IASP Task Forces - National Systems for Certifying Suicidal Deaths
Short-term and Long-term Goals
- To establish how we can best explain how suicides are tabulated in national database/vital registry systems.
- To provide the basis for case-control, cross-national studies to identify reasonably equivalent national systems with, for example, high versus low suicide rates or to reasonably conclude that such an exercise is futile.
IASP members are invited to draft descriptions of their national systems. The Irish system of death registration and cause of death classification is made available on this website (see: Inquest Study Technical Report System Description) as a guide and template for such descriptions, which can be sent to the chair of the Task Force.
Restructuring the External Causes of Injury Chapter for ICD-11
By now, we may all have become accustomed to the change from 2010 to 2011. However, there is another 'twenty-ten' to 'twenty-eleven' change to which it may be far more difficult for the suicidology community to become accustomed. I am referring to the planned restructuring of Chapter 20 (External Causes of Injury) of ICD-10 for the update to ICD-11. As mentioned by IASP President Lanny Berman in the last News Bulletin, it is proposed to reduce the current priority given to the coding of Intent.
The World Health Organization convened the Injuries and External Causes Topic Advisory Group which established a number of work groups leading to the production of a Background and Issues document and a Recommendations Paper. These highlighted some important issues needing to be addressed, for example, the need for better criteria for coding intentional self-harm and the underestimation of intentional self-harm because 'accidental' is sometimes the default where there are problems determining intent. Unfortunately, the difficulty in establishing intent is one of the reasons behind the recommendation to prioritise the coding of mechanism and object over intent.
Currently, ICD-10 requires coders to first choose which of six intents applied to the event (accidental, intentional self-harm, assault, undetermined, legal intervention or medical complication). Coders must then choose the mechanism involved (e.g. drowning, poisoning, fall, etc.) and then, where applicable, choose the object that was involved (e.g. sharp object, firearm, motor vehicle, etc.).
The proposal for ICD-11 is that the order of coding be Mechanism-Object-Intent. Therefore, coders will choose from a list of dozens of mechanisms then identify the class, category and type of object involved (as up to 1000 objects may be specified) and then assign intent. Prioritising the detailed coding of object over the coding of intent is almost certainly going to impact negatively on the completeness and quality of intentional self-harm data. We are all aware of the issues related to data quality in suicidology and we need to do what we can to prevent changes to ICD that will further compromise data quality.
The suicidology community are underrepresented on the groups associated with the proposed recommendations and therefore it is important that the IASP membership make its voice heard. Comments and requests for further information can be addressed to Dr Paul Corcoran using the form below.
Dr Paul Corcoran, Chair Task Force on National Systems for Certifying Suicidal Deaths. National Suicide Research Foundation, Cork, Ireland.
Please use the form below to send in your comments in relation to proposed changes for ICD 11.