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The accuracy of suicide statistics: are true suicide deaths misclassified?

Abstract

Purpose

Official suicide statistics often produce an inaccurate view of suicide populations, since some deaths endorsed as being of uncertain manner are in fact suicides; it is common, therefore, in suicide research, to account for these deaths. We aimed to test the hypothesis that non-suicide death categories contain a large potential reservoir of misclassified suicides.

Methods

Data on undetermined intent and ill-defined death causes, and official suicide deaths recorded in the district of Tel Aviv for the years 2005 and 2008 were extracted. Based on supplementary data, cases regarded as probable suicides (“suicide probable”) were then compared with official suicides (“suicide verdicts”) on a number of socio-demographic variables, and also in relation to the mechanism of death.

Results

Suicide rates were 42 % higher than those officially reported after accounting for 75 probable suicides (erroneously certified under other cause-of-death categories). Both death classifications (“suicide probable” and “suicide verdicts”) had many similarities, significantly differing only with respect to method used. Logistic regression confirmed that the most powerful discriminator was whether the mechanism of death was considered “less active” or “more active” (p < 0.001). Indeed, deaths among the less active group were 4.9 times as likely to be classified as “suicide probable” than were deaths among the more active group.

Conclusions

Caution is needed when interpreting local area data on suicide rates, and undetermined and ill-defined deaths should be included in suicide research after excluding cases unlikely to be suicides. Improving suicide case ascertainment, using multiple sources of information, and uniform reporting practices, is advised.

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Acknowledgments

We thank the following five organizations for supplying mortality data and for their most helpful cooperation: the regional Health Department of Tel Aviv, the Central Bureau of Statistics (CBS), the Israel Police (adolescents division and district of Tel Aviv), the National Institute of Forensic Medicine, Abu Kabir, and the Ministry of Health’s information division. This research was supported and funded by the national suicide prevention committee. Contents are solely the responsibility of the authors.

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Correspondence to Shelly S. Bakst.

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Bakst, S.S., Braun, T., Zucker, I. et al. The accuracy of suicide statistics: are true suicide deaths misclassified?. Soc Psychiatry Psychiatr Epidemiol 51, 115–123 (2016). https://doi.org/10.1007/s00127-015-1119-x

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  • DOI: https://doi.org/10.1007/s00127-015-1119-x

Keywords

  • Suicide under-enumeration
  • Suicide statistics
  • Epidemiology of suicide
  • Suicide validity