Types of suicide pacts: a comparative analysis using the National Violent Death Reporting System

Kawon Victoria Kim; Cayley Russell; Mark S Kaplan; Jürgen Rehm; Shannon Lange

doi:10.3389/fpsyt.2023.1139305

Types of suicide pacts: a comparative analysis using the National Violent Death Reporting System

Front Psychiatry. 2023 May 5:14:1139305. doi: 10.3389/fpsyt.2023.1139305. eCollection 2023.

Authors

Kawon Victoria Kim^{1

2}, Cayley Russell^{1

3}, Mark S Kaplan⁴, Jürgen Rehm^{1

2

3

5

6

7

8

9

10}, Shannon Lange^{1

5

6}

Affiliations

¹ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
² Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
³ Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁴ Luskin School of Public Affairs, University of California, Los Angeles, CA, United States.
⁵ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁶ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁷ Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
⁸ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
⁹ Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁰ Zentrum für Interdisziplinäre Suchtforschung (ZIS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.

Abstract

Introduction: Suicide pacts are lethal acts of violence involving multiple decedents. No study has ever compared suicide pact types using a large sample, limiting our understanding of this rare but serious phenomenon. The objective of the current study was to describe suicide pacts in the United States and empirically compare suicide pacts wherein all decedents died by self-harm with those that involved assisted suicide.

Methods: Using restricted access incident-level data from the National Violent Death Reporting System, we identified 277 suicide pact incidents (225 suicide pacts wherein all decedents died by self-harm and 52 suicide pacts wherein one pact member died by assisted suicide). The two suicide pact types were compared for demographics, pact characteristics, and preceding circumstances.

Results: Compared with decedents of suicide pacts involving assisted suicide, decedents of suicide pacts wherein both members died by self-harm had significantly lower odds of being non-white, Hispanic or non-Hispanic (OR = 0.33, 95%CI: 0.18, 0.64), using an active method of suicide (i.e., ICD-10 codes X70-X83) (OR = 0.01, 95%CI: <0.01, 0.04), and experiencing interpersonal relationship problems (OR = 0.48, 95%CI: 0.27, 0.87) and a crisis within two weeks of their death (OR = 0.58, 95%CI: 0.36, 0.97), but greater odds of preceding physical health problems (OR = 3.25, 95%CI: 1.84, 6.04).

Discussion: Overall, our findings indicate that suicide pacts wherein all decedents died by self-harm and suicide pacts that involved an assisted suicide appear to have largely distinct profiles. While further research is required, the discrete characteristics of these two types of suicide pacts have important implications for prevention.

Keywords: United States; mental health; public health; suicide; suicide pact.