Window on the Minority Suicide Paradox: A Multiple Cause-of-Death Study

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Meta-analyses and national multiple cause of death (MCOD) analyses have affirmed that comorbid psychopathology and physical disease are suicide determinants. MCOD and psychological autopsy studies indicate that reporting of comorbidity on death certificates of suicides may be more deficient for some demographic groups than others. This study examines that question for US whites, blacks, and Hispanics in order to shed light on a paradox. Contrary to the typical direction of health disparities, the two minorities register suicide rates half those of whites. MCOD public use files for 1999-2003 from the National Center for Health Statistics were accessed to estimate the prevalence of medical conditions among white and minority suicides, and to identify suicide-associated comorbidities through logistic regression analyses. Registered psychopathology among white male suicides is over twice as prevalent as for their two minority counterparts. It is also substantially higher among white female suicides than among minority opposites. With less racial-ethnic divergence, comorbid physical disease patterns follow the same direction as those for psychopathology. Suicide is associated with schizophrenia and mood disorders/ depression in all three groups, and cancer in whites and blacks only. While consistent with less access to health care for blacks and Hispanics than for whites, racial-ethnic gaps in the observed prevalence of comorbidity among suicides are incongruent with self-reported health status. Suicide in the United States is highly prone to underenumeration by medicolegal authorities. However, differential knowledge of actual comorbidity among true suicides could variously influence the respective tipping points where these authorities might misclassify white, black, and Hispanic suicides as nonsuicides. Findings induce skepticism about the magnitude, if not the validity, of the racial-ethnic divide in official suicide rates, and harbor adverse implications for suicide surveillance, etiology, policy, and prevention.

Keywords: Suicide, Validity, Comorbidity, Gender, Race, Ethnicity
Stream: Natural, Environmental and Health Sciences
Presentation Type: Paper Presentation in English
Paper: A paper has not yet been submitted.

Dr Ian R.H. Rockett

Professor of Epidemiology, Department of Community Medicine
Injury Control Research Center, West Virginia University

Morgantown, West Virginia, USA

Ian Rockett is Professor of Epidemiology in the Department of Community Medicine at West Virginia University. He also is affiliated with the CDC-funded Injury Control Research Center. Professor Rockett holds a BA in History from the University of Western Australia, an MA in Sociology from the University of Western Ontario, an MPH in Epidemiology from Harvard University, and a PhD in Demography and Medical Sociology from Brown University. He teaches epidemiology and medical demography. His research projects have included population-based studies on suicide and suicide misclassification, “brain drain”, motor vehicular trauma, occupational cancer, unmet substance abuse treatment need among hospital emergency department patients in relation to health services utilization and cost, and life table simulations assuming elimination or modification of injury and selected diseases as causes of death.

Ref: I08P0088