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Increased Suicide Risk: Fact or Artifact?

Jeffrey H. Boyd, MD
Arch Gen Psychiatry. 1981;38(6):720. doi:10.1001/archpsyc.1981.01780310120015.
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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


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