethodsPooled 2003–2011 National Violent Death Reporting System data were used to estimate the prevalence of postmortem blood alcohol content positivity (blood alcohol content >0.0 g/dL) and intoxication (blood alcohol content ≥0.08 g/dL). Population estimates of comparable use of alcohol (within the past 48 hours) were based on the National Epidemiologic Survey on Alcohol and Related Conditions. ResultsCompared with the living sample, male and female suicide decedents showed, respectively, a 1.83-fold (95% confidence interval [CI], 1.73–1.93) and 2.40-fold (95% CI, 2.24–2.57) increased risk of alcohol ingestion before their death after age, race/ethnicity, and chronic alcohol problems were controlled. Furthermore, male and female decedents exhibited, respectively, a 6.18-fold (95% CI, 5.57–6.86) and a 10.04-fold (95% CI, 8.67–11.64) increased risk of being intoxicated before their death after confounders were considered. ConclusionsThe findings underscore the crucial need to include among the essential components of suicide prevention policies programs that minimize the use of alcohol, particularly drinking to intoxication.

Gender and age differences in suicide mortality in the context of violent death: Findings from a multi-state population-based surveillance system

ObjectiveMales are more likely than females to die by all forms of violent death, including suicide. The primary purpose of the present study was to explore whether the gender difference in suicide rates is largely accounted for by males' general greater tendency to experience violent deaths. The current study examined gender and age differences in suicides and other violent deaths, using data from a population-based surveillance system. MethodPearson's chi-square tests and logistic regression analyses were conducted with data for 32,107 decedents in the 2003–2005 National Violent Death Reporting System (NVDRS). Decedents were categorized by gender, age, and death by suicide versus other violent means. ResultsWhen suicides were examined in the greater context of violent death, the total proportion of violent deaths due to suicide did not differ across gender. When deaths were examined by age group, after controlling for ethnicity, marital status, and U.S. location in which the death occurred, males in early to mid childhood were significantly more likely than same-aged females to die by suicide relative to all other violent deaths. The portion of deaths due to suicide was for the most part equal across both genders in late childhood, young adulthood, and mid-adulthood. Older males were more likely than older females to die by suicide relative to other violent deaths. ConclusionOur findings suggest that that the risk of dying by suicide relative to other violent deaths may be more pronounced at certain developmental stages for each gender. This knowledge may be valuable in tailoring prevention strategies.

Suicide Experts Identify Six Questions to Guide Research in Next Decade

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessSuicide Experts Identify Six Questions to Guide Research in Next DecadeAaron LevinAaron LevinSearch for more papers by this authorPublished Online:19 Mar 2014https://doi.org/10.1176/appi.pn.2014.3a19AbstractMore clearly defining the goals and mechanisms of research into suicide may move the field forward and lead to a substantial reduction in suicides.Despite efforts at prevention, suicide rates in the United States have remained the same for the last half century. Clarifying approaches to research into suicide and its antecedents might ultimately lead to reductions in those rates, according to a new report.The National Action Alliance for Suicide Prevention’s Research Prioritization Task Force issued a prioritized research agenda on February 5 by the public-private consortium led by Phillip Satow, chair of the board at the Jed Foundation, and Thomas Insel, M.D., director of the National Institute of Mental Health (NIMH). About 38,000 Americans die by suicide every year, and 650,000 hospital visits are attributed to suicide attempts, noted the report.“To reduce suicide, we need to know how to target our efforts: to be able to reliably identify who is at risk, how to reach them, and how to deter them from acting on suicidal thoughts,” said Insel in a statement.The NIMH funds $44 million in suicide research annually, said the research agenda authors.The document took about three years to produce, said Jane Pearson, Ph.D., chair of the Suicide Risk Consortium at NIMH and lead staffer for the research agenda. Task force members volunteered their time, and private groups and federal agencies provided administrative and meeting support.A number of organizations and advocacy groups observed that prioritizing research into other diseases helped to advance the science in those areas, she said. At present, many gaps in the science of suicide exist: surveillance, causes, detection, treatment, and trajectories through age groups.To begin the process of filling those gaps, the task force sought the views of 700 individuals, including scientists, funding bodies, clinicians, public health leaders, as well as survivors of suicide attempts and families of those who died by suicide.The research agenda distilled their inquiry down to six key questions that its authors hope will guide research over the coming decade, with an initial goal of reducing suicides by 20 percent over the next five years:Why do people become suicidalHow can we better or more optimally detect/predict risk?What interventions prevent individuals from engaging in suicidal behavior?What services are most effective for treating the suicidal person and preventing suicidal behavior?What other types of interventions (outside health care settings) reduce suicide risk?What new and existing research infrastructure is needed to reduce suicidal behavior?“This document will draw attention and researchers to the topic and facilitate funding,” said Robert Ursano, M.D., a professor and chair of the Department of Psychiatry at the Uniformed Services University of the Health Sciences School of Medicine in Bethesda, Md. Ursano is co-principal investigator of the ongoing Army STARRS research on military suicides (Psychiatric News, March 7) but did not take part in the task force’s work.The task force hopes to draw attention to measures already known to be effective, to test whether commonly used antisuicide programs are indeed effective, and to identify new research needed in less-studied areas.Research methodology needs attention, as well. For example, alternative trial designs may be needed to overcome difficulties in randomization. Models based on accident research or behavioral economics may be useful. Standardizations of nomenclature, national patient registries, and expansion of the National Violent Death Reporting System (which now collects data in only 18 states) would improve surveillance, to cite just some of the issues raised in the research agenda.“At NIMH, we have been trying to steer the field in this general direction to move interventions tested in clinical trials into clinical practice,” said Pearson. “We really have to compress the 17-year gap between research and clinical practice.”“[S]uicide has proven stubbornly difficult to understand, to predict, and to prevent,” said Insel. “We believe the research agenda gives us a roadmap to save lives.” ■“A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives” can be accessed here. ISSUES NewArchived

Beyond suicide: action needed to improve self-injury mortality accounting.

Beyond suicide: action needed to improve self-injury mortality accounting.

Characteristics of U.S. Suicide Decedents in 2005–2010 Who Had Received Mental Health Treatment

To inform suicide prevention efforts in mental health treatment, the study assessed associations between recent mental health treatment, personal characteristics, and circumstances of suicide among suicide decedents. Data from 18 states reporting to the National Violent Death Reporting System between 2005 and 2010 (N=57,877 suicides) were used to compare circumstances among adult decedents receiving any or no type of mental health treatment within two months before death. Of suicide decedents, 28.5% received treatment before suicide. Several variables were associated with higher odds of receiving treatment, including death by poisoning with commonly prescribed substances (adjusted odds ratio [AOR]=3.04, 95% confidence interval [CI]=2.84-3.26), a history of suicide attempts (AOR=2.77, CI=2.64-2.90), depressed mood (AOR=1.69, CI=1.62-1.76), and nonalcoholic substance abuse or dependence (AOR=1.13, CI=1.07-1.19). For nearly a third of all suicide decedents, better mental health care might have prevented death. Efforts to reduce access to lethal doses of prescription medications seem warranted to prevent overdosing with commonly prescribed substances.

Police Responses in Officer-Involved Violent Deaths: Comparison of Suicide by Cop and Non-Suicide by Cop Incidents

Officers’ responses in suicide by cop (SbC) situations often include use of deadly force. Given their training and experience, officers’ use of deadly force should mean that they reasonably believe that they or other people are in immediate threat of death or serious bodily harm. Using National Violent Death Reporting System data, the current study compares police responses in SbC and non-SbC cases and the possible influences of the characteristics of the situations and of the subjects on officers’ use-of-force decisions. Multivariate analysis reveals different significant predictors impacting different levels of police actions between and with SbC and non-SbC cases.

Altitude is a risk factor for completed suicide in bipolar disorder

Bipolar disorder (BD) is a severe brain disease that is associated with a significant risk for suicide. Recent studies indicate that altitude of residence significantly affects overall rate of completed suicide, and is associated with a higher incidence of depressive symptoms. Bipolar disorder has shown to be linked to mitochondrial dysfunction that may increase the severity of episodes. The present study used existing data sets to explore the hypothesis that altitude has a greater effect of suicide in BD, compared with other mental illnesses. The study utilized data extracted from the National Violent Death Reporting System (NVDRS), a surveillance system designed by the Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control (NCIPC). Data were available for 16 states for the years 2005–2008, representing a total of 35,725 completed suicides in 922 U.S. counties. Random coefficient and logistic regression models in the SAS PROC MIXED procedure were used to estimate the effect of altitude on decedent’s mental health diagnosis. Altitude was a significant, independent predictor of the altitude at which suicides occurred (F=8.28, p=0.004 and Wald chi-square=21.67, p<0.0001). Least squares means of altitude, independent of other variables, indicated that individuals with BD committed suicide at the greatest mean altitude. Moreover, the mean altitude at which suicides occurred in BD was significantly higher than in decedents whose mental health diagnosis was major depressive disorder (MDD), schizophrenia, or anxiety disorder. Identifying diagnosis-specific risk factors such as altitude may aid suicide prevention efforts, and provide important information for improving the clinical management of BD.

Intimate Partner Homicide and Corollary Victims in 16 States: National Violent Death Reporting System, 2003–2009

We estimated the frequency and examined the characteristics of intimate partner homicide and related deaths in 16 US states participating in the National Violent Death Reporting System (NVDRS), a state-based surveillance system. We used a combination of quantitative and qualitative methods to analyze NVDRS data from 2003 to 2009. We selected deaths linked to intimate partner violence for analysis. Our sample comprised 4470 persons who died in the course of 3350 intimate partner violence-related homicide incidents. Intimate partners and corollary victims represented 80% and 20% of homicide victims, respectively. Corollary homicide victims included family members, new intimate partners, friends, acquaintances, police officers, and strangers. Our findings, from the first multiple-state study of intimate partner homicide and corollary homicides, demonstrate that the burden of intimate partner violence extends beyond the couple involved. Systems (e.g., criminal justice, medical care, and shelters) whose representatives routinely interact with victims of intimate partner violence can help assess the potential for lethal danger, which may prevent intimate partner and corollary victims from harm.

Suicides in Urban and Rural Counties in the United States, 2006–2008

Suicide rates are higher in rural areas. It has been hypothesized that inadequate access to care may play a role, but studies examining individual decedent characteristics are lacking. We sought to characterize the demographic, socioeconomic, and mental health features of individual suicide decedents by urban-rural residence status. We analyzed suicides in 16 states using 2006-2008 data from the National Violent Death Reporting System and examined associations between decedent residence type and suicide variables with separate logistic regressions adjusted for age, sex, race, and ethnicity. Of 17,504 analyzed suicides, 78% were in urban, 15% in rural adjacent, and 8% in rural nonadjacent locations. Rural decedents were less likely than urban decedents to have a mental health diagnosis or mental health care, although the prevalence of depressed moods appeared similar. Most suicides were by firearm, and rural decedents were more likely than urban decedents to have used a firearm. Rural decedents were less likely to be receiving mental health care and more likely to use firearms to commit suicide. A better understanding of geographic patterns of suicide may aid prevention efforts.

The Effects of Misclassification Biases on Veteran Suicide Rate Estimates

We assessed the impact that possible veteran suicide misclassification biases (i.e., inaccuracy in ascertainment of veteran status on the death certificate and misclassification of suicide as other manner of death) have on veteran suicide rate estimates. We obtained suicide mortality data from the 2003-2010 National Violent Death Reporting System and the 2003-2010 Department of Defense Casualty Analysis System. We derived population estimates from the 2003-2010 American Community Survey and 2003-2010 Department of Veterans Affairs data. We computed veteran and nonveteran suicide rates. The results showed that suicide rates were minimally affected by the adjustment for the misclassification of current military personnel suicides as veterans. Moreover, combining suicides and deaths by injury of undetermined intent did not alter the conclusions. The National Violent Death Reporting System is a valid surveillance system for veteran suicide. However, more than half of younger (< 25 years) male and female suicides, labeled as veterans, were likely to have been current military personnel at the time of their death and misclassified on the death certificate.

Sociodemographic predictors of suicide means in a population-based surveillance system: Findings from the National Violent Death Reporting System

BackgroundMultivariate studies of specific suicide means are relatively rare, given the logistical challenges associated with the low base rate of suicide in the general population. Thus, information on individual characteristics associated with specific suicide means remains relatively wanting. The current study provided the largest examination to date of sociodemographic characteristics associated with different means of lethality among suicide decedents, using data from a multi-state population-based surveillance system. MethodsMultivariate logistic regression was used with data for 20,577 suicide decedents in the National Violent Death Reporting System from 2003 to 2005. ResultsFirearm decedents were more likely male, elderly, non-Hispanic white, married, veterans, and born in the U.S. Hanging and suffocation decedents were more likely male, young, racial/ethnic minorities, never married, non-veterans, and foreign-born. Decedents that jumped from heights were more likely female, older, non-Hispanic black, never married, non-veterans, and foreign-born. Decedents who used sharp instruments were more likely older, never married, and foreign-born. Self-poisoned decedents were more likely female, middle-age, non-Hispanic white, and not married. Regarding specific poisons, alcohol was more likely to be used by middle-age decedents; gas by males, elderly, and married individuals; over-the-counter drugs by females, adolescents, and foreign-born decedents; prescription drugs by females, middle-aged, and U.S. born individuals; and street drugs by males and racial/ethnic minorities. LimitationsThe data were drawn from 18 states and so cannot be regarded as nationally representative. ConclusionsSubstantial sociodemographic variability exists across different suicide means. Recognition of this variability may help to tailor prevention efforts involving means restriction.

Homicide-Followed-by-Suicide Incidents Involving Child Victims

To describe homicide-followed-by-suicide incidents involving child victims Using 2003-2009 National Violent Death Reporting System data, we characterized 129 incidents based on victim and perpetrator demographic information, their relationships, the weapons/mechanisms involved, and the perpetrators' health and stress-related circumstances. These incidents accounted for 188 child deaths; 69% were under 11 years old, and 58% were killed with a firearm. Approximately 76% of perpetrators were males, and 75% were parents/caregivers. Eighty-one percent of incidents with paternal perpetrators and 59% with maternal perpetrators were preceded by parental discord. Fifty-two percent of incidents with maternal perpetrators were associated with maternal psychiatric problems. Strategies that resolve parental conflicts rationally and facilitate detection and treatment of parental mental conditions might help prevention efforts.

Precipitating Circumstances of Suicide Among Youth Aged 10–17 Years by Sex: Data From the National Violent Death Reporting System, 16 States, 2005–2008

We examined the circumstances that precipitated suicide among 1,046 youth aged 10-17 years in 16 U.S. states from 2005 to 2008. The majority of deaths were among male subjects (75.2%), non-Hispanic whites (69.3%), those aged 16-17 years (58.1%), those who died by hanging/strangulation/suffocation (50.2%) and those who died in a house or an apartment (82.5%). Relationship problems, recent crises, mental health problems, and intimate partner and school problems were the most common precipitating factors and many differed by sex. School problems were reported for 25% of decedents, of which 30.3% were a drop in grades and 12.4% were bullying related. Prevention strategies directed toward relationship-building, problem-solving, and increasing access to treatment may be beneficial for this population.

Addressing the Burden of Gun Violence

Gun violence in the U.S. is a significant public health burden, accounting for over 30,000 deaths and an estimated 73,000 injures each year. Like other disease burdens with complex interactions between the host (individuals), agents (firearms) and the environment, epidemiological principles can identify patterns in the determinants and distribution of firearm injuries to develop, implement and evaluate evidence-based interventions (programs, policies, technologies). The National Violent Death Reporting System (NVDRS) was formed in 2002 with funding from the Centers for Disease Control and Prevention to link information on violent deaths from medical examiners and coroners to data on circumstances and weapons from law enforcement and crime laboratories. Involvement of forensic pathologists, medical examiners and coroners is critically important for a complete National Violent Death Reporting System and vital for the systematic collection, analysis, and dissemination of data on all violent deaths in the United States.

Acute Use of Alcohol and Methods of Suicide in a US National Sample

We explored age, gender, and racial/ethnic differences with alcohol use and firearms, hanging or asphyxiation, and poisoning methods of suicide. We analyzed data for 37,993 suicide decedents aged 18 years and older from the 2005-2010 National Violent Death Reporting System database. Multinomial logistic regressions examined associations of method with alcohol use defined by blood alcohol content. Two-way interactions tested the effects of age, gender, and race/ethnicity on the associations between alcohol use and method of suicide. Alcohol was present among decedents who used the 3 leading methods of suicide: firearm (35.0%), hanging (36.8%), and poisoning (32.7%). Two-way interaction tests suggested that in young and middle adulthood, individuals were more likely to drink alcohol when they used a firearm or hanging (compared with poisoning), but in older adulthood, the reverse was true, with alcohol use more likely with poisoning. Interaction tests also suggested that Asians and Pacific Islanders were most likely to use alcohol in poisonings and that Blacks were least likely to use alcohol in hangings. The results suggested that alcohol use before suicide was influenced by several factors, including age, race/ethnicity, and suicide method.

Acute Alcohol Intoxication and Suicide Among United States Ethnic/Racial Groups: Findings from the National Violent Death Reporting System

To assess the prevalence and sociodemographic correlates of suicide involving acute alcohol intoxication among U.S. ethnic minorities. Data were derived from the restricted 2003 to 2009 National Violent Death Reporting System. The study focused on the sociodemographic and toxicological information of 59,384 male and female suicide decedents for 16 states of the United States. Acute alcohol intoxication was defined as having a blood alcohol content (BAC) ≥0.08g/dl. Overall, 76% of decedents were tested for the presence of alcohol. The proportion of suicide decedents with a positive BAC ranged from 47% among American Indians/Alaska Natives (AIs/ANs) to 23% among Asians/Pacific Islanders (PIs). Average BAC was highest among AIs/ANs. Among those who were tested for BAC, the proportion of decedents legally intoxicated prior to suicide was as follows: Blacks, 15%; AIs/ANs, 36%; Asians/PIs, 13%; and Hispanics, 28%. Bivariate associations showed that most suicide decedents who were legally intoxicated were male, younger than 30years of age, with a high school education, not married, nonveterans, lived in metropolitan areas, and used a firearm to complete suicide. However, with the exception of Whites, most of these associations became not statistically significant in multivariate analysis. Alcohol use and legal intoxication prior to completing suicide are common among U.S. ethnic groups, especially among men and those who are younger than 30years of age. The AI/AN group had the highest mean BAC, the highest rate of legal intoxication and decedents who were particularly young. Suicide prevention strategies should address alcohol use as a risk factor. Alcohol problems prevention strategies should focus on suicide as a consequence of alcohol use, especially among AI/AN youth and young adults.

Homicide and Suicide During the Perinatal Period: Findings From the National Violent Death Reporting System

Homicide and Suicide During the Perinatal Period: Findings From the National Violent Death Reporting System

Homicide and Suicide During the Perinatal Period

OBJECTIVE: : To estimate the rates of pregnancy-associated homicide and suicide in a multistate sample from the National Violent Death Reporting System, to compare these rates with other causes of maternal mortality, and to describe victims' demographic characteristics. METHODS: : We analyzed data from female victims of reproductive age from 2003 to 2007. We identified pregnancy-associated violent deaths as deaths attributable to homicide or suicide during pregnancy or within the first year postpartum, and we calculated the rates of pregnancy-associated homicide and suicide as the number of deaths per 100,000 live births in the sample population. We used descriptive statistics to report victims' demographic characteristics and prevalence of intimate-partner violence. RESULTS: : There were 94 counts of pregnancy-associated suicide and 139 counts of pregnancy-associated homicide, yielding pregnancy-associated suicide and homicide rates of 2.0 and 2.9 deaths per 100,000 live births, respectively. Victims of pregnancy-associated suicide were significantly more likely to be older and white or Native American as compared with all live births in National Violent Death Reporting System states. Pregnancy-associated homicide victims were significantly more likely to be at the extremes of the age range and African American. In our study, 54.3% of pregnancy-associated suicides involved intimate partner conflict that appeared to contribute to the suicide, and 45.3% of pregnancy-associated homicides were associated with intimate-partner violence. CONCLUSION: : Our results indicate that pregnancy-associated homicide and suicide are important contributors to maternal mortality and confirm the need to evaluate the relationships between sociodemographic disparities and intimate-partner violence with pregnancy-associated violent death. LEVEL OF EVIDENCE: : II. Language: en

Factors Influencing Subjects’ Observed Level of Suicide by Cop Intent

The term suicide by cop (SbC) is used commonly for police-involved shootings that could be considered suicides because of the subject’s precipitated actions that demonstrate suicidal intent. The intent of the subject’s actions is often complicated and rarely understood. Using Lord and Sloop’s revised SbC decision model, the current study used a legal intervention incidents subset within the National Violent Death Reporting System data established by the Centers for Disease Control and Prevention to examine the intent of subjects who were reported to have died violently through the involvement of law enforcement. The study’s results support the importance of multiple points of data to make decisions of SbC. Based on the current model, certain personal characteristics, history of suicide attempts, a domestic dispute in progress, and refusal to surrender significantly contributed to the strength of association. Factors considered indicators of irrational thought were not found to be significant predictors.