title: Demographics of suicide victims in Sweden in relation to their blood-alcohol concentration and the circumstances and manner of death.
abstract: Specimens of blood and other body fluids were obtained at autopsy from all deaths in Sweden classified as suicide covering a 10-year period (N=11,441 cases). The mean age (+/-standard deviation, SD) of the victims was 51.3+/-18.8 years with a clear predominance of males 71% (mean age 51.3+/-18.8 years) compared with 29% females (mean age 51.4+/-18.9 years). The concentration of ethanol in blood samples was determined in duplicate by headspace gas chromatography and a mean blood-alcohol concentration (BAC) of 0.1g/L (10mg/100mL) was the cut-off used to identify ethanol positive cases. The suicides were coded (ICD-9) as self-poisonings (N=2462, 22%), hanging (N=4474, 39%), asphyxia by gas (N=509, 4.4%), drowning (N=803, 7.0%), gun shot (N=1307, 11.4%), fall from height (N=632, 5.5%), self-inflicted cuts or sharp-force injury (N=363, 3.1%) and miscellaneous ways (N=891, 7.8%). On average 34% of all suicide victims in Sweden had consumed alcohol before death, 36% of the males and 31% of the females had a positive BAC. The mean (median) concentration of alcohol in femoral blood for men was 1.34g/L (1.3g/L) compared with 1.25g/L (1.1g/L) for women. Many victims were heavily intoxicated and the 90th percentiles of the BAC distributions ranged from 2.3 to 2.8g/L depending on manner of death. Elevated blood-alcohol was most prevalent in poisoning deaths (45%) and gas asphyxia (51%) and least prevalent in falls from height (19%) and sharp-force injury (18%). Toxicological analysis for presence of drugs other than alcohol showed a predominance of paracetamol, SSRI antidepressants, anti-psychotics, sedative-hypnotics, and centrally acting opioids. A host of psycho-social factors drive a person to commit suicide and one of the catalysts is over-consumption of alcohol and acute alcohol intoxication. Heavy drinking leads to a loss of inhibitions, impulsive behaviour, poor judgment and a tendency to take risks, all of which might increase the propensity of predisposed individuals to take their own lives.
authors.affiliation: Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Artillerigatan 12, Linköping, Sweden.
authors.forename: Anita
authors.initials: A
authors.lastname: Holmgren
authors.forename: Alan Wayne
authors.initials: AW
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001237:Asphyxia / Q000401:mortality; D002492:Central Nervous System Depressants / Q000097:blood*; D002648:Child; D002849:Chromatography, Gas; D004332:Drowning / Q000401:mortality; D000431:Ethanol / Q000097:blood*; D005260:Female; D053593:Forensic Toxicology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000401:mortality; D017678:Sex Distribution; D013405:Suicide / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000401:mortality; D014951:Wounds, Stab / Q000401:mortality
chemical_list: D002492:Central Nervous System Depressants; D000431:Ethanol