Suicide and psychiatric diagnosis: a worldwide perspective.

Abstract

The World Health Organization (WHO) compiles and disseminates data on mortality and morbidity reported by its Member States, according to one of its mandates. Since the WHO's inception in 1948, the number of Member States has grown continually and so has the WHO mortality data bank. From 11 countries reporting data on mortality in 1950, the number of countries involved increased to 74 in the year 1985. More than 100 Member States reported on mortality at some point in time. Data from developed countries (mostly in the North of Europe and of America, and a few countries of the Western Pacific Region) are received on a mostly regular basis. Most developing countries (in Latin America, Asia and in the Eastern Mediterranean Region) report on an irregular basis; very few countries in Africa regularly report on mortality to WHO. Deaths associated with suicide are an integral part of the WHO mortality data bank. Throughout consecutive editions of the International Classification of Diseases (ICD-6 to ICD-10), the category name and code of suicide have remained relatively stable. Suicide data are reported in absolute numbers along with the mid-year population of a country. The suicide rates are usually represented by country, year, sex, and age group. The most recent data available to the WHO can be accessed through its web site (www.who.int). The official figures made available to WHO by its Member States are based on death certificates signed by legally authorized personnel, usually doctors and, to a lesser extent, police officers. Generally speaking, these professionals do not misrepresent the information. However, suicide may be hidden and underreported for several reasons, e.g. as a result of prevailing social or religious attitudes. In some places, it is believed that suicide is underreported by a percentage between 20% and 100%. This underlines the importance of bringing about corrections and improvement on a world wide basis. In contrast to data on completed suicide, no country in the world reports to WHO official statistics on attempted suicide (and most probably countries do not collect them), which makes it impossible to relate national trends of suicide to national trends of attempted suicide. In the absence of national data, one is forced to rely on local studies, which vary considerably, for instance in terms of the operational definition of attempted suicide. The WHO/EURO Multicentre Study on Suicidal Behaviour (1) constitutes a major step forward in this area.