Rosenberg M L, Davidson L E, Smith J C, Berman A L, Buzbee H, Gantner G, Gay G A, Moore-Lewis B, Mills D H, Murray D
Centers for Disease Control, Atlanta, GA.
J Forensic Sci. 1988 Nov;33(6):1445-56.
Suicide is an important public health problem for which we have an inadequate public health database. In the United States, decisions about whether deaths are listed as suicides on death certificates are usually made by a coroner or medical examiner. These certification decisions are frequently marked by a lack of consistency and clarity, and laws and procedures for guiding these decisions vary from state to state and even from county to county. Without explicit criteria to aid in this decision making, coroners or medical examiners may be more susceptible to pressures from families or communities not to certify specific deaths as suicide. In addition, coroners or medical examiners may certify similar deaths differently at different times. The degree to which suicides may be underreported or misclassified is unknown. This makes it impossible to estimate accurately the number of deaths by suicide, to identify risk factors, or to plan and evaluate preventive interventions. To remedy these problems, a working group representing coroners, medical examiners, statisticians, and public health agencies developed operational criteria to assist in the determination of suicide. These criteria are based on a definition of suicide as "death arising from an act inflicted upon oneself with the intent to kill oneself." The purpose of these criteria is to improve the validity and reliability of suicide statistics by: (1) promoting consistent and uniform classifications; (2) making the criteria for decision making in death certification explicit; (3) increasing the amount of information used in decision making; (4) aiding certifiers in exercising their professional judgment; and (5) establishing common standards of practice for the determination of suicide.
自杀是一个重要的公共卫生问题，但我们现有的公共卫生数据库对此并不完善。在美国，关于死亡证明上的死亡是否被列为自杀的决定通常由验尸官或法医做出。这些认证决定往往缺乏一致性和清晰度，指导这些决定的法律和程序因州而异，甚至因县而异。由于缺乏明确的标准来协助做出这一决定，验尸官或法医可能更容易受到来自家庭或社区的压力，从而不将某些特定死亡认定为自杀。此外，验尸官或法医在不同时间对类似的死亡可能会做出不同的认证。自杀可能被漏报或错误分类的程度尚不清楚。这使得准确估计自杀死亡人数、识别风险因素以及规划和评估预防干预措施变得不可能。为了解决这些问题，一个由验尸官、法医、统计学家和公共卫生机构组成的工作组制定了操作标准，以协助确定自杀。这些标准基于将自杀定义为“因某人故意对自己实施的行为导致的死亡”。这些标准的目的是通过以下方式提高自杀统计数据的有效性和可靠性：（1）促进一致和统一的分类；（2）明确死亡证明决策的标准；（3）增加决策中使用的信息量；（4）协助认证人员行使其专业判断；（5）建立确定自杀的通用实践标准。
