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

Abstract

BackgroundSuicide 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.MethodsThis 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.ResultsBlacks (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."ConclusionsData 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.

State-level social capital and suicide mortality in the 50 U.S. states

“…The very low rates of suicide among Blacks are somewhat questionable considering that Blacks suffer from higher rates of depression than Whites and are less likely to receive treatment for their mental health disorders than Whites (Rockett et al, 2010). It is possible that the rates of suicide for women are under-reported because women are more likely to use less violent means than men, and thus their suicides might be easier to classify as accidental or of unknown intent (Rockett et al, 2010). The systematic under-reporting of suicides by racial and ethnic minorities may contribute to the lack of data available for these groups and thus to their exclusion from the majority of this study.…”

“…There is some evidence that suicides among racial minorities (particularly Blacks) have been systematically under-reported for many years (Rockett et al, 2010). The very low rates of suicide among Blacks are somewhat questionable considering that Blacks suffer from higher rates of depression than Whites and are less likely to receive treatment for their mental health disorders than Whites (Rockett et al, 2010). It is possible that the rates of suicide for women are under-reported because women are more likely to use less violent means than men, and thus their suicides might be easier to classify as accidental or of unknown intent (Rockett et al, 2010).…”

“…It has been suggested that suicides among racial minorities (particularly Blacks) and women have been systematically underreported for many years (Rockett et al, 2010). These very low rates of suicide among Blacks are particularly questionable considering that Blacks suffer from higher rates of depression than Whites and are less likely to receive treatment for their mental health disorders than Whites (Rockett et al, 2010).…”

Gender differences in suicide methods

“…Classification of a drug poisoning death as suicide, accidental, or undetermined is controversial inasmuch as it could be a social construction, which perpetuates gendered explanations. For example, recent research suggests potential misclassification of suicides may account for apparent racial and ethnic gaps in suicide [60]. Gender differences, therefore, might attenuate or disappear if the true cause of death is known.…”

A Comparison of Suicides and Undetermined Deaths by Poisoning among Women: An Analysis of the National Violent Death Reporting System

“…Most literature agrees that low-lethality (Shenassa, Catlin, & Buka, 2003) methods (i.e., poisoning) are more common in undetermined deaths (Donaldson, Larsen, Fullerton-Gleason et al, 2006;Lindqvist & Gustafsson, 2002;Ohberg & Lonnqvist, 1998;Rockett, Wang, Stack et al, 2010;Sorenson, Shen, & Kraus, 1997). Men are more likely to be classified as suicide in part because of the high rate of firearm use, which also has a high fatality rate.…”