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Cited by 21Suicide and Self-Harm StudiesStatistical Methods in EpidemiologyHomicide, Infanticide, and Child Abuse

The case for case–control studies in the field of suicide prevention

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Pirkis, Jane, Nicholas, Angela, Gunnell, David·2020·Epidemiology and Psychiatric Sciences
DOI 10.1017/s2045796019000581PMC PMC8061211
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Abstract

Much of our knowledge about the risk factors for suicide comes from case-control studies that either use a psychological autopsy approach or are nested within large register-based cohort studies. We would argue that case-control studies are appropriate in the context of a rare outcome like suicide, but there are issues with using this design. Some of these issues are common in psychological autopsy studies and relate to the selection of controls (e.g. selection bias caused by the use of controls who have died by other causes, rather than live controls) and the reliance on interviewing informants (e.g. recall bias caused by the loved ones of cases having thought about the events leading up to the suicide in considerable detail). Register-based studies can overcome some of these problems because they draw upon contain information that is routinely collected for administrative purposes and gathered in the same way for cases and controls. However, they face issues that mean that psychological autopsy studies will still sometimes be the study design of choice for investigating risk factors for suicide. Some countries, particularly low and middle income countries, don't have sophisticated population-based registers. Even where they do exist, there will be variable of interest that are not captured by them (e.g. acute stressful life events that may immediately precede a suicide death), or not captured in a comprehensive way (e.g. suicide attempts and mental illness that do not result in hospital admissions). Future studies of risk factors should be designed to progress knowledge in the field and overcome the problems with the existing studies, particularly those using a case-control design. The priority should be pinning down the risk factors that are amenable to modification or mitigation through interventions that can successfully be rolled out at scale.

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  • Comparing suicide cases with controls who have died by other external causes such as accidents may generate smaller or no differences between groups because of overlapping risk factors and because prematurely deceased controls may be at increased risk of suicide themselves.

    “Comparing suicide cases with controls who have died by other external causes such as accidents may generate smaller or no differences between groups because of overlapping risk factors19 and because prematurely deceased controls may be at increased risk of suicide themselves.4”

    From Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies (2022) · cites this paper as [4]

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Authors
Pirkis, J., Nicholas, A., & Gunnell, D.
Affiliations
  • The University of Melbourne (AU)
  • University of Bristol (GB)
Corresponding author
Pirkis, Jane
ORCID
Venue
Epidemiology and Psychiatric Sciences
Publisher
Cambridge University Press (CUP)
Published
2019-10-01
Volume
29
Pages
e62-e62
ISSN
  • 2045-7960 (ISSN-L)
  • 2045-7979
DOI
10.1017/s2045796019000581
PMC
PMC8061211
OpenAlex
W2977952494
Cited by
21
References
28
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 6 · 2021: 2 · 2020: 4 · 2019: 1
FWCI
3.80
Type
journal article
Language
en
Open access
Licence
Locations
  • Epidemiology and Psychiatric Sciences (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Bristol Research (University of Bristol) (acceptedVersion, cc-by)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
Funders
National Institute for Health and Care Research (NF-SI-0512-10068)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
suicide prevention, suicide risk factors, case-control study, psychological autopsy, register-based cohort study, selection bias, recall bias, rare outcomes, suicide attempts, mental illness, low- and middle-income countries
MeSH terms
Suicide Prevention, Humans, Registries, Research Design, Confounding Factors, Epidemiologic, Case-Control Studies, Control Groups

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