A study of suicides in Kildare, 1995–2002

A systematic review of validated suicide outcome classification in observational studies

BACKGROUND

Suicidal outcomes, including ideation, attempt, and completed suicide, are an important drug safety issue, though few epidemiological studies address the accuracy of suicidal outcome ascertainment. Our primary objective was to evaluate validated methods for suicidal outcome classification in electronic health care database studies.

METHODS

We performed a systematic review of PubMed and EMBASE to identify studies that validated methods for suicidal outcome classification published 1 January 1990 to 15 March 2016. Abstracts and full texts were screened by two reviewers using prespecified criteria. Sensitivity, specificity, and predictive value for suicidal outcomes were extracted by two reviewers. Methods followed PRISMA-P guidelines, PROSPERO Protocol: 2016: CRD42016042794.

RESULTS

We identified 2202 citations, of which 34 validated the accuracy of measuring suicidal outcomes using International Classification of Diseases (ICD) codes or algorithms, chart review or vital records. ICD E-codes (E950-9) for suicide attempt had 2-19% sensitivity, and 83-100% positive predictive value (PPV). ICD algorithms that included events with 'uncertain' intent had 4-70% PPV. The three best-performing algorithms had 74-92% PPV, with improved sensitivity compared with E-codes. Read code algorithms had 14-68% sensitivity and 0-56% PPV. Studies estimated 19-80% sensitivity for chart review, and 41-97% sensitivity and 100% PPV for vital records.

CONCLUSIONS

Pharmacoepidemiological studies measuring suicidal outcomes often use methodologies with poor sensitivity or predictive value or both, which may result in underestimation of associations between drugs and suicidal behaviour. Studies should validate outcomes or use a previously validated algorithm with high PPV and acceptable sensitivity in an appropriate population and data source.

A Study of the Irish System of Recording Suicide Deaths

Background: Many studies have examined the reliability of national suicide statistics. Aims: To examine the Irish system of certifying suicide deaths and data collected by it. Methods: Data were recorded from a police form (Form 104) completed and sent to the Irish Central Statistics Office (CSO) after all inquested deaths that occurred in Ireland in 2002. Results: Of the approximately 1,800 inquested deaths, 6% (and 4% of suicides) were not included in routine mortality statistics because of late registration. Of the 495 deaths thought by the police to be suicide, 485 (98%) were so recorded by the CSO. Information relating to medical history and contributory factors was provided in just 54% and 34% of suicides, respectively. Suicide deaths showed significant variation by weekday (excess on Mondays) and calendar month (summer peak). The peak suicide rate (35 per 100,000) was among men aged 25–34 years. Persons separated, living alone, and unemployed had significantly elevated suicide rates. Conclusions: There is a need for a better understanding of national suicide recording systems, as this study has provided for Ireland. Such systems may routinely provide data relating to sociodemographic factors but not relating to medical and psychosocial factors.

The importance of the frequency of suicide attempts as a risk factor of suicide

The number of suicides in Japan has increased from approximately 22,000 per year in 1988-1997 to over 30,000 per year since then. The number has also increased in Mie Prefecture during this period. According to many reports, suicide attempts are one of the risk factors of suicide. In the present study, we investigated the incidences and circumstances of all suicide cases between 1996 and 2002, focusing in detail on the frequency of suicide attempts and general differences in the frequency of all suicide cases. During the 7 years, 1979 male and 969 female suicides were reported to Mie Prefectural Police Headquarters. During the test period, there were suicide attempts in 13.4% of all suicidal cases, 10.7% for men and 18.9% for women. The average age was 48.98 years (SD 17.68), 47.07 years (SD 16.32) for men, and 51.19 years (SD 18.89) for women. Among men, we discovered the risk factors of suicide attempts in completed suicides, which were "single time" of suicide attempts, "living with family" for the family constitution, and "visiting treatment" of the admission statuses. Among women, the risk factors were "living with family" and "visiting treatment". We must pay attention to those risk factors.

Causative factors as cues for addressing the rapid increase in suicide in Mie Prefecture, Japan: comparison of trends between 1996-2002 and 1989-1995

The number of suicides in Japan has increased from approximately 22 000 per year from 1988 to 1997 to >30 000 per year since 1998. Likewise, the number of suicides has been increasing in Mie Prefecture. The purpose of the present study was to examine the incidence of and circumstances surrounding all suicide cases during 1996-2002 in Mie Prefecture and to compare the data with those from 1989 to 1995. In Mie Prefecture, the age-specific suicide rate during the second 7-year period included marked increases among men aged 50-59 and 60-69 years. Among women, the age-specific suicide rate increased with age during both 7-year periods. During the second period, psychiatric disorders as causative factors increased in all generations. They were especially important for women of the younger generation, whereas economic problems were the most common causative factor among men aged 40-64. Physical illness as a causative factor in suicide was high among the elderly, but among the other age groups this factor trailed behind economic difficulties for men and psychiatric disorders for women. To prevent suicide, social cooperation as well as a plenitude of visiting nurses and psychiatric care is required, and early detection and treatment are also important.