title: Clinical Prediction of Suicide and Undetermined Death: A Pseudo-Prospective Clinical and Medico-Legal Study of Substance Abusers.
abstract: This study examines aspects of prediction of suicide and death of undetermined intent. We investigated all consecutive, autopsied patients between 1993 and 1997 who had been in contact with the Addiction Centre in Malmö from 1968 onwards. The staff was asked, shortly after autopsy but before they knew of the manner of death, if they thought the patient had committed suicide. The case records were blindly evaluated, and toxicological autopsy findings for alcohol in blood samples investigated. The specificity of prediction was 83% and significantly more often correct than the sensitivity, which was only 45% for suicide and for suicide/death of undetermined intent (93% versus 39%). Suicidal communication was more often considered non-serious before death of undetermined intent than before suicide. The former could be predicted by ideation but not by suicide attempt reported in case records, unlike suicide, which was predicted by both. The undetermined group also showed higher levels of alcohol in the blood at autopsy. We concluded that more serious clinical investigation of suicidal feelings, which may be hidden and not taken seriously, and treatment of alcohol use disorders with active follow-up appear urgent in the efforts to prevent suicide.
authors.affiliation: Department of Clinical Sciences, Division of Psychiatry, Lund University, SE-221 85 Lund, Sweden. louise@bradvik.se.
authors.forename: Louise
authors.initials: L
authors.lastname: Brådvik
authors.affiliation: Department of Clinical Sciences, Division of Psychiatry, Lund University, SE-221 85 Lund, Sweden. mats.berglund@med.lu.se.
authors.forename: Mats
authors.initials: M
authors.lastname: Berglund
authors.affiliation: Department of Clinical Sciences, Division of Psychiatry, Lund University, SE-221 85 Lund, Sweden. mats.berglund@med.lu.se.
authors.forename: Arne
authors.initials: A
authors.lastname: Frank
authors.affiliation: Forensic Medicine, Lund University, SE-221 85 Lund, Sweden. peter.lowenhielm@sjobo.nu.
authors.forename: Peter
authors.initials: P
authors.lastname: Löwenhielm
mesh_terms: D000437:Alcoholism / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D006801:Humans; D011446:Prospective Studies; D015203:Reproducibility of Results; D059020:Suicidal Ideation; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D013997:Time Factors
keywords: autopsy findings; death of undetermined intent; prediction; substance use disorders; suicidal ideation; suicide; suicide attempt