title: Suicide-associated comorbidity among US males and females: a multiple cause-of-death analysis.
abstract: OBJECTIVE
  To describe physical and mental comorbidity among male and female suicides in the US. This research replicates a seminal Australian study, which permits inference on comparative cause-of-death data quality.
  
  
  METHODS
  National cross-sectional study of suicides and unintentional injury decedents (comparison group) using Multiple Cause of Death (MCOD) public use files for 1999-2003.
  
  
  METHODS
  Prevalence of medical conditions; relative odds of suicide-associated comorbidity.
  
  
  RESULTS
  For 14% of male suicides and 19% of female suicides, comorbidity was shown on their death certificates. Respective prevalences for mental and physical comorbidity were 7.2% and 7.1% for males and 10.0% and 9.3% for females. Mean numbers of psychopathologies mentioned were virtually identical for male and female suicides (1.22 and 1.21) for whom comorbidity was registered. Mean mentions of physical disease were lower for male suicides: 1.64 vs 1.77. Multiple medical conditions were registered for 4% of male suicides and 6% of female suicides. Suicides manifested excess comorbidity for depression and mood disorders (adjusted odds ratio (AOR) = 34.6, 95% CI = 32.41 to 36.92), schizophrenia (AOR = 2.5, 95% CI = 2.16 to 2.88), and cancer (AOR = 2.1, 95% CI = 1.93 to 2.19), but unexpectedly no excess comorbidity for HIV.
  
  
  CONCLUSIONS
  The US system of death certification appears to be less fastidious than the Australian system. Although comorbidity patterns were very similar, only half as much psychopathology was reported for US suicides as for Australian suicides. A questionable deficit of comorbid physical disease was also documented for US suicides. Findings have important implications for medical training, as well as for suicide surveillance, policy, and prevention.
authors.affiliation: Injury Control Research Center, West Virginia University, Morgantown, West Virginia 26506-9190, USA. irockett@hsc.wvu.edu
authors.forename: Ian R H
authors.initials: IR
authors.lastname: Rockett
authors.forename: Shuhui
authors.initials: S
authors.lastname: Wang
authors.forename: Yinjuan
authors.initials: Y
authors.lastname: Lian
authors.forename: Steven
authors.initials: S
authors.lastname: Stack
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000523:psychology*; D012044:Regression Analysis; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology