Team Uncovers Discrepancy In Death Certificates Listing Suicide

Main Category: Psychology / Psychiatry
Also Included In: Depression;  Mental Health;  Public Health
Article Date: 15 Apr 2009 - 4:00 PDT

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Even though suicide outranks homicide as a cause of death in the United States, incomplete death certificates thwart healthcare policymakers who want to create prevention strategies especially for black and Hispanic populations, a WVU study shows.

"The Institute of Medicine has documented that half of people who commit suicide have been diagnosed with a mental disorder, but death certificates register little of this history," said lead researcher Ian Rockett, Ph.D., professor of epidemiology and associate chair of the WVU Department of Community Medicine. "Less than 10 percent of people who committed suicide had a record of mental disorder on their death certificates. It's a major gap."

The study is published in the online British medical journal BMC Psychiatry. Suicide is the 11th leading cause of death, according to the National Institute of Mental Heath. Estimates are that 25 people attempt suicide for every one who carries out the act.

"Death certificates are vital to an understanding of suicide, because they provide frontline data in terms of suicide surveillance," Rockett said. "We need detailed and accurate information to help get our high suicide rates down. To help us plan and provide treatment, researchers need to know about medical conditions such as depression and what medications people were taking. We can't track this when reporting is casual, sloppy or nonexistent."

This is the first study of suicide to find discrepancies involving minorities in the reporting of contributing health conditions on death certificates. Blacks and Hispanics are much less likely to have recorded on their death certificates any mention of depression or other health problems. The gap is largest among males, with white males twice as likely as their minority counterparts to have their current health problems enumerated.

In analyzing data from more than 140,000 death certificates listing suicide from 1999 to 2003, released by the National Center for Health Statistics, the WVU team found that many requested items on the certificates were left blank. "Death certificates are standardized, but they're not picking up all the information that needs to be collected," he said.

During the review period, the suicide rate in the United States was almost double the homicide rate.

Inaccuracies in death certificates also may signal that many suicide deaths are misclassified as something else. "Suicides are underreported there's widespread agreement on that," Rockett said. "I'm very concerned about underreporting. I'm also concerned there may be a treatment gap that people at risk of suicide are not receiving appropriate treatment."

The study also reported that being HIV positive previously considered a risk factor for suicide in fact shows no association. This finding held true for all groups in the study. Rockett said, "This finding indicates that minorities as well as whites may be receiving antiretroviral therapy when needed."

Source: West Virginia University Health Sciences Center

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