some critical methodological issues in secondary analysis of world health organization data on elderly suicide rates

Background: Suicides may be misclassified as accidental deaths in countries with strict legal definitions of suicide, with cultural and religious factors leading to poor registration of suicide and stigma attached to suicide. Methods: The concordance between four different definitions of suicides was evaluated by examining the relationship between pure suicide and accidental death rates, gender differences, age-associated trends and potential distil risk and protective factors by conducting secondary analysis of the latest World Health Organisation data on elderly death rates. The four definitions of suicide were: (i) one-year pure suicides rates; one-year combined suicide rates (pure suicide rates combined with accidental death rates); (iii) five-year average pure suicide rates; and (iv) five-year average combined suicides rates (pure suicides rates combined with accidental death rates). Results: The predicted negative correlation between pure suicide and accidental death rates was not observed. Gender differences were similar for all four definitions of suicide. There was a highly significant concordance for the findings of age-associated trends between one-year pure and combined suicide rates, one-year and five-year average pure suicide rates, and five-year average pure and combined suicide rates. There was poor concordance between pure and combined suicide rates for both one-year and five-year average data for the 14 potential distil risk and protective factors, but this concordance between one-year and five-year average pure suicide rates was highly significant. Conclusions: The use of one-year pure suicide rates in cross-national ecological studies examining gender differences, age-associated trends and potential distil risk and protective factors is likely to be practical, pragmatic and resource-efficient.