The effects of misclassification biases on veteran suicide rate estimates.
OBJECTIVE
We assessed the impact that possible veteran suicide misclassification biases (i.e., inaccuracy in ascertainment of veteran status on the death certificate and misclassification of suicide as other manner of death) have on veteran suicide rate estimates.


METHODS
We obtained suicide mortality data from the 2003-2010 National Violent Death Reporting System and the 2003-2010 Department of Defense Casualty Analysis System. We derived population estimates from the 2003-2010 American Community Survey and 2003-2010 Department of Veterans Affairs data. We computed veteran and nonveteran suicide rates.


RESULTS
The results showed that suicide rates were minimally affected by the adjustment for the misclassification of current military personnel suicides as veterans. Moreover, combining suicides and deaths by injury of undetermined intent did not alter the conclusions.


CONCLUSIONS
The National Violent Death Reporting System is a valid surveillance system for veteran suicide. However, more than half of younger (< 25 years) male and female suicides, labeled as veterans, were likely to have been current military personnel at the time of their death and misclassified on the death certificate.
Nathalie Huguet is with the Center for Public Health Studies, Portland State University, Portland, OR. At the time of the study, Mark S. Kaplan was with the School of Community Health, Portland State University. Bentson H. McFarland is with the Department of Psychiatry, Oregon Health and Science University, Portland.
Nathalie
N
Huguet
Mark S
MS
Kaplan
Bentson H
BH
McFarland
D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D013405:Suicide / Q000145:classification* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014728:Veterans