The black–white suicide paradox: Possible effects of misclassification

Rockett, Ian Richard Hildreth; Samora, Julie Balch; Coben, Jeffrey H.

doi:10.1016/j.socscimed.2006.05.017

Cited by 88 publications

(82 citation statements)

References 50 publications

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“…Coroners appear more likely to misclassify suicides when, for example, they have fewer personhours to investigate the case (Douglas 1967;Rockett, Samora, and Coben 2006). This misclassification is largely unidirectional since the risk of ruling a nonsuicide as a suicide appears small (Moyer, Boyle, and Pollock 1989;O'Carroll 1989).…”

Section: Discussionmentioning

confidence: 99%

Does Deinstitutionalization Increase Suicide?

Yoon

Bruckner

2009

Health Services Research

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Objectives. (1) To test whether public psychiatric bed reduction may increase suicide rates; (2) to investigate whether the supply of private hospital psychiatric beds—separately for not‐for‐profit and for‐profit—can substitute for public bed reduction without increasing suicides; and (3) to examine whether the level of community mental health resources moderates the relationship between public bed reduction and suicide rates. Methods. We examined state‐level variation in suicide rates in relation to psychiatric beds and community mental health spending in the United States for the years 1982–1998. We categorize psychiatric beds separately for public, not‐for‐profit, and for‐profit hospitals. Principal Findings. Reduced public psychiatric bed supply was found to increase suicide rates. We found no evidence that not‐for‐profit or for‐profit bed supply compensates for public bed reductions. However, greater community mental health spending buffers the adverse effect of public bed reductions on suicide. We estimate that in 2008, an additional decline in public psychiatric hospital beds would raise suicide rates for almost all states. Conclusions. Downsizing of public inpatient mental health services may increase suicide rates. Nevertheless, an increase in community mental health funding may be promising.

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Section: Discussionmentioning

confidence: 99%

Does Deinstitutionalization Increase Suicide?

Yoon

Bruckner

2009

Health Services Research

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“…Pertinent to data quality, future research will disaggregate suicides to consider the question of whether minority populations manifest similar or divergent patterns of comorbidity from non-Hispanic whites, and by extension from Australian suicides. Confined to underlying cause-of-death data, a computer simulation suggested that suicide among black people is much more prone to underenumeration than suicide among white people 35. If valid, an important contributor could be heterogeneity in documentation of medical histories.…”

Section: Discussionmentioning

confidence: 99%

Suicide-associated comorbidity among US males and females: a multiple cause-of-death analysis

2007

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Objective: To describe physical and mental comorbidity among male and female suicides in the US. This research replicates a seminal Australian study, which permits inference on comparative cause-of-death data quality. Design and setting: National cross-sectional study of suicides and unintentional injury decedents (comparison group) using Multiple Cause of Death (MCOD) public use files for 1999-2003. Main outcome measures: Prevalence of medical conditions; relative odds of suicide-associated comorbidity. Results: For 14% of male suicides and 19% of female suicides, comorbidity was shown on their death certificates. Respective prevalences for mental and physical comorbidity were 7.2% and 7.1% for males and 10.0% and 9.3% for females. Mean numbers of psychopathologies mentioned were virtually identical for male and female suicides (1.22 and 1.21) for whom comorbidity was registered. Mean mentions of physical disease were lower for male suicides: 1.64 vs 1.77. Multiple medical conditions were registered for 4% of male suicides and 6% of female suicides. Suicides manifested excess comorbidity for depression and mood disorders (adjusted odds ratio (AOR) = 34.6, 95% CI = 32.41 to 36.92), schizophrenia (AOR = 2.5, 95% CI = 2.16 to 2.88), and cancer (AOR = 2.1, 95% CI = 1.93 to 2.19), but unexpectedly no excess comorbidity for HIV. Conclusions: The US system of death certification appears to be less fastidious than the Australian system. Although comorbidity patterns were very similar, only half as much psychopathology was reported for US suicides as for Australian suicides. A questionable deficit of comorbid physical disease was also documented for US suicides. Findings have important implications for medical training, as well as for suicide surveillance, policy, and prevention.

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“…There is a sharp disparity in age-related patterns of suicide between Black and White males in American society [Rockett, Samora, & Coben, 2006]. For White males, there is a rise in suicide rates with age, with a sharp increase in later adulthood (beyond age 65).…”

Section: Evidence and Hypothesesmentioning

confidence: 99%