Skip to main content
SpringerLink
Log in

Forensic pathology and forensic epidemiology of suicides in allegheny county, pennsylvania

A 10-year retrospective review (1990–1999)

  • Original Article
  • Published:
Forensic Science, Medicine, and Pathology Aims and scope Submit manuscript

Abstract

Suicide has assumed epidemic proportions and constitutes a major public health issue throughout the United States. Suicide remains one of the top eight leading causes of death, accounting for approximately 30,000 deaths annually. The understanding and prevention of suicide requires a multidisciplinary approach that involves psychosocial and medical specialties starting with a forensic analysis of the characteristics of suicide. The aim of this 10-year (1990–1999) retrospective study was threefold: first, to examine the forensic epidemiological characteristics of suicides examined by the Allegheny County Coroner’s Office; second, to describe emerging epidemiological patterns of suicide; and finally, to make recommendations for preventive measures. A total of 1447 suicides were identified, with 1164 males (80%) and 283 females (20%) resulting in a male to female ratio of 4:1. The race distribution comprised 90% whites, 9% blacks, and 1% other races. The age of suicide victims ranged from 13 to 96 years old with a peak within the 31- to 40-year-old age group, which represented 24.5% of all suicides. Overall, 40% of the victims were single and more blacks than whites were single. The greatest number of suicides occurred in July, with the least in December. Suicides most frequently occurred between 9:01 am and 3:00 pm. Suicide notes were present in 29% of all suicides. Firearm injuries, hanging, and drug overdose were the leading methods of suicide. Use of firearms was the leading method of suicide among both sexes. Female drug overdose deaths outnumbered male drug overdose deaths. The 10 most common overdose drugs were all central nervous system depressants, with amitriptyline being the most common prescription overdose drug. Based on reported antecedent trends in suicides, we make two recommendations regarding suicide prevention: (1) physicians should be educated to replace the prescription of older and more toxic antidepressants such as amitriptyline with newer and less toxic antidepressants such as serotonin reuptake inhibitors; and (2) firearms should be made inaccessible to individuals with risk factors for suicide, especially in the home.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. U.S. Census Bureau. State and National Data (C2SS). United States Department of Commerce, Washington, DC, 2001.

  2. The Surgeon General’s Call to Action to Prevent Suicide. U.S. Public Health Service, Washington, DC, 1999.

  3. World Health Organization. Prevention of Suicide: Guidelines for the Formulation and Implementation of National Strategies. World Health Organization, Geneva, Switzerland, 1996.

    Google Scholar 

  4. Hoyert DL, Arias E, Smith BL, Murphy SL, Kochanek KD. Deaths: final data for 1999. Natl Vital Stat Rep 2001;49:1–113.

    Google Scholar 

  5. Welch SS. A review of the literature on the epidemiology of parasuicide in the general population. Psychiatr Serv 2001;52:368–375.

    Article  PubMed  CAS  Google Scholar 

  6. Spicer RS, Miller TR. Suicide acts in 8 states: incidence and case fatality rates by demographics and method. Am J Public Health 2000;90:1885–1891.

    PubMed  CAS  Google Scholar 

  7. Mortensen PB. Can suicide research lead to suicide prevention? Acta Psychiatr Scand 1999;99:397–398.

    PubMed  CAS  Google Scholar 

  8. Moscicki EK. Epidemiologic surveys as tools for studying suicidal behavior: a review. Suicide Life Threat Behav 1989;19:131–146.

    PubMed  CAS  Google Scholar 

  9. Gunnell D, Nowers M. Suicide by jumping. Acta Psychiatr Scand 1997;96:1–6.

    PubMed  CAS  Google Scholar 

  10. Baker FM. Black youth suicide: literature review with a focus on prevention. J Natl Med Assoc 1990;82:495–507.

    PubMed  CAS  Google Scholar 

  11. Pennsylvania Annotated Code Statutes. Coroner’s Investigations. Chapter 16, Section 4236a.

  12. Knight B. Forensic Pathology. 2nd ed. Oxford University Press, Inc., New York, 1996.

    Google Scholar 

  13. Black HC, Nolan JR, West Group. Black’s Law Dictionary: Definitions of the Terms and Phrases of American and English Jurisprudence, Ancient and Modern. 6th ed. West Group. St. Paul, MN, 1990.

    Google Scholar 

  14. Minino AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: final data for 2000. Natl Vital Stat Rep 2002;50:1–119.

    PubMed  Google Scholar 

  15. Sigurdson E, Staley D, Matas M, Hildahl K, Squair K. A five year review of youth suicide in Manitoba. Can J Psychiatry 1994;39:397–403.

    PubMed  CAS  Google Scholar 

  16. Diekstra RF. The epidemiology of suicide and parasuicide. Acta Psychiatr Scand Suppl 1993;371:9–20.

    Article  PubMed  CAS  Google Scholar 

  17. Moscicki EK. Epidemiology of suicidal behavior. Suicide Life Threat Behav 1995;25:22–35.

    PubMed  CAS  Google Scholar 

  18. Moscicki EK. Identification of suicide risk factors using epidemiologic studies. Psychiatr Clin North Am 1997;20:499–517.

    Article  PubMed  CAS  Google Scholar 

  19. Moscicki EK. Gender differences in completed and attempted suicides. Ann Epidemiol 1994;4:152–158.

    Article  PubMed  CAS  Google Scholar 

  20. Leenaars A, De Wilde E, Wenckstern S, Kral M. Suicide notes of adolescents: a life span comparison. Can J Behav Sci 2001;33:47–57.

    Google Scholar 

  21. Elfawal MA. Cultural influence on the incidence and choice of method of suicide in Saudi Arabia. Am J Forensic Med Pathol 1999;20:163–168.

    Article  PubMed  CAS  Google Scholar 

  22. Marzuk PM, Tardiff K, Hirsch CS, Leon AC, Stajic M, Hartwell N, et al. Increase in suicide by asphyxiation in New York City after the publication of Final Exit. N Engl J Med 1993;329:1508–1510.

    Article  PubMed  CAS  Google Scholar 

  23. Ohberg A, Penttila A, Lonnqvist J. Driver suicides. Br J Psychiatry 1997;171:468–472.

    PubMed  CAS  Google Scholar 

  24. Griffith EE, Bell CC. Recent trends in suicide and homicide among blacks. JAMA 1989;262:2265–2269.

    Article  PubMed  CAS  Google Scholar 

  25. Neeleman J, Mak V, Wessely S. Suicide by age, ethnic group, coroners’ verdicts and country of birth. A three-year survey in inner London. Br J Psychiatry 1997;171:463–467.

    PubMed  CAS  Google Scholar 

  26. Neeleman J, Wessely S. Ethnic minority suicide: a small area geographical study in south London. Psychol Med 1999;29:429–436.

    Article  PubMed  CAS  Google Scholar 

  27. Rosewater KM, Burr BH. Epidemiology, risk factors, intervention, and prevention of adolescent suicide. Curr Opin Pediatr 1998;10:338–343.

    Article  PubMed  CAS  Google Scholar 

  28. Retterstol N. Suicide in the Nordic countries. Psychopathology 1992;25:254–265.

    Article  PubMed  CAS  Google Scholar 

  29. Klerman GL. Clinical epidemiology of suicide. J Clin Psychiatry 1987;(48 Suppl):33–38.

  30. Bennett AT, Collins KA. Elderly suicide: a 10-year retrospective study. Am J Forensic Med Pathol 2001;22:169–172.

    Article  PubMed  CAS  Google Scholar 

  31. Kaplan MS, Adamek ME, Johnson S. Trends in firearm suicide among older American males: 1979–1988. Gerontologist 1994;34:59–65.

    PubMed  CAS  Google Scholar 

  32. Mino A, Bousquet A, Broers B. Substance abuse and drug-related death, suicidal ideation, and suicide: a review. Crisis 1999;20:28–35.

    PubMed  CAS  Google Scholar 

  33. Isometsa E. Suicide. Curr Opin Psychiatry 2000;13:143–147.

    Article  Google Scholar 

  34. Lester D, Abe K. The effect of controls on sedatives and hypnotics on their use for suicide. J Toxicol Clin Toxicol 1989;27:299–303.

    Article  PubMed  CAS  Google Scholar 

  35. Lester D. Estimates of prescription rates and the use of medicaments for suicide. Pharmacol Toxicol 1994;75:231–232.

    PubMed  CAS  Google Scholar 

  36. Robins E, Murphy GE, Wilkinson RH Jr, Gassner S, Kayes J. Some clinical considerations in the prevention of suicide based on a study of 134 successful suicides. Am J Public Health 1959;49:888–899.

    CAS  Google Scholar 

  37. Barraclough B, Bunch J, Nelson B, Sainsbury P. A hundred cases of suicide: clinical aspects. Br J Psychiatry 1974;125:355–373.

    Article  PubMed  CAS  Google Scholar 

  38. Leonard BE. Toxicity of antidepressants. Lancet 1986;2:1105.

    Article  PubMed  CAS  Google Scholar 

  39. Isometsa E, Heikkinen M, Marttunen M, Henriksson M, Aro H, Lonnqvist J. The last appointment before suicide: is suicide intent communicated? Am J Psychiatry 1995;152:919–922.

    PubMed  CAS  Google Scholar 

  40. Beaumont G. Suicide and antidepressant overdosage in general practice. Br J Psychiatry Suppl 1989:27–31.

  41. Isometsa E, Heikkinen M, Henriksson M, Marttunen M, Aro H, Lonnqvist J. Differences between urban and rural suicides. Acta Psychiatr Scand 1997;95:297–305.

    PubMed  CAS  Google Scholar 

  42. Kevan SM. Perspectives on season of suicide: a review. Soc Sci Med [Med Geogr] 1980;14:369–378.

    Article  CAS  Google Scholar 

  43. Kevan SM. The seasonal behaviour of Canadians. Can Ment Health 1978;26:16–18.

    PubMed  CAS  Google Scholar 

  44. Morselli EA. Suicide: an Essay on Comparative Moral Statistics. C.K. Paul & Co., London, 1881.

    Google Scholar 

  45. Altamura C, VanGastel A, Pioli R, Mannu P, Maes M. Seasonal and circadian rhythms in suicide in Cagliari, Italy. J Affect Disord 1999;53:77–85.

    Article  PubMed  CAS  Google Scholar 

  46. Gallerani M, Avato FM, Dal Monte D, Caracciolo S, Fersini C, Manfredini R. The time for suicide. Psychol Med 1996;26:867–870.

    PubMed  CAS  Google Scholar 

  47. Ho TP, Yip PS, Chiu CW, Halliday P. Suicide notes: what do they tell us? Acta Psychiatr Scand 1998;98:467–473.

    PubMed  CAS  Google Scholar 

  48. Pennsylvania Annotated Code Statutes. Causing or Aiding Suicide. Chapter 18, Section 2505.

Download references

Author information

Authors and Affiliations

  1. Allegheny County Coroner’s Office, 542 Fourth Avenue, 15219, Pittsburgh, PA

    Bennet I. Omalu, Steven A. Koehler, Abdulrezzak M. Shakir, Leon Rozin & Cyril H. Wecht

  2. Allegheny College, Meadville, PA

    Krystle M. Macurdy

  3. Ebonyi State University Teaching Hospital, Abakaliki, Nigeria

    Uche H. Nnebe-Agumadu

Authors
  1. Bennet I. Omalu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Krystle M. Macurdy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven A. Koehler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Uche H. Nnebe-Agumadu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abdulrezzak M. Shakir
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leon Rozin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cyril H. Wecht
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bennet I. Omalu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Omalu, B.I., Macurdy, K.M., Koehler, S.A. et al. Forensic pathology and forensic epidemiology of suicides in allegheny county, pennsylvania. Forens Sci Med Pathol 1, 125–137 (2005). https://doi.org/10.1385/FSMP:1:2:125

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1385/FSMP:1:2:125

Key Words

Search

Navigation