We used US death certificate data for premature death (ie, ages years) from drug poisonings, suicide, and alcohol-induced causes and conducted hot spot and trend analyses for each cause. This cross-sectional study found alarming recent increases in drug poisoning, suicide, and alcohol-induced death rates that differed substantially by demographic and geographic factors in the US. Increases in alcohol-induced death rates began more recently (in 2005) than drug poisoning deaths and suicides and accelerated during 2012 to 2017.
This appears to be related to the easy availability of the means, as these are predominantly agricultural countries. In contrast, in Western or industrialized countries, use of illicit drugs (mainly opioids) and medicines (antidepressants, anxiolytics, and neuroleptics) for suicide appeared to be more frequent. More precisely, greater use of antidepressants than drug abuse has been observed over the years, probably due to their greater availability and the progressive increase in the incidence of psychiatric pathologies and stress-related disorders [45,46]. A retrospective study conducted in Iran highwatch online meetings [26] examined 1667 autopsies and found that suicide by poisoning accounted for 45.8% of the sample.
As blood alcohol concentration (BAC) increases, so does the effect of alcohol—as well as the risk of harm. Even small increases in BAC can decrease motor coordination, make a person feel sick, and cloud judgment. This can increase an individual’s risk of being injured from falls or car crashes, experiencing acts of violence, and engaging in unprotected or unintended sex. When BAC reaches high levels, blackouts (gaps in memory), loss of consciousness (passing out), and death can occur. An alcohol overdose occurs when there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support functions—such as breathing, heart rate, and temperature control—begin to shut down.
How alcohol misuse relates to death by suicide.
Our study found those who drink heavily and more frequently have increased risk of death by suicide, particularly over longer periods of time. Especially vulnerable populations include women, military personnel and youth. Self-poisoning is one of the most common methods how to make myself pee used to attempt suicide in Poland [24]. Nearly 70% of suicide victims consume a toxic substance prior to death, and the primary method used in one in five suicides in the United States in 2006–2008 was overdose [25]. According to Cavanagh and Smith [9], self-poisoning is a common method, accounting for over half of all female suicides.
Lower suicide rates clustered along the East coast, and lower alcohol-induced death rates clustered from Missouri east through Pennsylvania and from Louisiana east through Georgia. Cold spots for all three causes were present in Mississippi, Alabama, and Georgia. The retrospective study by Goswami et al. [20] examined autopsies of suspected deaths by poisoning.
Mixing alcohol with drugs intensifies its effects, which may have tragic consequences, especially for people already burdened with mental problems. This is when a male rapidly consumes five or more alcoholic drinks within two hours or a female consumes at least four drinks within two hours. It’s not necessary to have all the above symptoms before seeking medical help. A gallstones and alcohol person with alcohol poisoning who has passed out or can’t wake up could die.
Critical Signs and Symptoms of an Alcohol Overdose
The data of the selected studies are coherent with literature data and highlight that the characteristics of suicide by consuming poison show changing trends according to social and demographic factors [52,61]. Autopsy and toxicological analysis in suicide deaths are crucial for assessing the cause and manner of death and shed light on death by self-poisoning. When performing an autopsy in the case of suspected suicides, it is crucial to analyze social factors and medical history to pinpoint a suicide by self-poisoning and provide helpful information for prevention and public health measures. In this regard, the results of the present study lack significant information about sociodemographic factors. In this study, data from several geographic areas, such as Australia, Eastern Europe, Russia, and South America, are missing.
However, suicide rates were highest in counties in the lowest quintile of unemployment and lowest in the second highest quintile of unemployment (Figure 2A). The prevention of suicide by self-poisoning is a relevant public health concern. Public health and worldwide authorities are responsible for addressing the increase in suicide rates, which is affecting all populations and our society [47].
Trends Over Time
Hot spots for of all 3 causes were present in New Mexico and Colorado. Research on methods of committing suicide and the risk factors involved in suicide by consuming poison is still inadequate. Moreover, literature studies are often not homogeneous, leading to inconsistent and non-representative socio-demographic and public health analyses of such phenomena. Our findings indicate that these 3 causes of death merit individual consideration, and their underlying causes and optimal prevention strategies may differ in nature, intensity, and duration across populations and contexts. For drug poisoning deaths, there were significant clusters of counties with lower death rates that extended from North Dakota and Minnesota south through Texas and then east from Texas to Georgia and South Carolina.
First and foremost, these are benzodiazepine sedatives and hypnotics, antiepileptic drugs (carbamazepine, valproic acid), antidepressants (tricyclic, serotonin reuptake inhibitors), and neuroleptics (classic and atypical). Drug poisoning concerns mostly psychiatric patients and people addicted to drugs and alcohol (they resort to psychotropic drugs when withdrawal symptoms are intensified, or symptoms of acute alcohol intoxication appear) [12]. Other psychoactive substances that are used for suicidal purposes are many over the counter (OTC) drugs, which contain substances that can affect consciousness, behavior, and feeling when consumed in large amounts. The most popular substances of this type are dextromethorphan (a synthetic analog of codeine), ephedrine, and pseudoephedrine [13]. The autopsy rate in deaths by suicide and poisoning is still low [21,22,23,24,25,26,27,28]. The data emerging from the studies included in the review only partially reflect the toxicological characteristics of the country where the study was conducted.
Risk factors
In line with what has been observed, what is lacking in the study of most of the reviews carried out on suicide cases is an in-depth evaluation of clinical and medical history of the subjects. Significant differences in the substances used for suicide by self-poisoning were observed in the examined studies (Figure 2). In the study by Jones et al. [27] covering 1993–2010, 13,963 poisoning-related autopsies were examined, of which 4843 were suicides (34.68%). Toxicological analyses revealed that ethanol was involved in 55% of the cases, paracetamol in 21% of the cases, diazepam in 19% of the cases, morphine in a similar percentage of cases, and minor antidepressants in a few cases. Suicidal poisoning refers to intoxication with carbon monoxide contained in the light gas.
- The most frequently found substance in toxicological analyses, carried out using GC-SM methods, were organophosphates (pesticides, 61.9%), followed by insecticides such as carbamates (18.4%) and other organic derivatives.
- And V.P.; writing—original draft preparation, G.D.A. and G.M.; writing—review and editing, A.A., S.Z.
- It is important to determine what chemical agent the suicide was caused by.
- One of these is psychological autopsy, developed in the United States and a few other countries (primarily Nordic) and introduced in France, including Lyon, in the 1990s.
- Especially vulnerable populations include women, military personnel and youth.
- Flow diagram illustrating the search strategy and included and excluded studies in this systematic review.
Fatal self-poisoning most frequently involves pesticides, analgesics, and antidepressants. Overdoses of illicit substances, such as heroin, are also common, but the intention to die may be difficult to determine. Stratified by county-level percentage of unemployment, drug poisoning and alcohol-induced death rates were highest in counties in the highest quintile of unemployment and lowest in the lowest quintile.
Recognizing risk
Data on the number of suicides per year are provided by the General Police Headquarters of Poland (the GPHP) and the Statistics Poland (GUS). The GPHP base their analysis on the KSIP-10 report on suicide attempt/behavior. It is not necessary to introduce the social security number of a victim there.