Demographics of suicide victims in Sweden in relation to their blood–alcohol concentration and the circumstances and manner of death

Specimens of blood and other body fluids were obtained at autopsy from all deaths in Sweden classified as suicide covering a 10-year period (N = 11,441 cases). The mean age (±standard deviation, SD) of the victims was 51.3 ± 18.8 years with a clear predominance of males 71% (mean age 51.3 ± 18.8 years) compared with 29% females (mean age 51.4 ± 18.9 years). The concentration of ethanol in blood samples was determined in duplicate by headspace gas chromatography and a mean blood–alcohol concentration (BAC) of 0.1 g/L (10 mg/100 mL) was the cut-off used to identify ethanol positive cases. The suicides were coded (ICD-9) as self-poisonings (N = 2462, 22%), hanging (N = 4474, 39%), asphyxia by gas (N = 509, 4.4%), drowning (N = 803, 7.0%), gun shot (N = 1307, 11.4%), fall from height (N = 632, 5.5%), self-inflicted cuts or sharp-force injury (N = 363, 3.1%) and miscellaneous ways (N = 891, 7.8%). On average 34% of all suicide victims in Sweden had consumed alcohol before death, 36% of the males and 31% of the females had a positive BAC. The mean (median) concentration of alcohol in femoral blood for men was 1.34 g/L (1.3 g/L) compared with 1.25 g/L (1.1 g/L) for women. Many victims were heavily intoxicated and the 90th percentiles of the BAC distributions ranged from 2.3 to 2.8 g/L depending on manner of death. Elevated blood–alcohol was most prevalent in poisoning deaths (45%) and gas asphyxia (51%) and least prevalent in falls from height (19%) and sharp-force injury (18%). Toxicological analysis for presence of drugs other than alcohol showed a predominance of paracetamol, SSRI antidepressants, anti-psychotics, sedative-hypnotics, and centrally acting opioids. A host of psycho-social factors drive a person to commit suicide and one of the catalysts is over-consumption of alcohol and acute alcohol intoxication. Heavy drinking leads to a loss of inhibitions, impulsive behaviour, poor judgment and a tendency to take risks, all of which might increase the propensity of predisposed individuals to take their own lives.