Vehicular fatalities : accident or suicide?

Literature review. Vehicular suicide : overview and directions for future research. Suicide remains a significant public health problem, and a manner of death which is often misclassified by coroners. There are no standardised criteria for coroners to assist with manner of death determination, and the decisions as to which deaths are attributed to be suicides are often complex, and vary both between individual coroners, and coronial jurisdictions. Despite the variety of available means of suicide completion, only a few methods are commonly used (e.g., overdose, hanging). Often overlooked as a means of suicide is the fatal single vehicle crash. A motor vehicle presents an ideal means of suicide, due to ease of access, frequency of use, inherent risks involved, and the ability to conceal one's suicidal intent from others. Previous research has suggested that suicide by motor vehicle crash may be attributed to between 1.5% and 5.0% of all vehicular fatalities, but some motor vehicle fatalities are misclassified as accidents, with the true rate of suicide by motor vehicle crash unknown. Suicide prevention strategies have had limited success in reducing the rates of suicide by restricting the availability of access to means of suicide completion. Suicide by motor vehicle crash does not allow for this method of suicide prevention to be implemented, therefore further research is required to not only determine a more accurate account of the number of suicides by motor vehicle crash, but also to establish strategies to prevent suicide by motor vehicle crash and to clarify the parameters by which coroners determine an individual's manner of death. Empirical study. An examination of 100 closed coronial case files was conducted, (N 100) involving vehicular fatalities (the death of the driver, passenger, pedestrian or cyclist). Ninety-five percent of cases were determined by coroners to be accidental deaths, 2% were deemed to be suicides and 3% were not attributed a manner of death. Key features of each vehicular fatality were identified, including; speed travelled at the time of the crash, road and weather conditions, seatbelt use, substance use and psychological history. Backwards stepwise logistic regression was performed to explore the influence of certain variables on the likelihood a fatality was the result of suicide or an accident. The model indicated a statement of suicidal intent and the presence of alcohol to be significant variables in differentiating between an accident and suicide. This model correctly identified 98% of cases as either accident or suicide, highlighting two discrepant cases where regression analysis suggested a manner of death determination in contrast to that provided by the coroner. The results presented are consistent with previously reported figures concerning the rate of vehicular suicide and are discussed in terms of the implications of public health and road safety campaigns, as well as improvements in accuracy and consistency in the determination of manner of death.