The Role of Medicolegal Systems in Producing Geographic Variation in Suicide Rates

Authors


  • We wish to acknowledge Bessie Flatley, Tatiana Poladko, Roy Pollock, Sarah Pollock, Matt Ruther, Temple University, and the Department of Sociology for their research assistance. We are also grateful to Steven Elkins, Otto Hiller, Joan Jung, Bob Kulhanek, Gib Parrish, Brian Peterson, and Lindsey Thomas for their advice and information on medico-legal systems.

Direct correspondence to Joshua Klugman, Department of Sociology, Temple University, 1115 W. Polett Walk, Gladfelter Hall 713, Philadelphia, PA 19103 〈klugman@temple.edu〉.

Abstract

Objectives

In this analysis, we ask whether there is systematic variation in the reporting of suicide by medicolegal system and if so whether this biases estimated effects of social correlates on suicide.

Methods

With cause of death records (1999–2002) and 2000 Census data, we use negative binomial regression to analyze the effects of medicolegal system on suicide and nonsuicide mortality aggregated at county of occurrence.

Results

We find that elected coroners have slightly lower official suicide rates than medical examiners (MEs; all of whom are appointed) and appointed coroners. In addition, we find that omitting medicolegal system does not bias estimates of the social determinants of suicide.

Conclusion

Contrary to arguments that MEs' greater scientific training makes them more likely to underreport suicides, we conclude that appointed death investigators (MEs and appointed coroners) underreport suicide to a lesser degree than elected coroners, who are subject to greater public pressures that result in the misclassification of suicides.

Ancillary