Suicide Decedents Research Articles

Ethanol and illicit drugs acute use and abuse as risk factors for suicide: A case–control study based on forensic autopsies in the Basque Country, Spain

IntroductionAbuse/dependence and acute use of ethanol and illicit drug are considered risk factors for suicide. The risk is also influenced by demographic conditions and/or psychiatric comorbidity. The aim of the study was to test the association between presence of ethanol, illicit substances and prescribed drugs in suicide decedents and controls. Materials and methodsCase–control study of autopsies performed in the Biscay Forensic Pathology Service, Basque Country, Spain from 01/01/2010 to 30/06/2021 in subjects between 15 and 55 years old. Suicide deaths (n=481) with completed autopsy were evaluated. Concurrent natural deaths were chosen as controls (n=330). The risk for suicide according to demographic, toxicological and psychiatric variables was analyzed using logistic regression. ResultsEthanol was present in 21% and illicit drugs, mainly cannabis, cocaine and amphetamine, in 27% of suicide deaths. Illicit drugs were more frequent among males. In 63% of suicide cases, prescribed psychotropic drugs were detected.In a multivariate analysis, the main risk factors for suicide were psychiatric diagnosis of illicit drug abuse/dependence (OR=5.56, 95% CI 2.74–11.30) or another mental disease as mood or psychotic disorders (OR=13.05, 95% CI 8.79–19.37). Acute presence of ethanol (OR=4.22, 95% CI 2.52–7.08), recent use of cocaine (OR=2.52, 95% CI 1.05–6.07) and age <35 years (OR=2.50, 95% CI 1.62–3.87) were also associated with suicide deaths. ConclusionsThe presence of drugs of abuse in suicide deaths of people ≤55 years old is high. Recent use of ethanol and cocaine is significantly associated with an increased suicide risk. Specific prevention strategies against exposition to substances of abuse should be promoted, especially in psychiatric patients.

391. Early Life Adversity and Recent Life Stress Are Associated With Cell-Specific Cox-2 Increased Expression in the Human Dorsolateral Prefrontal Cortex in Depressed Suicide Decedents

391. Early Life Adversity and Recent Life Stress Are Associated With Cell-Specific Cox-2 Increased Expression in the Human Dorsolateral Prefrontal Cortex in Depressed Suicide Decedents

Association Between Acute Alcohol Use and Firearm-Involved Suicide in the United States

Firearms are the method of suicide used most often in the US. Acute alcohol use is associated with an increased risk of suicide by firearm. However, the dose-response association between acute alcohol use and the probability of using a firearm as the method of suicide is unknown. To evaluate the association between the amount of alcohol consumed and the probability of using a firearm as the method of suicide. This cross-sectional study used mortality data from the US National Violent Death Reporting System on suicide decedents aged 18 years or older with a positive blood alcohol concentration (BAC; ie, ≥0.01 g/dL). Statistical analysis was performed from January 2003 to December 2020. Acute alcohol use, ascertained via postmortem toxicologic examination. Probability of using a firearm as the method of suicide compared with all other methods of suicide. The study included 45 959 male suicide decedents (mean [SD] age, 42.6 [14.8] years) and 12 136 female suicide decedents (mean [SD] age, 44.2 [13.8] years) with a positive BAC; of those, 24 720 male decedents (53.8%) and 3599 female decedents (29.7%) used a firearm as the method of suicide. The probability of using a firearm as the method of suicide when alcohol is consumed was higher for male decedents, with the probability starting at just below 0.50 and increasing to approximately 0.75. In contrast, for female decedents, the probability began at just above 0.30 and increased to approximately 0.55. For both male and female decedents, the dose-response curves were an inverted U shape; as BAC increased, the probability of firearm-involved suicide initially increased and then decreased at very high BACs (approximately 0.40 g/dL for male decedents and approximately 0.30 g/dL for female decedents; these BACs were present among only a small percentage of alcohol-involved suicides: male decedents, 589 [1.3%]; female decedents, 754 [6.2%]). This cross-sectional study of suicide decedents who had consumed alcohol prior to their death suggests that, as alcohol consumption increased, the probability of a firearm-involved suicide increased until a certain BAC, at which point the probability started to decrease.

Assessing the Burden of Suicide Death Associated With Nonoptimum Temperature in a Changing Climate

Few studies have projected future suicide burden associated with daily temperatures in a warming climate. To assess the burden of suicide death associated with daily nonoptimal temperature and to project the change of suicide burden associated with nonoptimal temperature in different regions and seasons under various climate change scenarios. Between January 1, 2013, and December 31, 2019, we conducted a time-stratified, case-control study among more than 430 000 individual suicide decedents from all counties in mainland China. Daily meteorological data were obtained from the European Centre for Medium-Range Weather Forecasts Reanalysis Fifth Generation (ERA5) reanalysis product. Historical and future temperature series were projected under 3 scenarios of greenhouse-gas emissions from 1980 to 2099, with 10 general circulation models. The relative risk (RR) and burden of suicide death associated with nonoptimal temperature (ie, temperatures greater than or less than minimum-mortality temperature); the change of suicide burden associated with future climate warming in different regions and seasons under various climate change scenarios. Of 432 008 individuals (mean [SD] age; 57.6 [19.0] years; 253 093 male [58.6%]) who died by suicide, 85.8% (370 577) had a middle school education or less. The temperature-suicide associations were approximately linear, with increasing death risks at higher temperatures. The excess risk was more prominent among older adults (ie, ≥75 years; RR, 1.71; 95% CI, 1.46-1.99) and those with low education level (ie, middle school education or less; RR, 1.46; 95% CI, 1.36-1.57). There were 15.2% suicide deaths (95% estimated CI [eCI], 14.6%-15.6%) associated with nonoptimal temperature nationally. Consistent and drastic increases in excess suicide deaths over this century were predicted under the high-emission scenario, whereas a leveling-off trend after the mid-21st century was predicted under the medium- and low-emission scenarios. Nationally, compared with the historical period (1980-2009), excess suicide deaths were predicted to increase by 8.3% to 11.4% in the 2050s and 8.5% to 21.7% in the 2090s under the 3 scenarios. The projected percentage increments of excess suicide deaths were predicted to be greater in the South (55.0%; 95% eCI, 30.5%-85.6%) and in winter (54.5%; 95% eCI, 30.4%-77.0%) in the 2090s under the high-emission scenario. Findings of this nationwide case-control study suggest that higher temperature may be associated with the risk and burden of suicide death in China. These findings highlight the importance of implementing effective climate policies to reduce greenhouse gas emissions and tailoring public health policies to adapt to global warming.

Associations between nonfatal firearm injuries and risk of subsequent suicide among Veteran VA users: A retrospective cohort study.

Suicide is a leading cause of death in the United States, particularly among Veterans. Nonfatal firearm injuries may indicate subsequent risk of suicide and, thus, provide important opportunities for prevention in emergency departments and other health care settings. We used a retrospective cohort design to analyze associations between nonfatal firearm injuries and subsequent suicide among all Veterans who used U.S. Department of Veterans Affairs (VA) health care, nationally, between 2010 and 2019. We linked VA health care and mortality data to identify VA users, nonfatal firearm injuries, and deaths. International Classification of Diseases (ICD)-10th Revision cause-of-death codes were used to identify suicides. Veterans' firearm injuries and their intent were categorized using cause-of-injury codes from the ICD Clinical Modification-9th and 10th Revisions systems. Using bivariable and multivariable regression, we estimated risk of subsequent suicide among Veterans with, versus without, nonfatal firearm injuries. Among Veterans with nonfatal firearm injuries, we examined characteristics associated with subsequent suicide; electronic health record (chart) reviews explored documentation about firearm access among those who died. Among 9,817,020 VA-using Veterans, 11,503 experienced nonfatal firearm injuries (64.9% unintentional, 12.3% intentional self-harm, 18.5% assault). Of these, 69 (0.6%) subsequently died by suicide (42 involving firearms). The odds of subsequent suicide among Veterans with, versus without, nonfatal firearm injuries were 2.4 (95% confidence interval 1.9-3.0); odds were only slightly attenuated in multivariable modeling. Among Veterans with nonfatal firearm injuries, those with depression or substance use disorder diagnoses had twice the odds of subsequent suicide than those without. Chart reviews identified small proportions of suicide decedents who were assessed for (21.7%), and/or counseled about (15.9%), firearm access. Findings suggest that Veterans' nonfatal firearm injuries, regardless of injury intent, may be important but underutilized opportunities for suicide prevention. Future work should explore mechanisms to reduce risk among these patients.

Precipitating Circumstances Associated With Intimate Partner Problem–Related Suicides

In 2020, suicide was the 12th leading cause of death among adults in the U.S. Previous research has shown that one common precipitating circumstance among adult suicide decedents is experiencing intimate partner problems (IPPs), such as divorce, separation, romantic break-ups, arguments, conflicts, and intimate partner violence. This study examines how precipitating factors differ between IPP- and non-IPP-related suicides. In 2022, this study analyzed National Violent Death Reporting System data from adult suicide decedents in 48 states and 2 territories between 2003 and 2020. Multivariable logistic regression models were used to compare precipitating circumstances between IPP- and non-IPP-related suicides, controlling for sociodemographic characteristics. Of the 402,391 suicides, 20% (n=80,717) were known to be IPP-related. Circumstances that significantly increased the odds of IPP-related suicides included a history of suicidal thoughts and attempts and mental health problems (depressed mood, alcohol problem, mental health diagnosis), life stressors (interpersonal violence perpetration and victimization, arguments, financial problems, job problems, family problems), and recent legal problems. Non-IPP-related suicides were more likely to occur among older individuals and to be precipitated by a physical health problem or crime. The findings can inform prevention strategies that build resiliency and problem-solving skills, strengthen economic support, and identify and assist people at risk for IPP-related suicides. The Centers for Disease Control and Prevention's Suicide Resource for Action and Intimate Partner Violence Prevention resource packages highlight the best available evidence for policies, programs, and practices related to preventing suicides and IPP.

Suicide in the Australian Mining Industry: Assessment of Rates among Male Workers Using 19 Years of Coronial Data

BackgroundInternational evidence shows that mining workers are at greater risk of suicide than other workers; however, it is not known whether this applies to the Australian mining sector. MethodsUsing data from the National Coronial Information System, rates of suicide among male mining workers were compared to those of three comparators: construction workers, mining and construction workers combined, and all other workers. Age-standardized suicide rates were calculated for 2001–2019 and across three intervals ‘2001–2006’, ‘2007–2011’, and ‘2012–2019’. Incidence rate ratios for suicide were calculated to compare incidence rates for mining workers, to those of the three comparative groups. ResultsThe suicide rate for male mining workers in Australia was estimated to be between 11 and 25 per 100,000 (likely closer to 25 per 100,000) over the period of 2001–2019. There was also evidence that the suicide rate among mining workers is increasing, and the suicide rate among mining workers for the period 2012–2019 was significantly higher than the other worker group. ConclusionsBased on available data, we tentatively deduce that suicide mortality among male mining workers is of concern. More information is needed on both industry and occupation of suicide decedents in order to better assess whether, and the extent to which, mining workers (and other industries and occupations) are at increased risk of suicide.

Recent Stressful Experiences and Suicide Risk: Implications for Suicide Prevention and Intervention in U.S. Army Soldiers.

To identify the extent to which the presence of recent stressful events are risk factors for suicide among active-duty soldiers as reported by informants. Next-of-kin (NOK) and supervisors (SUP) of active duty soldiers (n=135) who died by suicide and two groups of living controls: propensity-matched (n=128) and soldiers who reported suicidal ideation in the past year, but did not die (SI) (n=108) provided data via structured interviews from the Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Multivariate logistic regression analyses were used to create a risk score for suicide. The odds of suicide increased significantly for soldiers experiencing relationship problems, military punishment, and perceived failure or humiliation in the month prior to death. Suicide risk models with these risk factors predicted suicide death among those who reported SI in the past year (OR=5.9, [95% CI = 1.5, 24.0] χ 2=6.24, p=0.0125, AUC, 0.73 (0.7, 0.8) NOK) and (OR=8.6, [95% CI = 1.4, 51.5] χ 2=5.49, p=0.0191, AUC, 0.78 (0.7, 0.8); SUP) suggesting the combination of these recent stressors may contribute to the transition from ideation to action. Our findings suggest for the first time recent stressors distinguished suicide ideating controls from suicide decedents in the month prior to death as reported by informants. Implications for preventive intervention efforts for clinicians, supervisors and family members in identifying the transition from ideation to action are discussed.

Means of suicide among adults with schizophrenia across the life span

Background and hypothesesAdults with schizophrenia have increased risk of suicide with highest risk among younger adults. We investigated whether means of suicide among these adults were different from the general population. Study designThis retrospective longitudinal analysis used the National Death Index to characterize means of suicide among 4 cohorts of Medicare patients with schizophrenia (2007–2016) by age: 18 to 34, 35 to 44, 45 to 54, and aged 55+ years. Means of suicide were categorized by age at death and sex. Adjusted hazard ratios were calculated for common means. Mortality rates per 100,000 person-years were estimated by age group stratified by sex, and standardized to the general population by age, sex, and race-ethnicity using standardized mortality ratios. Study results668,836 adults were included with 2218 suicide decedents: 1444 men and 774 women. The most common means of suicide was poisoning (36.8 %), with a significant sex difference by means: 55.9 % of women died by poisoning, 13.8 % by firearms, 11.0 % by hanging and 9.4 % by jumping, while among men suicide by poisoning (26.6 %), firearms (25.5 %), and hanging (24.2 %) were similar, followed by jumping (12.0 %). Suicide by poisoning among the schizophrenia cohort was 10 times that of the general population, while suicide by firearm was twice that of the general population. ConclusionsMeans of suicide differed for patients with schizophrenia compared to the general population: poisoning was the most common means among men and women with schizophrenia, while firearms accounted for over half of all suicides in the general U.S. population.

Sexual and gender identity and note-leaving among adult suicide decedents in the USA

Suicide is one of the leading causes of preventable death in the USA, representing a critical public health threat. Suicide risks differ for different populations. In particular, the sexual and gender minority (SGM) population remains at increased risk for suicide. One of the circumstances that may differ for SGM and non-SGM individuals is the propensity to leave a suicide note. Information regarding note-leaving may be helpful in informing suicide prevention and intervention. This study documents the differences in note-leaving in SGM individuals compared with non-SGM individuals, using recent data from the National Violent Death Reporting System (N = 98 515) and accounting for important covariates. We fit a logistic regression model with SGM status and covariates predicting note-leaving in suicide. SGM decedents were 1.508 times more likely to leave a note than their non-SGM counterparts, controlling for demographic, mental health and substance use covariates. These findings highlight the importance of tailoring suicide prevention and intervention efforts to meet the needs of SGM populations.

Who discovers the firearm suicide decedent: an epidemiologic characterization of survivor-victims

BackgroundSuicide is the tenth leading cause of death in the United States, with over half of cases involving firearms. Despite research indicating negative effects of exposure to suicide, there is little research on who typically finds the body of the suicide decedent. Understanding who finds the body of the suicide decedent may be important to understand trauma and mental health effects.FindingsOf the 332 people who died by suicide in El Paso County, Colorado, 182 (55%) used firearms. Those who died by firearm suicide were more likely to be male (83.5% vs. 67.3%) have military affiliation (39.0% vs. 19.3%) and were less likely to have a known mental health diagnosis (47.3% vs. 64.7%) compared to those who died from other means. Most suicide decedents were found by a family member or friend (60.2%). The remaining decedents were found by a stranger/acquaintance (21.0%) or a first responder (22.4%) One-fifth of suicides involved forced witnessing (19%) and the majority were already deceased when the body was discovered (73.2%).ConclusionsWhile most suicide decedents are discovered by a family member or a friend, it is unknown what the bereavement and trauma-related outcomes are among people who discover a suicide decedent who has died by violent means, especially by firearms. Further studies exploring who discovers suicide decedents and targeted postvention strategies for supporting impacted family, friends, first responders, and strangers are needed.

Suicide among those who use mental health services: Suicide risk factors as evidenced from contact-based characteristics in Victoria.

The majority of suicide decedents have had contact with health services in the months before their death. Contacts for mental health services present potential suicide prevention opportunities. This study aims to compare contact-based characteristics among suicide decedents and living controls in the year subsequent to clinical mental health contact with the public health system in Victoria, Australia. A population-based nested case-control study of those who had mental health-related hospital and community contacts with the public health system was conducted. Cases (suicide decedents) were age and gender-matched to living controls (suicide non-decedents). These records were linked to records of suicides that occurred in the 12 months following the health service contact, between January 1, 2011, and December 31, 2016. Victorian residents aged 10 years and above were selected at the time of contact (483,933 clients). In the study population, conditional logistic regression models were used to assess the relationship between contact-based characteristics and suicide. Socio-demographics and mental health-related hospital and community contact data was retrieved from the Victorian Admitted Episodes Dataset, the Victorian Emergency Minimum Dataset and the Public Clinical Mental Health database and suicide data from the Victorian Suicide Register. During a six-year period, 1,091 suicide decedents had at least one mental health contact with the public health system in the 12 months preceding the suicide. Overall, controls used more mental health services than cases; however, cases used more mental health services near the event. The relationship between the type of service and suicide differed by service type: hospital admissions and emergency department presentations had a significant positive association with suicide with an OR of 2.09 (95% CI 1.82-2.40) and OR of 1.13 (95% CI 1.05-1.22), and the effect size increased as the event approached, whereas community contacts had a significant negative association with an OR of 0.93 (95% CI 0.92-0.94), this negative association diminished in magnitude as the event approached (OR∼1). Suicide decedents had less contact with mental health services than non-decedents; however, evidence suggests suicide decedents reach out to mental health services proximal to suicide. An increase in mental health service contact by an individual could be an indication of suicide risk and therefore an opportunity for intervention. Further, community level contact should be further explored as a possible prevention mechanism considering the majority of suicide decedents do not access the public clinical mental health services.

Characteristics and precipitating circumstances of suicide among youth involved with the U.S. child welfare system

Suicide is the second leading cause of death among youth aged 10–21 years in the United States. Evidence suggests rates of suicide are particularly concerning among youth involved with the child welfare system. Approximately 618,000 children in the U.S. were involved with the child welfare system in 2020, however, little is known about factors associated with suicide in these vulnerable youth. This retrospective study uniquely examines characteristics and precipitating circumstances of suicide in youth involved with the child welfare system using integrated data from a state’s child welfare and violent death reporting systems from 2011 to 2017. Participants included 499 youth suicide decedents with (n = 191) and without (n = 308) child welfare system involvement. Most decedents were male (n = 370), White (n = 377), non-Hispanic (n = 477), aged 10–18 years (n = 274), and died by hanging/suffocation (n = 258). No significant differences were found between suicide decedents for precipitating circumstances associated with other relationship problems, interpersonal trauma, or life stressors. A current mental health problem was present in 55.5 % of all suicide decedents with child welfare system involvement, compared to 47.8 % of youth with no system involvement. The presence of alcohol, opioids, or marijuana at time of death was significantly higher for youth suicide decedents involved with the child welfare system. Youth decedents with a history of suicide attempts were also significantly more likely to be involved with the child welfare system. (AOR = 2.16, 95 % CI 1.32–3.55, p =.002). Findings underscore the need for more effective suicide risk detection and targeted prevention initiatives for youth involved with the child welfare system.

Demographic differences in the type of firearm and location of bodily injury in firearm suicide decedents

This study describes the type of firearm used and location of bodily injury among demographic subgroups of suicide decedents. Data on those who died by suicide via firearm from the National Violent Death Reporting System (N = 117,126) between the years 2003–2018 was utilized. A series of five logistic regression analyses examining the age of decedent, type of firearm, location of wound site, loaded vs. unloaded firearms, and locked vs. unlocked storage, using predictors including gender, race, who owns the firearm and age were performed. Findings have important public health implications. Increasing safe storage or removing the specific types of firearms one is likely to use in their death from the home during a time of crisis may decrease risk of suicide.

Characteristics of suicide decedents with no federally funded mental health service contact in the 12months before death in a population-based sample of Australians 45 years of age and over.

More than half of suicide decedents have no contact with mental health services 12months before death. It is uncertain if they have different characteristics than decedents who use mental health services. A case-series design. Participants 45 years and older, who died by suicide (2006-2018). Comparisons were made between those who did and did not have contact with mental health services, using individually linked data from federal services in the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). Of 186 cases, 71% had no contact with mental health services. Physical health services were used equally by 75%. Psychiatric medication use was uncommon, except for antidepressants, 50% with mental health service contact and 20% with no contact. Older age, lower income, involuntarily unemployed, firearms as suicide method, greater physical disability, less functional impairment due to emotional problems and lesser proportions with mental illness, were associated with no contact with mental health services. For suicide prevention, middle-older aged adults may have less requirement for mental health intervention, and greater requirement for the development of complementary interventions focused on physical health and social issues, which are not necessarily best delivered by clinical mental health services.

Health Diagnoses and Service Utilization in the Year Before Youth and Young Adult Suicide.

Suicide rates among young people are rising. Health care visits provide opportunities for identification and intervention, yet studies have been limited by small or circumscribed samples. This study sought to expand the knowledge base by examining health care encounters and diagnoses among young people who later died by suicide. This case-control study examined diagnoses of mental and general medical disorders and health care utilization in the 30 and 365 days before suicide death in nine large U.S. health care systems. Data (years 2000-2015) from 445 suicide decedents ages 10-24 years were matched with data from 4,450 control group patients. Suicide decedents were more likely to have at least one mental disorder diagnosis (51% vs. 16%; adjusted OR [AOR]=5.74, 95% CI=4.60-7.18) and had higher rates of nearly all mental health conditions. Substance use disorders were common (12%) and more likely (AOR=8.50, 95% CI=5.53-13.06) among suicide decedents. More than one in three (42%) suicide decedents had a health care visit in the month before death, and nearly all (88%) had a visit in the previous year. Despite the greater likelihood of suicide associated with mental disorder diagnoses, such disorders were present among only 51% of suicide decedents. High rates of health care utilization among suicide decedents indicate a need for improving identification of mental health conditions and suicide risk across the health care system. Increased substance use screening may help identify youths at high risk because substance use disorders were significantly more prevalent and likely among suicide decedents.

Parkinson's disease and suicide among individuals seeking care within the United States Veterans Health Administration

BackgroundIndependently, veterans and individuals with Parkinson's Disease (PD) are at increased risk for suicide. To our knowledge, the risk of suicide among veterans with PD has yet to be evaluated. This study aimed to examine the associations between PD and risk of suicide, as well as suicide means among those using Veteran Health Administration (VHA) services. MethodsRetrospective cohort study of individuals who used VHA services between 1/1/2001-12/31/2019. Cox proportional hazard models were used to estimate the hazard of suicide for those with PD relative to those without. A nested-case control study was carried out among the suicide decedents where logistic regression was used to assess the relationship between PD and suicide by firearms versus suicide by any other means. ResultsThe unadjusted hazard of death by suicide for those with a PD diagnosis, relative to those without, was 1.51 (95% CI: 1.32–1.72, p < 0.0001), and was still significant after controlling for age/gender, and psychiatric/chronic physical health diagnoses (HR: 1.50; 95% CI: 1.32–1.72, p < 0.0001; HR:1.21, 95% CI:1.06–1.38, p = 0.006, respectively). Compared to the non-PD cohort, the PD group also had higher rates of mood, anxiety, and psychotic disorders. There was no significant difference between the method of suicide for those with PD versus those without PD (p = 0.60). Most suicide deaths among both cohorts were firearm-related (PD = 78.9%, No-PD = 80.3%). ConclusionsPD is associated with an elevated risk for suicide. Based on the high rate of deaths by firearm, increased efforts to facilitate lethal means safety among veterans is warranted.

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.

Acute use of alcohol before suicide in Kazakhstan: A population-wide study

BackgroundAcute use of alcohol is a proximal risk factor for suicidal behavior and suicide attempts. Previous studies have established that alcohol consumption prior to suicide increases the risk of suicide completion. Thus, the current study aims to explore the association between alcohol use and suicide mortality in Kazakhstan. This is the first study to address this association in Kazakhstan. MethodsThe main outcome measure was the presence of alcohol in blood of suicide decedents. Logistic regression models were used to test unadjusted and adjusted odds ratios of the risk of suicide involving acute use of alcohol. Regression modeling was used to identify significant predictors of alcohol use among suicide decedents. ResultsMales (22.5 %) used alcohol more commonly before conducting suicide than females (13.4 %). The odds of alcohol involvement was 2.73 times higher for males compared to females after controlling for age and other covariates. Being a male younger than 45 years old and using suicide methods such as poisoning, immolation, and drowning increased the odds of acute use of alcohol among suicide decedents. LimitationsData on alcohol use included information only on individuals with a positive alcohol test, and it is unknown how many suicide decedents were not tested for alcohol. ConclusionsAlcohol use is common factor contributing to suicide, particularly among young and middle-aged male adults. Alcohol use is also associated more strongly with certain methods of suicide. Further studies and more detailed data exploring alcohol consumption and suicide risks are needed in countries such as Kazakhstan.

Suicidal intent disclosure among adult suicide decedents: Four age group comparisons

Research on who does/does not disclose suicidal intent (SI) and related factors has important implications for suicide risk management. In this paper based on the 2017–2019 National Violent Death Reporting System, we compared four age groups (18–24, 25–44, 45–64, and 65+ years) of suicide decedents with respect to associations between SI disclosure and (1) suicide contributing/precipitating factors, and (2) suicide means. The results shows that those age 18–44 were more likely to disclose SI than those age> =45, especially among those with relationship problems. Physical health problems and death/suicide of family/friend increased the likelihood of SI disclosure in the 65+ age group.