Suicide by motor vehicle "accident" in Queensland

Road vehicle collision suicide in Australia: Trends, collision types, and individual characteristics

BACKGROUND

Suicide by road vehicle collision in Australia is under-explored with mixed findings. We aimed to address this research gap by examining time trends, different types of vehicle collision, and individual characteristics related to vehicle-collision suicide.

METHOD

We retrospectively analyzed deaths by suicide between 1st January 2001 and 31st December 2017 in Australia, using coronial records from the National Coronial Information System. The travel mode used and collision counterpart were retrieved from records of death by vehicle-collision suicide using all available information. We conducted negative binomial regression analysis to examine annual changes in suicide rate by vehicle collision on a public road (N = 640) and other methods of suicide (N = 41,890), and logistic regression analysis to examine individual characteristics associated with the likelihood of dying by suicide via road vehicle collision.

RESULTS

Overall, the national suicide rate involving road vehicle collision significantly increased, while the rate by other methods significantly decreased. Drivers accounted for 61% of suicide events by vehicle collision, of which 72% were single-vehicle collisions (commonly involving a tree). For multiple-vehicle collision suicide events, 82% involved collision with a truck. Pedestrians accounted for more than one-third of suicide events, of which 58% involved collision with a truck and 23% involved collision with a car/van. Individuals who were male (odds ratio 1.15; 95% CI 0.88-1.50), aged <25 years old (odds ratio 5.27; 95% CI 3.05-9.10), non-Indigenous (odds ratio 3.36; 95% CI 1.71-6.62), and born overseas (odds ratio 1.40; 95% CI 1.10-1.79) were more likely to die by vehicle-collision suicide than by other methods of suicide.

CONCLUSIONS

This study provides a better understanding of road vehicle collision suicide in Australia and informs future research directions on topic. Our findings can be used to inform suicide prevention initiatives to reduce vehicle-collision suicide deaths.

Self-harm in adolescence and risk of crash: a 13-year cohort study of novice drivers in New South Wales, Australia

INTRODUCTION

Self-harm and suicide are leading causes of morbidity and death for young people, worldwide. Previous research has identified self-harm is a risk factor for vehicle crashes, however, there is a lack of long-term crash data post licensing that investigates this relationship. We aimed to determine whether adolescent self-harm persists as crash risk factor in adulthood.

METHODS

We followed 20 806 newly licensed adolescent and young adult drivers in the DRIVE prospective cohort for 13 years to examine whether self-harm was a risk factor for vehicle crashes. The association between self-harm and crash was analysed using cumulative incidence curves investigating time to first crash and quantified using negative binominal regression models adjusted for driver demographics and conventional crash risk factors.

RESULTS

Adolescents who reported self-harm at baseline were at increased risk of crashes 13 years later than those reporting no self-harm (relative risk (RR) 1.29: 95% CI 1.14 to 1.47). This risk remained after controlling for driver experience, demographic characteristics and known risk factors for crashes, including alcohol use and risk taking behaviour (RR 1.23: 95% CI 1.08 to 1.39). Sensation seeking had an additive effect on the association between self-harm and single-vehicle crashes (relative excess risk due to interaction 0.87: 95% CI 0.07 to 1.67), but not for other types of crashes.

DISCUSSION

Our findings add to the growing body of evidence that self-harm during adolescence predicts a range of poorer health outcomes, including motor vehicle crash risks that warrant further investigation and consideration in road safety interventions. Complex interventions addressing self-harm in adolescence, as well as road safety and substance use, are critical for preventing health harming behaviours across the life course.

An overview of suicides related to motor vehicles

Although vehicles may be used in a wide variety of suicides, this has not been a focus in the forensic literature. Thus, an analysis of coronial autopsy reports at Forensic Science SA, Adelaide, South Australia over a 16-year period from January 2005 to December 2020 was undertaken to provide an overview of cases in which it was considered that a vehicle had been integral to the successful completion of a suicide. De-identified details were collected from all cases in which a vehicle had facilitated or been used as a method of suicide. A number of different types of vehicle-related suicide methods were identified, including cases where vehicles had been used as secure places for suicide or where the vehicle had been used to cause significant blunt force trauma or to enter a lethal environment such as water. Specific examples were taken from the following categories: (1) inhalation of gas, (2) drug toxicity, (3) hanging or ligature strangulation, (4) self-immolation, (5) drowning, (6) vehicle collision, (7) driving off a cliff, (8) jumping or lying in front of a vehicle and (9) the use of more than one method (i.e. complex). This report is not intended to provide an epidemiological analysis of car-related suicides. Instead, the details of selected cases have been used to illustrate the spectrum of methods that may be used in vehicle-assisted suicides.

Characteristics of suicide-related crashes and their potential interventions: A literature review

OBJECTIVE

To develop countermeasures to decrease road trauma, it is essential to increase our understanding of fatal and injury crashes with suicidal intent. As suicide-related crashes can be difficult to identify it seems likely suicide-related road fatalities and injuries are under-reported. Under-reported crashes may lead to two policy issues: these types of casualty crashes may not receive adequate funding for countermeasure development and implementation due to not having a sufficient evidence-basis to justify allocation of resources, and may be miscategorized as having other factors contributing to the crashes, thus resources may be incorrectly allocated to countermeasures to address these other factors. This paper seeks to develop and document characteristics and potential countermeasures to identify and prevent such crashes.

METHODS

Two literature reviews of peer-reviewed journal manuscripts were performed to identify suicide-crash characteristics and potential countermeasures and strategies. Of 61 peer-reviewed journal manuscripts identified from the literature searches, 17 manuscripts fit the criteria and were reviewed. Information regarding the characteristics of suicide-related crashes, as well as potential strategies and countermeasures were gleaned from these manuscripts.

RESULTS

A list of characteristics was developed, underpinning development of a methodology to identify these types of crashes. Strategies and countermeasures recommended by international (road-) agencies to identify and prevent suicide-related crashes were documented and discussed.

CONCLUSION

As suicide-related crashes almost always take place in public space, the grief and pain resulting from such crashes not only relates to the victim, the people who knew the victim, but in many cases also involve the general public. It is therefore paramount to start the discussion about suicide-related crashes to increase awareness, increase willingness to establish a reliable data and knowledge base, and encourage help seeking in individuals at increased risk of attempting suicide using this method.

Speeding and impaired driving in fatal crashes-Results from in-depth investigations

OBJECTIVE

The aim of the study was to identify typical patterns of risk factors among speeding and impaired drivers involved in fatal crashes and to suggest countermeasures.

METHOD

Results from in-depth investigations of 1,501 fatal passenger car crashes that occurred in Norway from 2005 to 2015 and involved 1,949 passenger cars are summarized. Relationships between speeding (excessive speed, EXC, or inappropriate speed, INAP); driving under the influence (DUI) of alcohol (ALC), drugs (DRUG), or both (MIX); and other driver-, crash-, vehicle-, and road-related variables were investigated.

RESULTS

Speeding and DUI drivers have in common that they are more often male, unbelted, unlicensed, driving old cars, and involved in single-vehicle crashes under low-volume conditions (nighttime, weekend, low-volume roads). They are also less often fatigued, ill, or suicidal. EXC and ALC drivers are on average younger and they generally show more high-risk behavior than INAP, DRUG, and MIX drivers. In crashes with pedestrians/cyclists and crashes on slippery roads or in winter, INAP drivers are overrepresented and EXC and DUI drivers are underrepresented. Among DRUG and MIX drivers there may be differences according to the type of substance.

CONCLUSIONS

Those drivers who show most types of high-risk behaviors, especially EXC and ALC drivers, are less likely to respond to measures relying on voluntary behavior changes, such as recommended speed, speed warnings, or classical enforcement, although such measures may be effective for INAP and some DRUG drivers. To change the behavior of EXC and ALC drivers, more restrictive measures are called for, such as non-overridable intelligent speed adaptation, vehicle impoundment, or Alcolock.

Gender differences in combined homicide-suicide with consideration of female terrorist bombers

Combined homicide-suicide (H-S) is a phenomenon described as an offender committing a homicidal act followed by their suicide. Current literature on H-S is dominated by a focus on men and their particular set of motivations and actions, primarily because females constitute only a small fraction of the cases of completed H-S. This review begins by analyzing this data and integrating females within two subclassifications of H-S: the psychopathology of the actor (or perpetrator), and the actor's relationship to her homicide victims. Within the relational subcategory of H-S, females are: (1) underrepresented when victims are their spouses or intimate partners (consortial H-S); (2) more prevalent when victims are their own children (filial H-S); and (3) with rare exceptions, not represented in extrafamilial, adversarial and pseudo-commando H-S perpetrators. This review includes female bombers in this gender comparison.

Suicide by crashing into a heavy vehicle: Focus on professional drivers using in-depth crash data

Objective: Road traffic suicides typically involve a passenger car driver crashing his or her vehicle into a heavy vehicle, because death is almost certain due to the large mass difference between these vehicles. For the same reason, heavy-vehicle drivers typically suffer minor injuries, if any, and have thus received little attention in the research literature. In this study, we focused on heavy-vehicle drivers who were involved as the second party in road suicides in Finland. Methods: We analyzed 138 road suicides (2011-2016) involving a passenger car crashing into a heavy vehicle. We used in-depth road crash investigation data from the Finnish Crash Data Institute. Results: The results showed that all but 2 crashes were head-on collisions. Almost 30% of truck drivers were injured, but only a few suffered serious injuries. More than a quarter reported sick leave following their crash. Injury insurance compensation to heavy-vehicle drivers was just above €9,000 on average. Material damage to heavy vehicles was significant, with average insurance compensation paid being €70,500. Three out of 4 truck drivers reported that drivers committing suicide acted abruptly and left them little opportunity for preventive action. Conclusions: Suicides by crashing into heavy vehicles can have an impact on drivers' well-being; however, it is difficult to see how heavy-vehicle drivers could avoid a suicide attempt involving their vehicle.

The significance of preexisting medical conditions, alcohol/drug use and suicidal behavior for drivers in fatal motor vehicle crashes: a retrospective autopsy study

Driver fatalities in motor vehicle collisions (MVCs) encompass accidents, suicides, and natural deaths when driving. The objective of this study was to determine the significance of pathology and other autopsy findings for drivers in fatal MVCs. Forensic autopsy records of driver fatalities in southeast Norway between 2000 and 2014 were studied retrospectively. Data from individual police and collision investigation reports were also collected and analyzed. In 406 driver fatalities, the male/female ratio was 340/66; 9% died from natural causes, 9% were suicides, 65% were culpable accidental deaths, 14% were nonculpable deaths, and 3% were undetermined deaths. Head injuries and thoracic injuries were the most common causes of death. A seatbelt had been worn in 50% of the fatalities, and its prevalence did not differ between accidental deaths and suicides. Blood levels of alcohol and/or drugs that indicated impairment at the time of the collision were found in 40% (105/262) of all culpable accidental deaths but in 50% (64/127) of drivers aged up to 35 years. Pathology (most often cardiovascular disease) suggestive of sudden incapacitation before the collision was present in 24% (62/264) of drivers who were culpable in the accident and in 70% (46/66) of culpable drivers older than 55 years. A substantial proportion of drivers are killed in accidental collisions that may have occurred as a result of either alcohol/drug impairment or preexisting disease. Suicides and natural deaths both constitute significant proportions of MVC fatalities and may be misclassified unless a full inquest including an autopsy is performed.

Suicide and murder-suicide involving automobiles

OBJECTIVE

We aim to explore the phenomenon of suicide by driving one vehicle into another, and draw attention to the cost to occupants of targeted vehicles.

METHOD

We examined academic literature, court and newspaper reports, and online sources.

RESULTS

Driver suicide may be achieved by colliding with a fixed object or another vehicle. When a second vehicle is targeted, the occupants of that vehicle experience property loss, and potentially physical and psychiatric injury, or death. Driver suicides are associated with death of another person, in 11.3% of cases. Some suicidal individuals are able to act with great consideration for the consequences of their actions.

CONCLUSION

Every effort must be made to help suicidal people with mental disorders or other predicaments. There is a need for public discussion of suicide by targeting an oncoming vehicle. It is less likely that suicide drivers who target other vehicles are unable to choose and more likely they have not considered the consequences of their actions.

Road Traffic Suicide in Switzerland

OBJECTIVE

To determine details of road traffic suicides in Switzerland between 2000 and 2010 and to look at our results in relation to studies from other countries.

METHODS

Retrospective data analysis of road traffic suicides extracted from the database of all suicides investigated by Swiss institutes of forensic medicine between 2000 and 2010 using a standardized assessment sheet.

RESULTS

Out of 4,885 suicides in Switzerland, we identified 76 cases (1.56%) of road traffic suicide. Twenty-three cases had to be excluded because, although the forensic medical experts suspected suicide, they could not establish it for sure. That left 53 cases (1.02% of all suicides), mostly unmarried men, who were on average 9 years younger than the study population as a whole. Most collided with other vehicles, mainly other cars, and usually on main highways or country roads. In most cases, the cause of death was multiple injuries. Other persons were killed 4 times more often than with other suicide methods. Toxicology screening was performed significantly more frequently than with other methods but more often proved negative. Acute psychiatric problems were commonly assumed to be the underlying reasons. Suicide notes were left by only 20%, a lower proportion than in the study population as a whole.

CONCLUSIONS

Road traffic suicides account for approximately 1% of all suicide methods used in Switzerland, although unclassifiable cases indicate that the rate might be higher. Every road traffic crash should therefore be routinely investigated by an interdisciplinary team and suicide should be considered as the possible cause.