Suicide: who's counting?

A study of suicide certifications explored their accuracy in the light of the difficulties inherent in the certification of death. The primary question addressed was whether the variation in reported suicide rates was significantly related to the structure, function, and procedures of coroners' offices, in comparison with traditional social aspects of the community, such as demographic factors, socioeconomic status, and residential mobility. A stratified sample of 202 counties in the 11 continental western States was selected, and data on coroners' offices were obtained from 191 of these counties. These data were analyzed by means of weighted least squares, which separately related coroner's office variables and community variables to indirectly age-standardized suicide rates. Data for counties with populations of 30,000 or more and those with less than 30,000 were also separately analyzed. Assessment of the multiple regression analyses suggests that the coroner's office variables compare favorably with the community variables in predicting suicide rates, provided a distinction is made between large and small counties. The coroner's office variables in counties with 30,000 or more population explained 37 percent of the variation in reported suicide rates, whereas the community characteristics explained 41 percent. In the counties with less than 30,000 coroner's office variables explained 24 percent of the variation, while community variables explained 13 percent. In the more populous counties, the characteristics of the coroners most predictive of the suicide rates were a nonrejecting attitude toward suicide, an interest in the personal aspects of the deceased, and concern with the physical circumstances of the death. In the less populous counties, the variables most predictive of the suicide rates were related to the physical aspects of the death.