Definition of suicide and the reliability of suicide statistics

Suicidal behaviour or suicidality can be conceptualized as a continuum ranging from suicidal ideation to suicide attempts and completed suicide. A developmental process which leads to suicidal ideation, self-destructive behaviour, in some cases even to suicide, and its consequences to the survivors is often referred to as a suicidal process. There is no single unanimously accepted definition of suicide, although in most proposed definitions it is considered as a fatal act of self-injury (self-harm) undertaken with more or less conscious self-destructive intent, however vague and ambiguous. Since the deceased cannot testify as to his or her intent, the conclusions about this must be drawn by inference. The evidence required for this inference depends on many factors, for example the mode of death, the use of autopsy, age, gender, social and occupational status, and the social stigma of suicide in the person's culture. The assessment of suicide intent is always based on a balance of probabilities.

Besides the conceptual problems, there are differences in operational definitions of suicidal behaviour which may lead to lack of uniformity of case definition and difficulties in comparing suicide statistics. The reliability of suicide statistics is influenced by whether suicide is ascertained by legal officials as in the United Kingdom and Ireland, or by medical examiners as elsewhere in Europe. In general, suicides tend to be undercounted, whereas non-suicidal deaths are very rarely misidentified as suicides. Most misclassified suicides fall into the category of undetermined deaths and are more like suicides than accidents. Underestimation is reasoned to be less than 10 per cent in the more developed countries, which allows rate comparisons between countries and over time. Despite problems in the recording of suicide, reports on suicide rates among different cultures or people suggest a true variation in suicide mortality. (12)

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