Alcohol Consumption and 15 Causes of Fatal Injuries: A Systematic Review and Meta-Analysis

INTRODUCTION

The proportion of fatal nontraffic injuries that involve high levels of alcohol use or alcohol intoxication was assessed by cause of injury to generate alcohol-attributable fractions. Updated alcohol-attributable fractions can contribute to improved estimates of the public health impact of excessive alcohol use.

METHODS

Peer-reviewed and gray literature for 1995-2019 on 15 causes of fatal nontraffic injuries in the U.S., Canada, or Mexico were systematically reviewed, and state data systems were queried for available estimates of fatalities with recorded blood alcohol concentration levels and proportions of decedents with blood alcohol concentrations ≥0.10 g/dL by cause of injury. For each injury cause, alcohol-attributable fractions across studies were synthesized by meta-analysis of single proportions using generalized linear mixed models.

RESULTS

In total, 60 published studies and 40 additional population-level data points from 6 state data systems were included. The meta-analyzed alcohol-attributable fractions by cause of injury are as follows: air-space transport (0.03), aspiration (0.24), child maltreatment (0.09), drowning (0.31), fall injuries (0.37), fire injuries (0.34), firearm injuries (0.24), homicide (0.29), hypothermia (0.29), motor vehicle nontraffic crashes (0.42), occupational and machine injuries (0.08), other road vehicle crashes (railroad trespasser injuries) (0.63), poisoning (not alcohol) (0.20), suicide (0.21), and water transport (0.27), yielding an overall median alcohol-attributable fraction of 0.27.

DISCUSSION

Excessive alcohol use is associated with substantial proportions of violent and nonviolent injury deaths. These findings can improve the data used for estimating alcohol-attributable injury deaths and inform the planning and implementation of evidence-based strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) to prevent them.

Suicide in children and adolescents: a Tunisian perspective from 2009 to 2015

This study presents the characteristics of child and adolescent suicides which occurred in Kairouan, Tunisia. Data were collected from autopsy records of the Forensic Department of the University Hospital Ibn El Jazzar of Kairouan. General characteristics of suicides among children and adolescents (under the age of 18) between 2009 and 2015 were retrospectively reviewed. A total of 49 cases, with a female predominance (61.2%) and a mean age of 15.4 ± 2.1, were registered. Most of the victims were from rural areas (93.1%). In most cases, suicide occurred in the victim's home or the surrounding area (73.4%). The identified precipitating factors were family problems in 55.1%, and school issues in 12.2%. The most common suicide method was hanging (69.38%) for both genders, followed by self-immolation for males and poisoning for females, the majority using pesticides. This study offers useful information to understand the risk factors in Tunisian child and adolescent suicides and provides a basis for the development of urgently needed preventive strategies.

Revisão de literatura sobre suicídio na infância

Resumo Objetivou-se analisar a literatura específica sobre os fatores associados ao comportamento suicida em crianças com até 14 anos. Trata-se, portanto, de uma revisão integrativa sobre este tema. Os dados foram coletados nas bases de dados PubMed e Psycinfo, a partir dos seguintes descritores: “risk of suicide”; “children”; “suicide”; “childhood”. O tempo de publicação foi limitado ao período de 1980 a 2016. Um total de 29 artigos preencheu os critérios de elegibilidade e, portanto, foram selecionados e analisados. Os resultados indicaram haver associação do suicídio com fatores neurobiológicos, escolares, sociais e mentais, dentre eles destaca-se o papel da impulsividade. Além disso, evidenciou-se que a maioria dos fatores de vulnerabilidade ao comportamento suicida podem ser prevenidos desde que sejam identificados e a criança receba tratamento psicológico e médico. Conclui-se que conflitos familiares, problemas na escola, bullying, impulsividade e depressão estão associados ao suicídio na infância. Adicionalmente, a escassez de pesquisas no âmbito nacional acerca da temática do suicídio pode contribuir para a invisibilidade desse tema na instauração de programas de promoção e tratamento de saúde.

Suicide in Children: A Systematic Review

The objective of this study was to provide a review of studies on suicide in children aged 14 years and younger. Articles were identified through a systematic search of Scopus, MEDLINE, and PsychINFO. Key words were "children, suicide, psychological autopsy, and case-study." Additional articles were identified through manual search of reference lists and discussion with colleagues. Fifteen published articles were identified, 8 psychological autopsy studies (PA), and 7 retrospective case-study series. Suicide incidence and gender asymmetry increases with age. Hanging is the most frequent method. Lower rates of psychopathology are evident among child suicides compared to adolescents. Previous suicide attempts were an important risk factor. Children were less likely to consume alcohol prior to suicide. Parent-child conflicts were the most common precipitant.

Suicide in children and young adolescents: a 25-year database on suicides from Northern Finland

Despite the large amount of research on adolescent suicidality, there are few detailed studies illustrating the characteristics of child and adolescent completed suicide. Our study presents the characteristics of child and adolescent suicides occurring over a period of 25 years within a large geographical area in Northern Finland, with a special focus on gender differences. The study sample included all 58 suicides among children and adolescents (<18 years) occurring in the province of Oulu in Finland between 1988 and 2012. The data is based on documents pertaining to establish the cause of death from forensic autopsy investigations. A register linkage to the data from the Finnish Hospital Discharge Register (FHDR) was also made. 79% of the suicide victims were male. Violent suicide methods predominated in both genders (males 98%, females 83%). While symptoms of mental illness were common, only a minority (15% of males and 17% of females) had a previous history of psychiatric hospitalization. 17% of females but none of the males had been hospitalized previously due to self-poisoning. A greater proportion of females than males had a history of self-cutting (33% vs. 7%) and previous suicide attempts (25% vs. 4%). 48% of males and 58% of females were under the influence of alcohol at the time of their suicide, and alcohol intoxication was related to suicides during the night. One fifth of the adolescents screened positive for substances other than alcohol. The results of this study indicate that there are similarities but also some differences in the characteristics of male and female suicides in adolescents.

When a student dies: organizing the school's response

Principals, teachers, and guidance counselors feel ill-prepared to address a student’s death. Often the death is not anticipated, comes as a shock, and has many reverberations in the school itself and in the broader community. The principal and others in the school may be called upon to serve as leaders in this sudden crisis and have broad responsibilities to their school community that may seem overwhelming in the face of their own grief and reactions to the loss. These guidelines present a meaningful response to an event that can profoundly affect the school and community.

Mortalities among children and adolescents in manipal, southern India

OBJECTIVE

To describe the epidemiology and trends of traumatic deaths among children and adolescents in Manipal, Southern India.

METHODS

Analysis of all trauma deaths in children and adolescents aged between 1 and 19 years, autopsied between January 1994 and December 2005. The study is based on autopsy records, information furnished by the police, and chemical analysis report.

RESULTS

There has been a substantial decline in the incidence of traumatic deaths among children and adolescents during 1994 to 2005. Road traffic injuries were responsible for maximum mortalities (38.4%), followed by those because of burns (24.9%) and poisoning (15.9%). Males comprised 59.6% of cases. Male-to-female ratio was 1.5:1. Males predominantly died of traffic injuries (45.2%), whereas females as a result of burns (37.4%). There was more than two-fold increase in injury-related mortalities from childhood to adolescence (1:2.3).

CONCLUSION

Among children and adolescents, traffic injuries and burns are responsible for maximum injury-related mortalities in males and females, respectively. More injury reducing measures are required for effective reduction in traumatic deaths.

An Analysis of Parent-Female Adolescent Relationships in Female Adolescent Suicides

This study analyzed Turkish female adolescent-family relations, which is believed to be one of the significant factors in female adolescents' suicide attempts, from a multidimensional perspective. The Parent-Adolescent Relationship Inventory, a multidimensional evaluation tool based on the behavioral family-system approach was used as a research tool. The inventory consists of the concepts and techniques of behavioral theory, family system theory, and cognitive theory in parent-adolescent' problems and conflicts. Based on these theories, the parent-adolescent relations inventory (PARQ), involves three main dimensions: problem solving and communication skills, cognitive/internalized beliefs, and functions and structures in family systems. There are two forms of the inventory, the adolescent form and the parent form. Only the adolescent form of PARQ, including 284 items, was used in this research. The inventory also consists of 16 subscales. It was adapted into Turkish by Eryüksel (1996) . The subjects of the study were 52 female adolescents who had attempted suicide and were taken to the Emergency Department of The Faculty of Medicine in Çukurova University, and 52 normal female adolescents from two different secondary schools at the southern province in Turkey. The age range of the clinical and normal groups were 14–18 ([Formula: see text] = 16). The results of the study revealed that the general stress level of female adolescents who attempted suicide is higher than those of normal groups. The examination of family structures of these female adolescents made it clear that mothers were the mediator between fathers and adolescents. It was also observed that both mothers and fathers shared many somatic concerns.

Neuropsychological profile following suicide attempt by hanging: two adolescent case reports

Hippocampal damage and amnesia following hypoxia and ischemia are described in the few published adult cases of suicide attempt by hanging. However, a recent review (Caine & Watson, 2000) suggests a variable pattern of brain involvement and neuropsychological impairments following hypoxic-ischemic injury that may or may not involve amnesia. To help clarify the impact of hanging on the developing brain, we examined neuropsychological functioning in two adolescents who survived suicide attempt by hanging. Despite differences in Glasgow Coma Scale (GCS), coma duration, and structural imaging findings, both patients had similar IQ (VIQ>PIQ) and presented with various combinations of deficits in expressive/receptive language, visual-constructional and perceptual ability, processing speed, attention, working memory, and/or executive functioning shortly after injury. In spite of their similarities, only one of the patients presented with classic amnesia symptoms in his early recovery. This patient was evaluated 1 year postinjury, and persistent deficits in processing speed and memory encoding were noted. Several hanging-related variables, including longer estimated hanging duration, greater weight, and severe airway edema, were thought to place this patient at increased risk for cognitive deficits. Clinical MRI scans of this patient obtained 6 weeks postinjury revealed mild volume loss as well as abnormalities in bilateral superior cortex. However, CT and MRI scans obtained throughout early recovery did not reveal overt evidence of injury to specific memory-related structures. Comprehensive neuropsychological evaluation of all adolescent survivors of suicide attempt by hanging is recommended, as a variety of postacute cognitive deficits were observed in these patients despite relatively short (<or=15 minutes) estimated hanging durations.

Adolescent and Young Adult Suicide: A 10-Year Retrospective Review of Kentucky Medical Examiner Cases

The compilation of all suicidal causes of death attained the third highest ranking of mortality between the ages of 15 and 24 following unintentional deaths and homicide in the United States, accounting for approximately 4000 deaths in 2002. A variety of biopsychosocial factors may contribute to adolescent suicidal behavior, including psychiatric disorders, risk-taking behaviors, and lack of a cohesive family unit. The authors conducted a 10-year (1993-2002) retrospective review of 108 Medical Examiner cases of suicide ages 11-17 and 358 cases ages 18-24 in Kentucky, which represents two thirds of the Coroner cases in the state. The majority of victims were male and Caucasian. The major causes of death were the same for the two age groups, specifically, firearm injury (72.2% and 70.7%), hanging (22.2% and 18.7%), and drug intoxication (2.8% and 5.3%). An integrated Coroner-Medical Examiner system profits in the public health arena by providing collaborative research data for policy decisions. The prevalence of youth suicide by firearm should prompt further discussion regarding ways to better identify high-risk adolescents and young adults and restrict pediatric access to unsecured household firearms.

Suicide in Children and Adolescents

Suicide is second only to accidents as the most common cause of death for children and adolescents age 10 to 19 in Canada. All of the pediatric cases that were referred to the Hamilton Regional Forensic Pathology Unit from 1993 to 2002 were reviewed. For the purpose of this study, pediatric deaths were defined as deaths in the age group of 1 day up to and including 19 years of age. Specific criteria for suicide were applied to each case, independent of the manner of death issued by the coroner. The criteria were 3-fold. First, homicide had to be ruled out by the police investigation and autopsy findings. Second, the method had to be consistent with self-infliction. Finally, there had to be some evidence of suicidal intent. Questionable cases were discussed among the authors, and if reasonable intent could not be established, then the case was excluded. The autopsy and police reports were examined in detail regarding age, sex, location and method of suicide, presence of suicide notes, and any contributing psychologic factors or stressors. Of the 501 pediatric autopsies performed during the 10-year period, 31 (6%) met the criteria of suicide. The majority of cases (87%) were in older adolescents (age 15 to 19), and the male to female ratio was 2.4:1. Psychologic factors were identified in some of the cases, including depressed mood (77%), suicidal ideation (45%), previous suicide attempts (23%), and drug or alcohol problems (19%). Most of the suicides (61%) occurred in the victim's home, and 12 (39%) cases left a suicide note. In 9 cases (29%), alcohol or street drugs were detected postmortem, though in 8 cases toxicology was not performed. Hanging (48%) was the most common method of suicide, followed by firearms (13%), poisoning (10%), drowning (10%), and blunt force vehicular trauma (10%). Almost 60% of the male suicides were by hanging. No specific trend was identified in the 9 female suicides. These results were compared with similar studies within Canada and other countries. Overall, the method of suicide is dictated by what is convenient and readily available, though the acceptance of various suicide methods can change over time. Suicide prevention efforts should be tailored to address local trends.

Suicidal deaths in childhood and adolescence

Suicide has been reported as the second or third most common cause of death in children and adolescents worldwide. In this study, cases of under the age of 19 years submitted to the Institute of Forensic Medicine, First Specialization Board between 1996 and 2000 as suicides by the Board were evaluated retrospectively. The cases included in this study were the cases bearing locally questionable components, so had been submitted to the evaluations by the Board in order to eradicate the doubts. A total of 43 cases were investigated regarding age, gender, cause of death, manner of death, place of death, time of death, and the risk factors. Of the 43 cases evaluated, 31 cases were female and 12 cases were male. The notable suicide method was found to be firearms. Although it was clear that that not all of the suicide cases in this age group had been submitted to the Institute of Forensic Medicine, the most striking result of this study, nevertheless, was that girls constituted the 72% of suicidal deaths in this age group.

Suicide in children and adolescents at a province in Turkey

Despite the well-documented increases in the rate of completed suicide among children, accurate knowledge of the characteristics of these suicides is limited. We examined all suicides by children and adolescents in Diyarbakir during 1999 and 2001. All of the cases were analyzed regarding the age, sex, method and location of suicide, time of year, and predictive factors. There were 56 children aged 11 through 19 years. Adolescents between 15 and 19 years of age constituted the overwhelming number (87%) of all the childhood suicides. Female children and adolescents predominated among the suicide victims (71%). The most frequent means of suicide were firearms (43%), hanging (28%), and jumping (16%), respectively. The majority of suicides occurred at the decedent's home (88%). Reasons identified were mainly psychiatric disorders, followed by troubles within the family. A prior suicide attempt or a note that was left by the decedent and elucidated the reason for the suicide was rare. There was no seasonal difference in rates of suicides.