Clinical Prediction of Suicide and Undetermined Death: A Pseudo-Prospective Clinical and Medico-Legal Study of Substance Abusers

• Published in: International journal of environmental research and public health Vol. 14; no. 3; p. 310
• Main Authors: Brådvik, Louise, Berglund, Mats, Frank, Arne, Löwenhielm, Peter
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 17.03.2017; MDPI
• Subjects: Addictions; Alcohol use; Alcoholism - epidemiology; Alcoholism - mortality; Alcohols; Autopsies; Autopsy findings; Blood; Cause of Death; Classification; Clinical Medicine; Death; Death of undetermined intent; Disease control; Drug addiction; Drug dosages; Drug use; Family medical history; Humans; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Mortality; Murders & murder attempts; Prediction; Prospective Studies; Psychiatry; Psykiatri; Reproducibility of Results; Self destructive behavior; Studies; Substance use disorders; Suicidal Ideation; Suicide; Suicide - statistics & numerical data; Suicide attempt; Suicide, Attempted - statistics & numerical data; Suicides & suicide attempts; Time Factors; autopsy findings; death of undetermined intent; substance use disorders; suicide; prediction; suicidal ideation; suicide attempt
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph14030310

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.