neous sub-samples that can be subjected to genetic analyses. Complementary concurrent methods with intense, highly focused ethnography can improve knowledge about setting, process, motivations, and outcome, and thereby increase validity of data.

SURVEILLANCE OF SUICIDE AND SUICIDE ATTEMPTS

To address suicide as a public health problem requires the sustained and systematic collection, analysis and dissemination of accurate information on the incidence, prevalence and characteristics of suicide and suicide attempts. Surveillance is a cornerstone of public health, allowing realistic priority setting, the design of effective prevention initiatives, and the ability to evaluate such programs (IOM, 1999). Official suicide rates have been used to chart trends in suicide; monitor the impact of change in legislation, treatment policies, and social change; and to compare suicides across regions, both within and across countries. In addition, suicide rates have offered a way to assess risk and protective factors for geographical areas (counties, states and countries). However, there exist serious inadequacies in the availability and quality of information. The sources of data that are currently available remain “fragmentary and unlinked” (Berman, 2001). The need for improved and expanded surveillance systems is highlighted as one of the central goals of the National Strategy for Suicide Prevention (PHS, 2001).

Completed Suicide: Sources of Variability in Suicide Statistics

The suicide rate information available on a national level is derived from state vital records systems that collect data from local death certificate registries. States forward the information to the National Center for Health Statistics of the CDC which maintains the National Vital Statistics System (Davies et al., 2001). The utility and accuracy of these data are constrained by the variability in suicides statistics. As described in Chapter 2, there are at least four sources of this variability (Jobes et al., 1987; O’Carroll, 1989), including:

  • regional differences in the definition of suicide and how ambiguous cases are classified

  • regional differences in the requirements and political arrangements for the office of coroner or medical examiner

  • differences in terms of the extent to which cases are investigated

  • variations that have to do with the quality of data management involved in preparing official statistics.



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