Declining Autopsy Rates and Suicide Misclassification: A Cross-national Analysis of 35 Countries

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Title Declining Autopsy Rates and Suicide Misclassification: A Cross-national Analysis of 35 Countries
Author Kapusta, Nestor D.; Tran, Ulrich S.; Rockett, Ian R. H.; De Leo, Diego; Naylor, Charles P. E.; Niederkrothenthaler, Thomas; Voracek, Martin; Etzersdorfer, Elmar; Sonneck, Gernot
Journal Name Archives of General Psychiatry
Year Published 2011
Place of publication United States
Publisher American Medical Association
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.
Peer Reviewed Yes
Published Yes
Alternative URI http://dx.doi.org/10.1001/archgenpsychiatry.2011.66
Volume 68
Issue Number 10
Page from 1050
Page to 1057
ISSN 1538-3636
Date Accessioned 2011-09-27
Language en_US
Research Centre Australian Institute for Suicide Research and Prevention
Faculty Griffith Health Faculty
Subject Mental Health
URI http://hdl.handle.net/10072/41881
Publication Type Journal Articles (Refereed Article)
Publication Type Code c1

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