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Open Access Highly Accessed Research article

Forty years of increasing suicide mortality in Poland: Undercounting amidst a hanging epidemic?

Peter Höfer1, Ian R H Rockett2, Peeter Värnik3, Elmar Etzersdorfer4 and Nestor D Kapusta5*

Author Affiliations

1 Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

2 Injury Control Research Center and Department of Epidemiology, West Virginia University, West Virginia, USA

3 Estonian-Swedish Mental Health and Suicidology Institute, Estonian Centre of Behavioural and Health Sciences, and Tallinn University, Tallinn, Estonia

4 Furtbach Hospital for Psychiatry and Psychotherapy, Stuttgart, Germany

5 Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria

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BMC Public Health 2012, 12:644  doi:10.1186/1471-2458-12-644

Published: 11 August 2012

Abstract

Background

Suicide rate trends for Poland, one of the most populous countries in Europe, are not well documented. Moreover, the quality of the official Polish suicide statistics is unknown and requires in-depth investigation.

Methods

Population and mortality data disaggregated by sex, age, manner, and cause were obtained from the Polish Central Statistics Office for the period 1970-2009. Suicides and deaths categorized as ‘undetermined injury intent,’ ‘unknown causes,’ and ‘unintentional poisonings’ were analyzed to estimate the reliability and sensitivity of suicide certification in Poland over three periods covered by ICD-8, ICD-9 and ICD-10, respectively. Time trends were assessed by the Spearman test for trend.

Results

The official suicide rate increased by 51.3% in Poland between 1970 and 2009. There was an increasing excess suicide rate for males, culminating in a male-to-female ratio of 7:1. The dominant method, hanging, comprised 90% of all suicides by 2009. Factoring in deaths of undetermined intent only, estimated sensitivity of suicide certification was 77% overall, but lower for females than males. Not increasing linearly with age, the suicide rate peaked at ages 40-54 years.

Conclusion

The suicide rate is increasing in Poland, which calls for a national prevention initiative. Hangings are the predominant suicide method based on official registration. However, suicide among females appears grossly underestimated given their lower estimated sensitivity of suicide certification, greater use of “soft” suicide methods, and the very high 7:1 male-to-female rate ratio. Changes in the ICD classification system resulted in a temporary suicide data blackout in 1980-1982, and significant modifications of the death categories of senility and unknown causes, after 1997, suggest the need for data quality surveillance.

Keywords:
Poland; Suicides; Validity; Misclassification; Reliability; Undetermined Intent