Fewer autopsies distorts suicide statistics

Vienna (7th September 2011) - In Austria, the number of autopsies carried out has fallen over the past 20 years from 35 per cent to 17 per cent. "The reduced number of autopsies is reducing the quality of the official suicide statistics", says Nestor Kapusta from the University Department of Psychoanalysis and Psychotherapy. This is also demonstrated by a study led by Kapusta involving data from 35 countries taken from suicide statistics and which has just been published in the renowned US journal "Archives of General Psychiatry".

In Austria, 1,300 people a year commit suicide, which is twice as many as the number of people killed in road traffic accidents. The number of unreported cases could be higher, however, since the quality of the suicide statistics is diminishing. Researchers at the MedUni Vienna are therefore - on the occasion of World Suicide Prevention Day on 10th September 2011 - raising the alarm and asking for the "urgent preservation of the high quality of Austrian cause of death statistics and therefore also suicide statistics".

High autopsy rate, higher suicide rate
From a statistical perspective, a total of 2,139 people died in Austria from suicide 25 years ago, compared with 1,261 in 2010. Although this reduction in suicides can be attributed to the prevention work carried out since then, such as the development of the psycho-social system and greater numbers of support organisations, the results of the study suggest that the number of unreported cases is on the rise. Says Kapusta: "In countries with high autopsy rates, such as in the Baltic States or in Hungary, the suicide rate is higher than in countries with lower autopsy rates. Countries in which autopsy rates are falling are also increasingly seeing fewer recorded suicides.”

The results of the study represent a plea for more autopsies. "In an international comparison, Austria has always had an excellent quality of mortality statistics, but causes of death are being recorded with less and less detail. In older people especially, autopsies are now virtually never carried out. This concerns not only suicides, but also all causes of death. The United States has already warned of this development. There, national suicide statistics are already questionably low, with there appearing to be an epidemic of poisoning with unclear intention, which really cannot be trusted."

This raises the question of how long one might still be able to trust the official suicide statistics at all, says the suicide researcher, who is also a board member of the Austrian Society for Suicide Prevention and the "Wiener Werkstätte für Suizidforschung" organisation. This is because only high-quality baseline data enables demand-orientated healthcare planning to be established or prevention programmes to be evaluated from a reliable scientific perspective.

"This applies not only to our sphere of activity. It's important for medicine as a whole, and in particular for health promotion and preventive research."

National suicide prevention programme
Austria is in the process of developing a national suicide prevention programme, inspired by other such programmes around the world. On 8th July 2011, the resolution was passed unanimously in parliament. Says Kapusta: "The right coordination between existing national resources and scientific knowledge has been needed and desirable for a long time now." The programme aims to create an extensive and permanent initiative for the prevention of suicide. Nestor Kapusta, along with Thomas Niederkrotenthaler and Gernot Sonneck from the MedUni Vienna, is playing a key role in the development of the programme by the Ministry of Health.

Service: Archives of General Psychiatry
» Nestor D. Kapusta; Ulrich S. Tran; Ian R. H. Rockett; Diego De Leo; Charles P. E. Naylor; Thomas Niederkrotenthaler; Martin Voracek; Elmar Etzersdorfer; Gernot Sonneck: “Declining Autopsy Rates and Suicide Misclassification”, A Cross-national Analysis of 35 Countries; Arch Gen Psychiatry. Published online June 6, 2011. doi:10.1001/archgenpsychiatry.2011.66.