Trends in adolescent suicide: misclassification bias?

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Abstract
OBJECTIVES: This study investigated the effect of misclassification of accidental deaths and undetermined deaths on age-, sex-, and race/ethnicity-specific adolescent suicide rates from 1979 through 1994. METHODS: Official mortality data were used to present suicide mortality trends. Two estimates of misclassified suicides in other death categories were applied to calculate "corrected" trends of adolescent suicide. RESULTS: The corrected trends showed a downward adjustment for Black adolescent males and young adolescents. This result does not, however, substantially alter the trend toward a recent increase in suicide in these groups. CONCLUSIONS: Despite misclassification, the true direction of trends in adolescent suicide is reflected in recent official data. However, suicide rates should continuously be tested for misclassification, mainly in populations with proportionately high accidental and undetermined death rates.