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Method overtness, forensic autopsy, and the evidentiary suicide note: A multilevel National Violent Death Reporting
Ian R H Rockett1,2, Eric D Caine3,4, Steven Stack5,6
1Department of Epidemiology, West Virginia University, Morgantown, West Virginia, United States of America.
Plos One
|May 23, 2018
Summary
Suicide notes are more common in drug intoxication and poisoning deaths, especially when autopsies are not performed. This highlights the need for better investigative standards in suicide ascertainment.
Area of Science:
- Forensic Science
- Public Health
- Epidemiology
Background:
- Suicide investigation requires clear evidence, with less overt methods potentially leading to undercounting.
- The presence of suicide notes may vary by method and autopsy performance.
Purpose of the Study:
- To test if suicide notes are more likely in less violent methods (drug intoxication, poisoning) compared to more violent ones (firearm, hanging).
- To determine if forensic autopsies influence the association between method overtness and the presence of suicide notes.
Main Methods:
- A multilevel, multivariable analysis using a generalized linear mixed model (GLMM).
- Data from 32,151 suicides aged 15+ across 17 states in the National Violent Death Reporting System (2011-2013).
- Outcome measure: relative odds of an authenticated suicide note.
Main Results:
- Suicide notes were documented in 31% of cases.
- Notes were more likely in drug intoxication (OR, 1.70) and poisoning suicides (OR, 2.12) versus firearm suicides.
- The association between notes and method overtness was stronger when autopsies were absent or unknown.
Conclusions:
- Drug intoxication suicides require a high burden of proof for manner of death affirmation.
- Findings suggest a need for more stringent investigative standards and resources for accurate suicide ascertainment.
- Improved case ascertainment is crucial for developing effective suicide prevention strategies.
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