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Authors' reply

Published online by Cambridge University Press:  02 January 2018

N. D. Kapusta
Affiliation:
Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Austria. Email: [email protected]
E. Etzersdorfer
Affiliation:
Furtbach Hospital for Psychiatry and Psychotherapy, Stuttgart, Germany
G. Sonneck
Affiliation:
Institute for Medical Psychology, Medical University of Vienna, Austria
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2007 

McPhedran & Baker point out an unsolved problem of Australian suicide research. There are concerns about the quality of mortality data and statistics based upon them. Therefore, they urge researchers to approach Australian firearms data with caution. The authors cite a letter to the Medical Journal of Australia (Reference De LeoDe Leo, 2007) which highlighted inconsistencies in Australian mortality data since the year 2001 and called for standardised certification procedures of deaths according to ICD-10 and for other improvements of death registries. However, in Austria autopsies are performed when there is any uncertainty regarding the cause of death. The autopsy rate is high, with a mean rate of 29% in 1991-2000 (Reference Waldhoer, Berzlanovich and VutucWaldhoer et al, 2003). If the cause of death is not clear, an additional investigation by Statistics Austria takes place. Statistics Austria registers deaths as suicide if that is the most probable cause of death. The International Classification of Diseases (ICD-8, -9, -10) has been applied for many years and there are no signs of a decrease in the data quality of Statistics Austria. The work reported by Kapusta et al (2007) is based on these data.

Furthermore, De Leo (Reference De Leo2007) realistically states that some underreporting is ubiquitous and has to be tolerated in suicide statistics. On the other hand, underreporting of firearm deaths seems less probable than underreporting of, for example, deaths due to poisonings (with longer survival periods), which tend to be classified as disease-related deaths.

We agree with McPhedran & Baker that Australian firearm laws should be reevaluated on the basis of more reliable data, but as long as sufficient evidence is not available, theoretical assumptions that Australian firearm laws had no life-saving effects remain speculative. This applies also to Europe where independent scientific evaluations of firearm law are still rare.

References

De Leo, D. (2007) Suicide mortality data needs revision. Medical Journal of Australia, 186, 157.CrossRefGoogle Scholar
Waldhoer, T., Berzlanovich, A., Vutuc, C., et al (2003) Rates of postmortem examination in Austria: the effect of distance between location of death and site of examination. Journal of Clinical Epidemiology, 56, 891895.Google Scholar
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