title: Suicide or undetermined intent? A register-based study of signs of misclassification.
abstract: BACKGROUND
  Several studies have concluded that some deaths classified as undetermined intent are in fact suicides, and it is common in suicide research in Europe to include these deaths. Our aim was to investigate if information on background variables would be helpful in assessing if deaths classified as undetermined intent should be included in the analyses of suicides.
  
  
  METHODS
  We performed a register study of 31,883 deaths classified as suicides and 9,196 deaths classified as undetermined intent in Sweden from 1987 to 2011. We compared suicide deaths with deaths classified as undetermined intent with regard to different background variables such as sex, age, country of birth, marital status, prior inpatient care for self-inflicted harm, alcohol and drug abuse, psychiatric inpatient care, and use of psychotropics. We also performed a multivariate analysis with logistic regression.
  
  
  RESULTS
  Our results showed differences in most studied background factors. Higher education was more common in suicides; hospitalization for self-inflicted harm was more common among female suicides as was prior psychiatric inpatient care. Deaths in foreign-born men were classified as undetermined intent in a higher degree and hospitalization for substance abuse was more common in undetermined intents of both sexes. Roughly 50% of both suicide and deaths classified as undetermined intent had a filled prescription of psychotropics during their last six months. Our multivariate analysis showed male deaths to more likely be classified as suicide than female: OR: 1.13 (1.07-1.18). The probability of a death being classified as suicide was also increased for individuals aged 15-24, being born in Sweden, individuals who were married, and for deaths after 1987-1992.
  
  
  CONCLUSIONS
  By analyzing Sweden's unique high-validity population-based register data, we found several differences in background variables between deaths classified as suicide and deaths classified as undetermined intent. However, we were not able to clearly distinguish these two death manners. For future research we suggest, separate analyses of the two different manners of death.
authors.affiliation: Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden ; National Board of Health and Welfare, Stockholm, Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Björkenstam
authors.affiliation: Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
authors.forename: Lars-Age
authors.initials: LA
authors.lastname: Johansson
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Nordström
authors.affiliation: Deparment of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Ingemar
authors.initials: I
authors.lastname: Thiblin
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Fugelstad
authors.affiliation: Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden ; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Hallqvist
authors.affiliation: National Board of Health and Welfare, Stockholm, Sweden ; Institue of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Rickard
authors.initials: R
authors.lastname: Ljung
keywords: Manner of death; Mortality classification; Psychotropics; Register study; Suicide; Sweden; Undetermined intent; Unintentional poisonings
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