Relationship between Suicide and Undetermined Causes of Death among the Elderly: Analysis of Italian Data from 1951 to 1988

Abstract

In the aged an accurate estimation of the incidence of suicide may prove difficult. Many suicides may not be recognized insofar as they are carried out with “indirect” methods. It may be even easier to misinterpret causes of death when less violent, “softer” methods are used, as there is little real evidence for correctly interpreting the death. In our work, we analyzed data on causes of death in the Italian over-sixty-five population, with a view to testing the hypothesis of a possible transfer between causes of death, and to analyzing any correlation between suicide and undetermined or unknown causes of death, and any change in suicide methods, from 1958 to 1988. During this period there was a constant increase in the suicide phenomenon among the elderly. Like the findings of other countries, in Italy “soft” methods appeared to show a marked decrease. A marked increase was instead found in “hard” methods and in undetermined causes of mortality. The increase over the years in unclear causes could be due to an increase in the “underreporting” of suicides. By correlating overall suicide rates with rates of unknown causes of death, a clear inverse correlation between the two categories does not emerge. The hypothesis of a possible exchange between suicides and unspecified causes, is only confirmed by our data in the case of “soft” suicide methods. Some categories (such as “soft” suicides) may therefore be underestimated through incorrect attribution of deaths to different diagnostic categories, though the importance of underreporting should be assessed differently, taking into consideration the various suicide methods.