title: Risk factors for unnatural death: Fatal accidental intoxication, undetermined intent and suicide: Register follow-up in a criminal justice population with substance use problems.
abstract: BACKGROUND
  Risk factors for suicide and fatal accidental intoxication are extensively studied, while risk factors for intoxications/injuries of undetermined intent are less well known. The latter have shown an overlap with suicides, but also with fatal accidental intoxications. The objective was to analyze potential differences and similarities in the patterns of risk factors for accidental intoxications, injuries/intoxications with undetermined intent, and suicides, respectively.
  
  
  METHODS
  A follow-up register study was conducted, using data from ASI interviews with clients in the criminal justice system in Sweden (n=6744), followed in the National Causes of Death Register. A set of risk factors from the ASI interview were tested in bivariate analysis with the respective cause of death, yielding significant risk factors further analyzed in three Cox regression models.
  
  
  RESULTS
  In Cox regression analyses, death from fatal accidental intoxication was associated with male gender (HR 4.09), use of heroin (HR 2.86), and use of cannabis (HR 1.94), and death from intoxication/injury of undetermined intent was associated with use of heroin (HR 3.48), binge drinking of alcohol (HR 2.46) and previous psychiatric hospitalization (HR 2.41), while negatively associated with depression (HR 0.33). Death from suicide was associated with previous suicide attempts (HR 2.78) and use of sedatives (HR 2.17).
  
  
  CONCLUSIONS
  In this population of criminal justice clients with reported substance use problems, fatal injuries/intoxications with undetermined intent - like fatal accidental intoxications - appear to be associated with substance use variables, and cannot readily be assumed to represent the same background factors as suicide.
authors.affiliation: Lund University, Department of Clinical Sciences Lund, Psychiatry, Psykiatri Lund, Baravägen 1, S-221 85 Lund, Sweden, Sweden. Electronic address: Martin_O.Olsson@med.lu.se.
authors.forename: Martin O
authors.initials: MO
authors.lastname: Olsson
authors.affiliation: Lund University, Department of Clinical Sciences Lund, Psychiatry, Psykiatri Lund, Baravägen 1, S-221 85 Lund, Sweden, Sweden.
authors.forename: Louise
authors.initials: L
authors.lastname: Bradvik
authors.affiliation: Lund University, Department of Clinical Sciences Lund, Psychiatry, Psykiatri Lund, Baravägen 1, S-221 85 Lund, Sweden, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Öjehagen
authors.affiliation: Lund University, Department of Clinical Sciences Lund, Psychiatry, Psykiatri Lund, Baravägen 1, S-221 85 Lund, Sweden, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Hakansson
mesh_terms: D000059:Accidents / Q000401:mortality* / Q000523:psychology; D000328:Adult; D002423:Cause of Death; D057237:Criminals / Q000523:psychology / Q000706:statistics & numerical data*; D062787:Drug Overdose / Q000209:etiology / Q000401:mortality* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000401:mortality* / Q000523:psychology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology
keywords: Criminal justice; Overdose; Prison; Substance use disorders; Suicide; Undetermined intent