Neeleman J, Wessely S
Institute of Psychiatry, London.
Psychol Med. 1997 Mar;27(2):467-72. doi: 10.1017/s0033291796004631.
The legal definition of suicide in England and Wales (E & W) gives rise to a high proportion of open verdicts and an underestimated suicide rate. We examined whether the ratio between open and suicide verdicts in E & W has changed between 1974 and 1991 and whether it varies according to coroners' qualifications.
Temporal changes of the ratio of open and suicide verdicts were examined using logistic regression adjusting for confounders such as changing age and gender distributions of suicide victims and the methods they use.
Adjusted for age at death and suicide method, the ratio between open and suicide verdicts had, over successive 3-year time periods, increased with a factor 1.21 (95% CI 1.20-1.23) for male and 1.15 (95% CI 1.14-1.17) for female deaths. Medical coroners were 1.25 (1.08-1.44) times more likely than non-medical coroners to return open rather than suicide verdicts.
As a likely result of factors in the death registration system, the ratio between open and suicide verdicts has increased substantially in E & W since the early 70s. In 1990 it was higher than in any other comparable country. This has important implications for comparisons of time trends in suicide between E & W and other countries.
英格兰和威尔士（E&W）对自杀的法律定义导致了大量死因不明的裁决以及被低估的自杀率。我们研究了1974年至1991年间E&W地区死因不明裁决与自杀裁决的比例是否发生了变化，以及它是否因验尸官的资质不同而有所差异。
使用逻辑回归分析来研究死因不明裁决与自杀裁决比例的时间变化，并对诸如自杀受害者年龄和性别分布变化以及他们所采用的自杀方式等混杂因素进行了调整。
在对死亡年龄和自杀方式进行调整后，在连续的3年时间段内，男性死亡的死因不明裁决与自杀裁决的比例以1.21的系数增长（95%置信区间为1.20 - 1.23），女性死亡的该比例以1.15的系数增长（95%置信区间为1.14 - 1.17）。医学验尸官做出死因不明裁决而非自杀裁决的可能性是非医学验尸官的1.25倍（1.08 - 1.44）。
作为死亡登记系统中各种因素的一个可能结果，自70年代初以来，E&W地区死因不明裁决与自杀裁决的比例大幅上升。1990年，该比例高于任何其他可比国家。这对于E&W与其他国家之间自杀时间趋势的比较具有重要意义。
