Study suggests suicide rates are higher than reported

The number of suicides in Canada may be under- reported by as much as 40 per cent in some provinces, obscuring the true extent of mental health’s most dire problem, suggests a new study.

Researchers in Montreal theorized that deaths due to injuries of “undetermined intent” are often cases of people killing themselves, but the true circumstances are unclear, or hidden by embarrassed family members.

Adding those deaths to the official suicide totals produced large increases in the suicide stats in some jurisdictions.

Exactly how many of those undetermined deaths were self- inflicted is an open question, the researchers conceded. But the findings at least raise the possibility that the breadth of Canada’s suicide problem is being substantially minimized.

“We monitor rates of suicide, they have been going down,” said Dr. Nathalie Auger, a physician and epidemiologist at the University of Montreal. “It’s a positive thing. But it may not be true.”

In Britain, suicide statistics routinely include injuries and poisonings of undetermined intent, the assumption being they were likely suicide, according to the Office for National Statistics.

It is important to have a clear picture of the most serious consequence of mental illness to help guide prevention programs, said Auger.

The premise of the research seems to be supported by British studies that concluded people whose deaths were undetermined had a similar psychiatric profile to those who killed themselves, said Dr. Alain Lesage, a psychiatry professor at the University of Montreal.

Statistics Canada and the Public Health Agency of Canada should follow Britain’s lead and include undetermined- intent deaths when they publicly report on suicide trends, he urged.

“You may have the impression that the suicide rates are increasing or decreasing or stabilizing, and maybe the undetermined deaths ratio has changed, and blurred the picture,” said the Canadian Psychiatric Association spokesman, who was not involved in the new study.

He noted that Canada lacks a national suicide- prevention strategy.

Representatives of provincial coroners’ offices said Monday some suicides are likely being missed because of insufficient evidence, but voiced doubt that under- reporting, or families hiding the truth, is widespread.

“Do they potentially not disclose a note or whatever, do I think that’s possible? Yeah, because it has such a powerful social impact,” said Dr. Reuven Jhirad, a deputy chief coroner of Ontario. “( But) I certainly don’t think it’s of significance in our numbers.”

Auger and colleagues at the University of Montreal research centre used a study that tracked mortality in a 15 per cent sample of the adult Canadian population in 1991- 2001.

Just over 3,300 of the deaths were classified in official databases as suicide, but another 702 were considered of undetermined intent.

Adding those to the suicide totals in each province produced increases of as little as 10 per cent — for male suicides in New Brunswick — to as high as 40 per cent for female suicides in the same province and 37 per cent for women in Manitoba.

Auger argues that under- reporting may be because fewer autopsies are being performed, as the rate of drug overdoses and other types of poisonings seems to be on the rise.

But even when an autopsy is not conducted and poisoning is suspected, investigators will perform toxicology tests, said Barbara McLintock of the B. C. Coroner’s Service.

A physical autopsy will not illuminate someone’s intent: whether they took a lethal dose of morphine tablets to treat unbearable physical pain, or to kill themselves, said McLintock.

Given the stigma, and practical issues such as life insurance, it would be unfair to label someone’s death a suicide if there was any doubt, said Jhirad.

“Using the word suicide obviously has huge societal implications,” he said. “That is not how we make our decision, ( but) it is an important thing that can have an impact.”

He said there may have been more unreported suicides until a few years ago as a result of a 1992 court case that overturned an Ontario coroner’s jury ruling the shooting death of a jockey was suicide. The man’s widow believed he had been murdered.

The stringent burden of proof imposed on death decisions by that ruling was reversed by another court decision in 2009, said Jhirad.