Increased Suicide Risk: Fact or Artifact?

To the Editor.—  I read with interest the three lead articles in the May 1980 issue of the Archives that suggest that younger people have a cohortspecific increased risk of suicide (1980;37:505-510, 511-513, 519-523). While these findings are provocative, it is not mentioned by the authors that these trends might be due to an artifact caused by diagnostic differences. The World Health Organization undertook a study to examine why the rates of suicide varied by a factor of ten from one country to another.¹ It found that there is so much variation in the manner in which different coroners diagnose suicide that the variations in rates of suicide could be attributable to artifact. Where a coroner chooses to draw the boundary between suicide and accident is not a matter determined by specific diagnostic criteria that are widely accepted; it is often idiosyncratic.¹ Furthermore, unless there has been a