Race/ethnicity and potential suicide misclassification: window on a minority suicide paradox?

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Title Race/ethnicity and potential suicide misclassification: window on a minority suicide paradox?
Author Rockett, Ian R H; Wang, Shuhui; Stack, Steven; De Leo, Diego; Frost, James L; Ducatman, Alan M; Walker, Rheeda L; Kapusta, Nestor D
Journal Name BMC Psychiatry
Year Published 2010
Place of publication United Kingdom
Publisher BioMed Central Ltd.
Abstract Background: Suicide officially kills approximately 30,000 annually in the United States. Analysis of this leading public health problem is complicated by undercounting. Despite persisting socioeconomic and health disparities, non- Hispanic Blacks and Hispanics register suicide rates less than half that of non-Hispanic Whites. Methods: This cross-sectional study uses multiple cause-of-death data from the US National Center for Health Statistics to assess whether race/ethnicity, psychiatric comorbidity documentation, and other decedent characteristics were associated with differential potential for suicide misclassification. Subjects were 105,946 White, Black, and Hispanic residents aged 15 years and older, dying in the US between 2003 and 2005, whose manner of death was recorded as suicide or injury of undetermined intent. The main outcome measure was the relative odds of potential suicide misclassification, a binary measure of manner of death: injury of undetermined intent (includes misclassified suicides) versus suicide. Results: Blacks (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 2.22-2.57) and Hispanics (1.17, 1.07-1.28) manifested excess potential suicide misclassification relative to Whites. Decedents aged 35-54 (AOR, 0.88; 95% CI, 0.84- 0.93), 55-74 (0.52, 0.49-0.57), and 75+ years (0.51, 0.46-0.57) showed diminished misclassification potential relative to decedents aged 15-34, while decedents with 0-8 years (1.82, 1.75-1.90) and 9-12 years of education (1.43, 1.40-1.46) showed excess potential relative to the most educated (13+ years). Excess potential suicide misclassification was also apparent for decedents without (AOR, 3.12; 95% CI, 2.78-3.51) versus those with psychiatric comorbidity documented on their death certificates, and for decedents whose mode of injury was "less active" (46.33; 43.32-49.55) versus "more active." Conclusions: Data disparities might explain much of the Black-White suicide rate gap, if not the Hispanic-White gap. Ameliorative action would extend from training in death certification to routine use of psychological autopsies in equivocal-manner-of-death cases.
Peer Reviewed Yes
Published Yes
Alternative URI http://dx.doi.org/10.1186/1471-244X-10-35
Copyright Statement Copyright 2010 Rockett, et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Volume 10
Issue Number 35
Page from 1
Page to 8
ISSN 1471-244X
Date Accessioned 2010-12-24
Date Available 2011-01-31T05:54:07Z
Language en_AU
Comments Page numbers are not for citation purposes. Instead, this article has the unique article number of 10:35.
Research Centre Australian Institute for Suicide Research and Prevention
Faculty Griffith Health Faculty
Subject Clinical Sciences
URI http://hdl.handle.net/10072/35735
Publication Type Journal Articles (Refereed Article)
Publication Type Code c1

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