Suicide and Overdose Mortality Among Victims and Defendants in Felony Domestic Violence Criminal Cases

Domestic violence (DV), death by suicide, and death by overdose are major public health concerns in the United States. While existing studies have documented associations of DV with both suicide and overdose, most studies utilize nonfatal outcomes and lifetime DV exposure. In this population-based case-control study, we aimed to estimate the association of both suicide death and overdose death with involvement in a DV case, either as a victim or alleged perpetrator, referred for felony charges in the year prior to death. All deaths in King County, Washington, United States or deaths occurring elsewhere among King County residents were included ( N = 113,388), as were all felony DV referrals to the King County Prosecuting Attorney’s Office. Suicide deaths ( n = 2,243) and overdose deaths ( n = 3,578) were separately matched to deaths of all other causes, and conditional logistic regression was used to determine associations of case status with DV referral in the year prior to death. We found an association of DV referral as a defendant with both suicide (adjusted odds ratio [aOR] = 3.68, 95% confidence interval [CI] [2.33, 5.81], p < .01) and overdose (aOR = 2.47, 95% CI [1.67, 3.66], p < .01). We also found an association of DV referral as a victim with overdose death (aOR = 4.36, 95% CI [2.76, 6.87], p < .01) but not with suicide (aOR = 0.74, 95% CI [0.18, 3.02], p = .42). These findings highlight a need for suicide and overdose prevention efforts among people involved in DV cases. Future research could evaluate prevention strategies and examine mediating links between DV and both suicide and overdose.