Last words: Are there differences in psychosocial and clinical antecedents among suicide decedents who leave e-notes, paper notes, or no note?

Objective
Only a minority of suicide decedents leave a suicide note. Typically, the notes are handwritten on paper; however, electronic suicide notes have been reported with increasing frequency. This emerging phenomenon remains generally under‐researched. The aim of this study was to compare the psychosocial and clinical antecedents of suicide decedents who left E‐notes with those who left paper notes or no notes.
Method
The study was embedded in the Southwestern Ontario Suicide Study (SOSS). The SOSS was a three‐year case series of consecutive deaths by suicide that occurred in the region between 2012 and 2014. Data on psychosocial and clinical antecedents were collected with a modified version of the Manchester questionnaire used in the UK.
Results
Of the 476 suicides files reviewed, 45.8% contained a suicide note. A total of 383 separate suicide notes were left: 74.3% were paper notes and 25.7% were E‐notes. The results of the multivariate regression analyses indicate that the likelihood of leaving a suicide note was negatively associated with a history of admissions to a mental health unit, while the likelihood of leaving an E‐note was negatively associated with age, positively associated with presence of a mental disorder, and negatively associated with history of hospital admissions.
Conclusions
Future studies with larger samples need to consider the timing of the text messages, and appraise whether there was the intent of seeking help or rescue in the text messages.