title: Misclassification of suicide deaths: examining the psychiatric history of overdose decedents.
abstract: OBJECTIVE
  The intent of a death from overdose can be difficult to determine. The goal of this study was to examine the association of psychiatric diagnoses among overdose deaths ruled by a medical examiner as intentional, unintentional and indeterminate intent.
  
  
  METHODS
  All Veterans Health Administration patients in Fiscal Year 1999 (n=3 291 891) were followed through Fiscal Year 2006. We tested the relative strength of association between psychiatric disorders among types of overdoses (categorised by intent) using multinomial models, adjusted for age, sex, Veterans Affairs priority status and Charlson comorbidity scores. Data were from National Death Index records and patient medical records.
  
  
  RESULTS
  Substance use disorders (SUD) had a stronger association with indeterminate intent overdoses than intentional overdoses (adjusted OR (AOR)=1.80, 95% CI 1.47 to 2.22). SUDs also had a stronger association with unintentional overdoses than intentional (AOR=1.48, 95% CI 1.27 to 1.72), but the reverse was true for all other psychiatric disorders (except post-traumatic stress disorder).
  
  
  CONCLUSIONS
  Overdoses ruled indeterminate may be misclassified suicide deaths and are important to suicide surveillance and prevention efforts. Additionally, overdose deaths not classified as suicides may include some cases due to suicidal-like thinking without overt suicidal intent.
authors: VA National Serious Mental Illness Treatment Resource and Evaluation Center and VA Health Services Research & Development, , Ann Arbor, Michigan, USA.
authors: Amy S B
authors: AS
authors: Bohnert
authors: John F
authors: JF
authors: McCarthy
authors: Rosalinda V
authors: RV
authors: Ignacio
authors: Mark A
authors: MA
authors: Ilgen
authors: Anna
authors: A
authors: Eisenberg
authors: Frederic C
authors: FC
authors: Blow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008875:Middle Aged; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult