title: Suicide and undetermined death by drowning.
abstract: Background Incidence of drowning varies among countries and even communities within the same country. The manner of death may remain undetermined even when the diagnosis of drowning is confirmed or excluded. It is expected that drowning suicide rates in some of the available studies may have been over- or under-reported because of misclassification. Objectives This study presents data on the time trends, age/sex mortality rates from death by drowning in England and Wales between 1979 and 2001. All coroners' verdicts in death by drowning; suicide, deaths undetermined whether accidentally or purposely inflicted were examined. Methods Counts of suicide due to drowning and submersion (ICD 9 codes; E954) and undetermined injury deaths (E984) 1 , reported in England and Wales between 1979 and 2001 were obtained from National Statistics (ONS). National population estimates were used to calculate age-specific rates and age-standardised rates of death by drowning. Results Over the last 23 years, there has been a gradual and significant reduction in drowning deaths. The decline in drowning suicide was less evident in the elderly, particularly those over the age of 75. During the study period, 62 and 38% of all death by drowning attracted an open verdict and suicide, respectively. Elderly drowning appear to attract more verdicts of suicide compared to younger age groups (odds ratio 4.3, 95% CI 2.3-8.3). Women, particularly elderly, are more likely to have a suicide verdict returned in drowning compared to men (odds ratio 1.5, 95% CI 1.1-1.6). Conclusion The high rate of open verdicts in death by drowning over the study period and compared to any other method of fatal self harm in England and Wales confirms the difficulties in reaching a firm conclusion in drowning death. Combining suicide and all undetermined deaths in drowning in nationally collected statistics may result in grossly exaggerated rates and misleading trends in suicidal drowning.
authors.affiliation: Liverpool University, 5 Boroughs Partnership Trust, Warrington, UK.
authors.forename: Emad
authors.initials: E
authors.lastname: Salib
authors.forename: Norman
authors.initials: N
authors.lastname: Agnew
keywords: Drowning; drowning suicide; suicide; trends in drowning; undetermined drowning