|Year : 2014 | Volume
| Issue : 2 | Page : 82-84
Suicide rate computation - Methodological inexactitude
Gopala Sarma Poduri
Consultant Psychiatrist, Department of Psychiatry, Yashoda Super Specialty Hospital, Malakpet, Hyderabad, India
|Date of Web Publication||4-Jul-2017|
Gopala Sarma Poduri
501, Highlight Haveli, Street No.6, Habsiguda, Hyderabad - 500 007
Source of Support: None, Conflict of Interest: None
Introduction: Suicide rates are computed on the basis of whole population without taking into consideration the cognitive capacity of children to appreciate death. This study was undertaken to find out the variability in suicide rate if children of various ages are excluded from computation of suicide rate Method: Suicide rates were computed taking the at risk population of India-above 6 yrs, 7 yrs, 8 yrs, and 9 yrs for the period 1991-2013, suicide data from the National Crimes Bureau statistics on Accidental Deaths and Suicides of Ministry of Home Affairs, Govt. of India. The data was analyzed for percentage increase for various ages. Results: Depending upon the cut-off age the rate increase over a twenty-three year period was from 11.2 to 14.6 and the percent increase was 16.1-33.7. Conclusion: A standardized definition of suicide and a thorough debate on child's concept of death and ability to decide to decide on death across various cultures and regions is needed to understand the enormity of suicide.
Keywords: Child, Cognition, Intent-Suicide-India
|How to cite this article:|
Poduri GS. Suicide rate computation - Methodological inexactitude. Acta Med Int 2014;1:82-4
| Introduction|| |
Any measurement to be meaningful should be valid and reliable. This depends on various factors-one of the main factors being definition of what is being measured. The same is the case with suicides. The reliability of suicide statistics is suspect for a variety of reasons. The quality and quantity of suicide statistics is far from satisfactory for many reasons. These include definition of suicide followed, reporting practices, recording practices, misclassification of death, etc. There are various definitions of suicide. Another notable cause could be inclusion of whole population in computing the rate. Suicide by definition involves intention, execution by self that culminates in death. Suicide rates are expressed as number of suicides per lakh population. This is to adjust for the underlying population, otherwise just stating the number of suicides will be meaningless and does not convey any information except the number. For any human deviant behavior to be probed, the magnitude of the problem must be clear. In this way, suicide is handicapped. For a variety of reasons as mentioned above, it is grossly under reported. The nearer the accuracy of the magnitude of the problem of suicide is known, better will be the assessment of the trends of suicides or in comparison with other populations, groups, etc. and for finding out environmental and social influences in the long run. Apart from gross under-reporting, suicide rate suffers from inclusion of persons who do not have the cognitive capacity to indulge in it. Children view death in different ways depending on their age. They do not have the cognitive capacity to appreciate death, finality, all the implications and consequences of it. This is needed to label the death as suicide. So including such a population which does not have the capacity, i.e., children, will give diluted suicide rates. If that population is more, the dilution factor will be more. As the age at which children acquire the capacity of intention was not definite a simple exercise was undertaken to see the change in suicide rate by excluding different age population-six to nine.
| Methods|| |
Year-wise rates for various at risk population in India-above 6 yrs, 7 yrs, 8 yrs, and 9 yrs, were taken from the mid-year population projections of US Census Bureau data on international Population for the years 1991-2013. This data was equalised by taking into consideration the total population as mentioned in Indian suicide rate. This was done as there were differences in the projected population by various agencies. Suicide details from National Crimes Bureau statistics on Accidental Deaths and Suicides of Ministry of Home Affairs, Govt. of India were collected for the same years. Then suicide rate was calculated basing on the above computed population for various years. The data was analyzed for percentage increase for various years and ages. Average rate for various years was computed with and without exclusion of various age groups. The same was done for percentage increase over whole populations rates.
| Results|| |
Computation of such data for twenty-three years excluding different age population yielded rates ranging from 11.2 to 14.6 against rate 9.2 to 11.4 for whole population, depending on the age and year of exclusion. The average rate over the computed period of twenty-three years was 10.4 increasing to 12.4 (>6 yrs), 12.8 (>7 yrs), 13(>8 yrs) and 13.5 (>9 yrs). [Figure 1] shows year-wise suicide rate without and with different exclusion age groups-6, 7, 8 and 9 Yrs.
|Figure 1: Year-Wise Suicide Rates for Total Population and After Excluding Different Age Groups-6, 7, 8 and 9 Yrs|
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The increase ranged from minimum of 16.1% to a maximum of 33.7%, depending on the age and year of exclusion. The average increased percentage for different age groups were 19.3, 22.6, 26.0, and 29.4 for >6 yrs, >7 yrs, >8 Yrs, and >9 Yrs respectively. [Figure 2] shows year-wise incremental percentage over suicide rate with different exclusion ages- 6, 7, 8 and 9 Yrs.
|Figure 2: Year-Wise Incremental Percentage over Suicide Rate with Different Exclusion Age Groups-6, 7, 8 and 9 Yrs|
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| Discussion|| |
Obviously, when the denominator is reduced-population in this case, the rate will go up. As observed there was a progressive increase when children of various age groups are excluded. The rate curves for different populations were almost running parallel. When it came to computation of percentage increase, the increase became comparatively less as the mortality between each year between 6-9 yrs is not much different. Traditionally children below ten years cannot comprehend the significance of death. They do not have the cognitive capacity to appreciate the permanency and irreversibility of death. Children’s understanding of death and suicide is immature. With increasing intelligence, exploding knowledge spread, the child is exposed to various knowledge sources, which may bring down the age at which the child can cognate death. But the moot point is whether such acquired knowledge regarding death is real. When a majority of adults, including those on death bed or nearer to death, know the inevitability and irreversibility of death are in denial mode and think it will not touch them, how can children with their immaturity, cognate death? What was noted about capacity for assisted dying (a form of suicide) holds good for suicide also. Legally also children are not considered to be mature enough to understand the nature and consequence of the crime. According to IPC (Indian Penal Code)-sections 82, 83 a child below seven is not considered to have committed a crime and a child between seven and twelve is considered incapable of committing a crime. Even though there were reports of suicide in children, they were debatable. Most of the reported and analyzed suicides in the literature were above ten years of age. One such example of 678 cases the age range was 12-94 yrs. It is unusual to find official records of various countries where children below ten were mentioned. With increasing detection of depression and other psychiatric disorders in children and rampant use of psychotropic including antidepressants, suicide is a possibility. At the same time one should keep in mind the cognitive immaturity, deficient abstract thinking of that segment of the population. In India, there are states where female children are not favoured and family planning is not practiced by some on religious and various other grounds. In the light of above, inclusion of whole population can lead to interpretational errors. In most of the Indian states there exists a skewed sex ratio in favour of males. If the above method of exclusion is followed, then the rate for male will substantially go-up. Till such time of clarity of capacity of the child, it may be meaningful to exclude children from suicide rate computation. This will help comparison across states, countries, communities, years, ranking. This will give a truer picture for comparison purposes as the dilution factor of non-vulnerable are excluded. The concept of cognitive capacity being central to the article can have far reaching effect on suicide analysis.
| Conclusion|| |
Extensive probing on child’s age of awareness of death in different cultures and arriving at that age in the population for a realistic arrival of suicide rate for a meaningful comparison and understanding of suicide is in order. This is needed in the context of knowledge explosion and easy and universal decimation in general and children in particular.
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[Figure 1], [Figure 2]