PMID- 29787584
OWN - NLM
STAT- MEDLINE
DCOM- 20181126
LR  - 20181126
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 5
DP  - 2018
TI  - Method overtness, forensic autopsy, and the evidentiary suicide note: A
      multilevel National Violent Death Reporting System analysis.
PG  - e0197805
LID - 10.1371/journal.pone.0197805 [doi]
AB  - OBJECTIVE: Higher prevalence of suicide notes could signify more conservatism in 
      accounting and greater proneness to undercounting of suicide by method. We tested
      two hypotheses: (1) an evidentiary suicide note is more likely to accompany
      suicides by drug-intoxication and by other poisoning, as less violent and less
      forensically overt methods, than suicides by firearm and hanging/suffocation; and
      (2) performance of a forensic autopsy attenuates any observed association between
      overtness of method and the reported presence of a note. METHODS: This multilevel
      (individual/county), multivariable analysis employed a generalized linear mixed
      model (GLMM). Representing the 17 states participating in the United States
      National Violent Death Reporting System throughout 2011-2013, the study
      population comprised registered suicides, aged 15 years and older. Decedents
      totaled 32,151. The outcome measure was relative odds of an authenticated suicide
      note. RESULTS: An authenticated suicide note was documented in 31% of the suicide
      cases. Inspection of the full multivariable model showed a suicide note was more 
      likely to manifest among drug intoxication (adjusted odds ratio [OR], 1.70; 95%
      CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm 
      suicides, the referent. Respective excesses were larger when there was no autopsy
      or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95%
      CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62,
      95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation
      suicides did not differ from the firearm referent given an autopsy. CONCLUSIONS: 
      Suicide requires substantial affirmative evidence to establish manner of death,
      and affirmation of drug intoxication suicides appears to demand an especially
      high burden of proof. Findings and their implications argue for more stringent
      investigative standards, better training, and more resources to support
      comprehensive and accurate case ascertainment, as the foundation for developing
      evidence-based suicide prevention initiatives.
FAU - Rockett, Ian R H
AU  - Rockett IRH
AUID- ORCID: 0000-0002-4584-9337
AD  - Department of Epidemiology, West Virginia University, Morgantown, West Virginia, 
      United States of America.
AD  - Injury Control Research Center, West Virginia University, Morgantown, West
      Virginia, United States of America.
FAU - Caine, Eric D
AU  - Caine ED
AD  - Department of Psychiatry, University of Rochester Medical Center, Rochester, New 
      York, United States of America.
AD  - Injury Control Research Center for Suicide Prevention, University of Rochester
      Medical Center, Rochester, New York, United States of America.
FAU - Stack, Steven
AU  - Stack S
AD  - Department of Criminal Justice, Wayne State University, Detroit, Michigan, United
      States of America.
AD  - Department of Psychiatry and Behavioral Neuroscience, Wayne State University,
      Detroit, Michigan, United States of America.
FAU - Connery, Hilary S
AU  - Connery HS
AD  - Division of Alcohol and Drug Abuse, McLean Hospital, Boston, Massachusetts,
      United States of America.
AD  - Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United
      States of America.
FAU - Nolte, Kurt B
AU  - Nolte KB
AD  - Office of the Medical Investigator, University of New Mexico School of Medicine, 
      Albuquerque, New Mexico, United States of America.
FAU - Lilly, Christa L
AU  - Lilly CL
AD  - Department of Biostatistics, West Virginia University, Morgantown, West Virginia,
      United States of America.
FAU - Miller, Ted R
AU  - Miller TR
AD  - Pacific Institute for Research and Evaluation, Calverton, Maryland, United States
      of America.
AD  - Curtin University School of Public Health, Perth, Australia.
FAU - Nelson, Lewis S
AU  - Nelson LS
AD  - Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New 
      Jersey, United States of America.
FAU - Putnam, Sandra L
AU  - Putnam SL
AD  - Injury Control Research Center, West Virginia University, Morgantown, West
      Virginia, United States of America.
FAU - Nestadt, Paul S
AU  - Nestadt PS
AUID- ORCID: 0000-0002-2479-703X
AD  - Department of Mental Health, Johns Hopkins Bloomberg School of Public Health,
      Baltimore, Maryland, United States of America.
AD  - Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School
      of Medicine, Baltimore, Maryland, United States of America.
FAU - Jia, Haomiao
AU  - Jia H
AD  - School of Nursing, Columbia University, New York, New York, United States of
      America.
AD  - Department of Biostatistics, Mailman School of Public Health, Columbia
      University, New York, New York, United States of America.
LA  - eng
GR  - U54 GM104942/GM/NIGMS NIH HHS/United States
GR  - R49 CE002109/CE/NCIPC CDC HHS/United States
GR  - R49 CE002093/CE/NCIPC CDC HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20180522
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Asphyxia/*epidemiology
MH  - Autopsy
MH  - Drug Overdose/*epidemiology
MH  - Female
MH  - Forensic Pathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multilevel Analysis
MH  - Poisoning/*epidemiology
MH  - Registries
MH  - Suicide/*statistics & numerical data
MH  - United States/epidemiology
MH  - Wounds, Gunshot/*epidemiology
MH  - Young Adult
PMC - PMC5963755
COIS- The authors have declared that no competing interests exist.
EDAT- 2018/05/23 06:00
MHDA- 2018/11/27 06:00
CRDT- 2018/05/23 06:00
PHST- 2017/12/15 00:00 [received]
PHST- 2018/05/09 00:00 [accepted]
PHST- 2018/05/23 06:00 [entrez]
PHST- 2018/05/23 06:00 [pubmed]
PHST- 2018/11/27 06:00 [medline]
AID - 10.1371/journal.pone.0197805 [doi]
AID - PONE-D-17-43882 [pii]
PST - epublish
SO  - PLoS One. 2018 May 22;13(5):e0197805. doi: 10.1371/journal.pone.0197805.
      eCollection 2018.