Citation

Kapusta ND, Tran US, Rockett IRH, De Leo D, Naylor CP, Niederkrotenthaler T, Voracek M, Etzersdorfer E, Sonneck G. Arch. Gen. Psychiatry 2011; 68(10): 1050-1057.

Affiliation

Department of General Practice, Center of Public Health (Dr Niederkrotenthaler), and Institute for Medical Psychology, Center of Public Health (Dr Sonneck), Medical University of Vienna, Ludwig Boltzmann Institute for Social Psychiatry (Dr Sonneck), and Departments of Clinical, Biological, and Differential Psychology (Dr Tran) and Basic Psychological Research (Dr Voracek), School of Psychology, University of Vienna, Austria; Furtbach Hospital for Psychiatry and Psychotherapy, Stuttgart, Germany (Dr Etzersdorfer); Department of Community Medicine and Injury Control Research Center, West Virginia University, Morgantown, West Virginia (Dr Rockett); and Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, and Life Promotion Clinic, Mount Gravatt Campus, Griffith University (Dr De Leo), and Forensic and Scientific Services, Queensland Health, Clinical and Statewide Services Division (Dr Naylor), Brisbane, Queensland, Australia.

Copyright

(Copyright © 2011, American Medical Association)

DOI

10.1001/archgenpsychiatry.2011.66

PMID

21646567

Abstract

CONTEXT: Suicides are prone to misclassification during death ascertainment procedures. This problem has generated frequent criticism of the validity of suicide mortality statistics. OBJECTIVE: To employ an external measure of the validity of cause-of-death statistics (ie, national autopsy rates) and to examine potential misclassification of suicide across countries from Europe to Central and Northern Asia. DESIGN: Cross-national analysis. SETTING: Thirty-five countries. PARTICIPANTS: Aggregated mortality data. MAIN OUTCOME MEASURES: Data from 35 countries during the period from 1979 to 2007 were used to analyze the association of suicide rates with autopsy rates and death rates of undetermined and ill-defined causes, respectively. Analyses were cross-sectional and longitudinal. RESULTS: Cross-sectionally, a 1% difference in autopsy rates among nations was associated with a suicide rate difference of 0.49 per 100 000 population. Longitudinally, a 1% decrease in the autopsy rate aligned with a decrease of 0.42 per 100 000 population in the suicide rate. These cross-sectional and longitudinal associations were robust after adjustment for unemployment, degree of urbanization, and prevalence of undetermined or ill-defined deaths. Associations strengthened when analyses were confined to 19 European Union member countries. CONCLUSION: Autopsy rates may spatially and temporally affect the validity of suicide mortality statistics. Caution should be exercised in comparing international suicide rates and evaluating interventions that target suicide rate reduction.

Language: en