title: Suicide by aircraft: a comparative analysis.
abstract: BACKGROUND
  Suicide is the 11 th leading cause of death in the United States. The objective of this study is to document the characteristics of aviation-related suicides and suicide attempts.
  
  
  METHODS
  Aviation accidents reported by the National Transportation Safety Board between 1983 and 2003 were screened for cases in which suicide was listed as a probable cause. For each suicide case, two accidents were randomly selected as controls, matched on sex of pilot, type of flight, state, and year of occurrence. Mantel-Haenszel summary Chi-square tests were used to compare cases to controls. Conditional logistic regression modeling was performed to assess the association of pilot and flight characteristics with suicide-related crashes.
  
  
  RESULTS
  During the 21-yr study period, 37 pilots committed or attempted suicide by aircraft, with 36 resulting in at least one fatality. All the cases were men and involved general aviation flights. Toxicological test results revealed that 24% of the cases had used alcohol and 14% had used other illicit drugs. Underlying factors included domestic and social problems (46%), legal trouble (40%), and pre-existing psychiatric conditions (38%). Compared with controls, suicide cases involved younger pilots (p < 0.05), were less likely to have another occupant (p < 0.0001), were more destructive to the aircraft (p < 0.0001), and were more likely to have occurred away from the airport (p < 0.0001).
  
  
  CONCLUSIONS
  Aviation crashes caused by suicide differ from unintentional aviation accidents in pilot characteristics, crash circumstances, and outcomes.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Emergency Medicine, 1830 E. Monument St., Ste. 6-100, Baltimore, MD 21205, USA.
authors.forename: Corey B
authors.initials: CB
authors.lastname: Bills
authors.forename: Jurek George
authors.initials: JG
authors.lastname: Grabowski
authors.forename: Guohua
authors.initials: G
authors.lastname: Li
mesh_terms: D000060:Accidents, Aviation / Q000706:statistics & numerical data; D000328:Adult; D000401:Aircraft; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D019966:Substance-Related Disorders; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted; D014481:United States / Q000453:epidemiology