Misclassification of suicide deaths: examining the psychiatric history of overdose decedents
Misclassification of suicide deaths: examining the psychiatric history of overdose decedents
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DOI：
10.1136/injuryprev-2012-040631
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发表时间：
2013-10-01
影响因子：
3.7
通讯作者：
Blow, Frederic C.
中科院分区：
文献类型：
--
作者：
Bohnert, Amy S. B.;McCarthy, John F.;Blow, Frederic C.
目的过量死亡的意图可能难以确定。本研究的目的是研究的关联过量死亡的精神病诊断裁定由体检医师故意，无意和不确定intent.Methods所有退伍军人健康管理局的患者在1999财政年度（n=3291891），通过2006财政年度。我们使用多项模型，调整年龄，性别，退伍军人事务部优先地位和Charlson合并症评分，测试了过量类型（按意图分类）中精神疾病之间的相关性的相对强度。结果物质使用障碍（SUD）与不确定的意向性药物过量的相关性强于意向性药物过量（校正OR（AOR）=1.80，95% CI 1.47 ~ 2.22）。SUDs也有一个更强的关联与无意过量比故意（AOR=1.48，95%CI 1.27至1.72），但相反的是真实的所有其他精神疾病（除创伤后应激障碍）。结论过量裁定不确定可能是错误的自杀死亡，是重要的自杀监测和预防工作。此外，未归类为自杀的过量死亡可能包括一些由于自杀样思维而无明显自杀意图的病例。
Objectives 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=3291891) 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.