The Disease Burden of Suicide: Conceptual Challenges and Measurement Standards

Abstract:

Suicide was among the first public health issues to be studied at a population level, and the field has a research tradition that now spans 110 years. Yet, despite 8 decades of research documenting their inherent error, suicide rates remain the most widely used population-based suicide metric today. Health expectancy and health gap measures have begun to replace disease rates in population health studies, but a number of conceptual and methodological challenges still need to be addressed when adapting these new tools to suicide research. A prerequisite to the use of any suicide measure is the need to define clearly what is being measured. The International Classification of Disease Manuals categorize suicidal acts as one type of injury event, suggesting that, like other injuries, these events are most often singular, largely unpredictable events. However, suicidal behavior is often preceded by functional decline and often follows a chronic, recurrent course – bearing more resemblance to a disease process than to an injury event. Next, both case definitions and procedures to correct for the error inherent in suicide data vary widely, highlighting the need to establish measurement standards. Because any burden study is only as valid as the disease concepts and measurement approaches upon which it is based, refinement of methodology will be necessary in order to achieve maximal benefit when applying the newer population summary statistics to suicide.