Abstract
:Background:Suicides may be misclassified as accidental deaths in countries with strict legal definitions of suicide, with cultural and religious factors leading to poor registration of suicide and stigma attached to suicide.Methods:The concordance between four different definitions of suicides was evaluated by examining the relationship between pure suicide and accidental death rates, gender differences, age-associated trends and potential distil risk and protective factors by conducting secondary analysis of the latest World Health Organisation data on elderly death rates. The four definitions of suicide were: (i) one-year pure suicides rates; one-year combined suicide rates (pure suicide rates combined with accidental death rates); (iii) five-year average pure suicide rates; and (iv) five-year average combined suicides rates (pure suicides rates combined with accidental death rates).Results:The predicted negative correlation between pure suicide and accidental death rates was not observed. Gender differences were similar for all four definitions of suicide. There was a highly significant concordance for the findings of age-associated trends between one-year pure and combined suicide rates, one-year and five-year average pure suicide rates, and five-year average pure and combined suicide rates. There was poor concordance between pure and combined suicide rates for both one-year and five-year average data for the 14 potential distil risk and protective factors, but this concordance between one-year and five-year average pure suicide rates was highly significant.Conclusions:The use of one-year pure suicide rates in cross-national ecological studies examining gender differences, age-associated trends and potential distil risk and protective factors is likely to be practical, pragmatic and resource-efficient.
Highlights
There was a positive correlation in females aged 65-74 years between five-year average pure suicide rates and five-year average accidental death rates; this was not observed in females aged 75+ years (N=60)
The “a priori” study hypothesis that there will be a negative correlation between pure suicide rates and accidental rates was rejected because there was an absence of statistically significant negative correlation between (i) one-year pure suicide rates and one-year accidental death rates and (ii) five-year average pure suicide rates and five-year accidental death rates in both sexes in both the elderly age-bands
It is possible that this hypothesis may be true in individual countries which use strict legal definitions for suicide, with cultural and religious factors leading to poor registration of suicides and stigma attached to suicide
Summary
C ross-national and single-country studies with an ecological design have conducted secondary analysis of data from the World Health Organization (WHO) on elderly suicide rates to examine age-associated trends,[1,2] time trends2,3 and potential distil protective and risk factors.[4,5] findings from cross-national ecological studies should be viewed cautiously because: data are not available from all countries; 6,7 the validity of this data is unclear;[7,8] the legal criteria for the proof of suicide vary between countries and in different regions within a country;[7,9] some countries have poor death registration facilities;[9] and, cultural and religious factors and stigma attached to suicide may lead to underreporting of suicides.[7,10] In countries with a strict legal definition of suicides, some possible suicides may be misclassified as accidental deaths. In countries with cultural and religious factors leading to poor registration of suicide and stigma attached to suicide, suicides may be misclassified as accidental deaths If either or both of these scenarios are true there would be a negative correlation between rates of pure suicide and accidental deaths. Methods: The concordance between four different definitions of suicides was evaluated by examining the relationship between pure suicide and accidental death rates, gender differences, age-associated trends and potential distil risk and protective factors by conducting secondary analysis of the latest World Health Organization data on elderly death rates. Conclusions: The use of one-year pure suicide rates in cross-national ecological studies examining gender differences, age-associated trends and potential distil risk and protective factors is likely to be practical, pragmatic and resource-efficient
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