Validity of suicide statistics in Europe in relation to undetermined deaths: developing the 2-20 benchmark

Värnik, Peeter; Sisask, Merike; Värnik, Airi; Arensman, Ella; Audenhove, Chantal Van; Feltz-Cornelis, Christina M. van der; Hegerl, Ulrich

doi:10.1136/injuryprev-2011-040070

Cited by 61 publications

(48 citation statements)

References 34 publications

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“…Death attributed to suicide, injury or unknown cause was reported for 28 participants in the efavirenz group and 7 in the efavirenz-free group. Suicide is sometimes misclassified as accidental death or unknown cause, and could have been underreported (36, 37). …”

Section: Discussionmentioning

confidence: 99%

Association Between Efavirenz as Initial Therapy for HIV-1 Infection and Increased Risk for Suicidal Ideation or Attempted or Completed Suicide

Mollan¹,

Smurzynski²,

Eron³

et al. 2014

Ann Intern Med

181

128

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Background The relationship between efavirenz use and suicidality is not well defined. Objective Compare time to suicidality with efavirenz-containing versus efavirenz-free antiretroviral regimens for initial treatment of HIV. Design Participant-level data were analyzed from four AIDS Clinical Trials Group (ACTG) antiretroviral-naïve studies conducted from 2001 to 2010. Within each study, participants were randomly assigned to an efavirenz-containing (n=3241) or efavirenz-free regimen (n=2091). Setting ACTG sites; 74% enrolled in the United States. Patients Antiretroviral-naïve participants. Intervention Efavirenz versus efavirenz-free regimens. Measurements Suicidality was defined as suicidal ideation, attempted or completed suicide. Groups were compared with a hazard ratio (HR) and 95% confidence interval (CI) estimated from a Cox model stratified by study. Results 73% were men, median age was 37 years; 32% had documented psychiatric history or received psychoactive medication within 30 days prior to study entry. Median follow-up was 96 weeks. Suicidality incidence per 1000 person-years was 8.08 (47 events) in the efavirenz group and 3.66 (15 events) in the efavirenz-free group, HR: 2.28 (95% CI: 1.27 to 4.10, p=0.006). Incidence of attempted or completed suicide was 2.90 (17 events) and 1.22 (5 events) in the efavirenz and efavirenz-free groups, respectively, HR: 2.58 (95% CI: 0.94 to 7.06, p=0.065). Eight suicide deaths in the efavirenz group and one in the efavirenz-free group were reported. Limitations There was not a standardized questionnaire regarding suicidal ideation or attempt. Efavirenz was open-label in three of four studies. Conclusions Initial treatment with an efavirenz-containing antiretroviral regimen was associated with a two-fold increased hazard of suicidality compared to a regimen without efavirenz.

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Section: Discussionmentioning

confidence: 99%

Association Between Efavirenz as Initial Therapy for HIV-1 Infection and Increased Risk for Suicidal Ideation or Attempted or Completed Suicide

Mollan¹,

Smurzynski²,

Eron³

et al. 2014

Ann Intern Med

181

128

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“…This can possibly be explainable by the lack of precision of suicide register and over-estimation of undetermined violent deaths concealing suicides [41], [59]. The small populations of both Luxembourg and Iceland and therefore the small numbers of suicides recorded, probably accounts for the lack of any relationship with high antidepressant utilization.…”

Section: Discussionmentioning

confidence: 99%

Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study

et al. 2013

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BackgroundResearch concerning the association between use of antidepressants and incidence of suicide has yielded inconsistent results and is the subject of considerable controversy. The first aim is to describe trends in the use of antidepressants and rates of suicide in Europe, adjusted for gross domestic product, alcohol consumption, unemployment, and divorce. The second aim is to explore if any observed reduction in the rate of suicide in different European countries preceded the trend for increased use of antidepressants.MethodsData were obtained for 29 European countries between 1980 and 2009. Pearson correlations were used to explore the direction and magnitude of associations. Generalized linear mixed models and Poisson regression distribution were used to clarify the effects of antidepressants on suicide rates, while an autoregressive adjusted model was used to test the interaction between antidepressant utilization and suicide over two time periods: 1980–1994 and 1995–2009.FindingsAn inverse correlation was observed in all countries between recorded Standardised Death Rate (SDR) for suicide and antidepressant Defined Daily Dosage (DDD), with the exception of Portugal. Variability was marked in the association between suicide and alcohol, unemployment and divorce, with countries depicting either a positive or a negative correlation with the SDR for suicide. Every unit increase in DDD of an antidepressant per 1000 people per day, adjusted for these confounding factors, reduces the SDR by 0.088. The correlation between DDD and suicide related SDR was negative in both time periods considered, albeit more pronounced between 1980 and 1994.ConclusionsSuicide rates have tended to decrease more in European countries where there has been a greater increase in the use of antidepressants. These findings underline the importance of the appropriate use of antidepressants as part of routine care for people diagnosed with depression, therefore reducing the risk of suicide.

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“…The UK to our knowledge is the only country that routinely includes injury deaths of undetermined intent in suicide statistics 3 16. In Taiwan, researchers included injuries of undetermined intent in a study of leading methods of suicide, to avoid bias in under-reporting between regions 17.…”

Section: Discussionmentioning

confidence: 99%

“…In Taiwan, researchers included injuries of undetermined intent in a study of leading methods of suicide, to avoid bias in under-reporting between regions 17. Other research has focused on how suicide misclassification affects international comparisons, especially in Western countries 3 8 13. Interestingly, Islamic countries that proscribe suicide may inordinately misclassify cases as injuries of undetermined intent 18.…”

Section: Discussionmentioning

confidence: 99%

Suicide in Canada: impact of injuries with undetermined intent on regional rankings

Auger¹,

Burrows

Gamache

et al. 2015

Inj Prev

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The impact of underreporting or misclassifying suicides as injuries with undetermined intent is rarely evaluated. We assessed whether undetermined injury deaths influenced provincial rankings of suicide in Canada, using 2 735 152 Canadians followed for mortality from 1991 to 2001. We found that suicide rates increased by up to 26.5% for men and 37.7% for women after including injuries with undetermined intent, shifting provincial rankings of suicide. Attention to the stigma of suicide and to coding suicides as injuries with undetermined intent is merited for surveillance and prevention.

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Validity of suicide statistics in Europe in relation to undetermined deaths: developing the 2-20 benchmark

Abstract: This study used the developed '2-20 benchmark' in Europe to assess suicide registration quality in a particular country, to compare the relative position of countries, and to set a target for those European countries that have not yet achieved the benchmark.

Cited by 61 publications

References 34 publications

Association Between Efavirenz as Initial Therapy for HIV-1 Infection and Increased Risk for Suicidal Ideation or Attempted or Completed Suicide

Association Between Efavirenz as Initial Therapy for HIV-1 Infection and Increased Risk for Suicidal Ideation or Attempted or Completed Suicide

Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study

Suicide in Canada: impact of injuries with undetermined intent on regional rankings

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