Some critical methodological issues in secondary analysis of world health organization data on elderly suicide rates

Background: suicides may be misclassified as accidental deaths in countries with strict legaldefinitions of suicide, with cultural and religious factors leading to poor registration of suicide andstigma attached to suicide.methods: the concordance between four different definitions of suicides was evaluated byexamining the relationship between pure suicide and accidental death rates, gender differences,age-associated trends and potential distil risk and protective factors by conducting secondaryanalysis of the latest world health organization data on elderly death rates. the four definitionsof suicide were: (i) one-year pure suicides rates; (ii) one-year combined suicide rates (pure suiciderates combined with accidental death rates); (iii) five-year average pure suicide rates; and (iv)five-year average combined suicides rates (pure suicides rates combined with accidental deathrates). results: the predicted negative correlation between pure suicide and accidental death rates was not observed. gender differences were similar for all four definitions of suicide. there was ahighly significant concordance for the findings of age-associated trends between one-year pureand combined suicide rates, one-year and five-year average pure suicide rates, and five-yearaverage pure and combined suicide rates. there was poor concordance between pure andcombined suicide rates for both one-year and five-year average data for the 14 potential distilrisk and protective factors, but this concordance between one-year and five-year average puresuicide rates was highly significant. conclusions: the use of one-year pure suicide rates in cross-national ecological studies examining gender differences, age-associated trends and potential distil risk and protective factors is likely to be practical, pragmatic and resource-efficient.