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Arch Gen Psychiatry. 2011 Oct;68(10):1050-7. doi: 10.1001/archgenpsychiatry.2011.66. Epub 2011 Jun 6.

Declining autopsy rates and suicide misclassification: a cross-national analysis of 35 countries.

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1
Department for Psychoanalysis and Psychotherapy, Medical University of Vienna, Austria. nestor.kapusta@meduniwien.ac.at

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.

[Indexed for MEDLINE]

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