Causes associated with suicide on death certificates. Analysis of medical death certificates, France, 2000–2014

Introduction: The objective of this study was to describe the distribution of mental and non-mental conditions associated with suicide based on medical death certificates. Methods: The analysis focuses on deaths that occurred in France between 2000 and 2014, drawn from the national database of the Center for Epidemiology on Medical Causes of Death (CépiDc-Inserm). Deaths were selected based on certificates containing a suicide code (CD suicide) from the International Classification of Diseases (ICD-10), specifically codes X60 through X84. Results: During the study period, 156,910 suicide deaths among individuals aged 10 years or older were recorded in France, 74% of whom were men. These deaths accounted for 1.9% of all deaths and averaged 10,461 cases per year. According to these death certificates, 40% of suicides were associated with the presence of mental disorders, more often in women than in men (48% vs. 36%). The vast majority of these were depressive disorders (38% in women and 28% in men). These were 41 times more frequently associated with suicides than with other deaths. Suicides among people under the age of 25 accounted for a moderate proportion of total suicides (5.5%), but resulted in a high number of years of life lost. Particularly strong associations were observed with mood disorders and anxiety disorders in this age group. For 16% of suicides, the death certificate indicated the presence of at least one non-mental condition that contributed to the death: the most commonly associated conditions were circulatory system diseases (5% of suicide death certificates), nervous system diseases (4%), and invasive tumors (3%), although the study was unable to identify non-mental health conditions specifically linked to suicides. Conclusion: despite the limitations of medical death certificates in reporting comorbidities, this study explored the information provided by certifying physicians over a 15-year period. It will be interesting to continue this work and expand upon it using data from the medical-administrative databases of the National Health Data System (SNDS), which will allow for the identification of any conditions treated prior to death, thereby mitigating biases in the medical certification of medical conditions that may have contributed to suicide.

Author(s): Ha Catherine, Chan Chee Christine

Publishing year: 2019

Pages: 55-62

Weekly Epidemiological Bulletin, 2019, n° 3-4, p. 55-62

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