Autor:innen:
A. Clement (Kingston, Ontario, CA)
K. Abdulla (Frankfurt am Main, DE)
A. Elsner (Leipzig, DE)
H. Reich de Paredes (Frankfurt am Main, DE)
A. Czaplicki (Frankfurt am Main, DE)
R. Gusmão (Porto, PT)
U. Hegerl (Frankfurt am Main, DE)
U. Hegerl (Frankfurt am Main, DE)
Introduction: Anti-suicide campaigns and policies need evaluation for their effectiveness. A common outcome for assessing anti-suicide activities is the rate of completed suicides. However, suicide deaths are often misclassified as deaths of undetermined cause, masking the effects of anti-suicide interventions. Our aim was to compare the rates of suicide deaths (SD) to undetermined deaths (UD) in Germany to understand how they are related.
Method: Death registration data for German inhabitants, aged 15 years and older, were obtained from the Federal Health Monitoring website for the period of 1991 to 2020. Age-standardized rates were calculated for SDs and UDs. Rate ratios were found by dividing the UD rate by the SD rate. A time-series analysis was then applied to detect structural changes (i.e., breakpoints).
Results: Three breakpoints in years 1997, 2010, and 2016 were identified (Chow test, F = 9.27, p < 0.05). The mean (M) and standard deviation (SD) of the rate ratios within the four time segments were 1991 to 1997: M=0.15, SD=0.013; 1998 to 2010: M=0.21, SD=0.012; 2011 to 2016: M=0.13, SD=0.020; and 2017 to 2020: M=0.18, SD= 0.015. Similar results were found when rate ratios for males and females were separated.
Discussion: Unlike the rate of SDs, which declined over the study period, the rate ratio did not follow a general linear trend. The 1997 breakpoint can be attributed to the 1998 adoption of the International Classification of Diseases (Tenth Revision), which impacted death registration procedures. We suggest that the 2010 breakpoint was affected by the suicide death of a famous German professional footballer in 2009 (Robert Enke). It is possible that the publicity surrounding his death led to reduced stigma and increased recognition of SDs.
Conclusion: By using the rate ratio of UDs compared to SDs, suicide statistics can be better understood. Researchers should consider measuring UDs in conjunction with SDs when evaluating anti-suicide activities.