2007 04: Spotlight: Data to give a true picture of suicide trends

NST online. Focus. 28/04/07

BY the year’s end, Malaysia will cease to be a "no suicide data" country.

This is because the Health Ministry has set up a national suicide database in an attempt to capture a true picture of suicides in Malaysia.

With this data, the ministry is expected to better identify suicide trends and contributing factors, and from there, tailor its preventive strategies appropriately, says National Suicide Registry Malaysia principal researcher Dr Nor Hayati Ali.

"It will also be a good health service indicator — the data will help us gauge whether our medical services are doing what they are meant to do, and to see whether there is anything that we need to improve," says Dr Nor Hayati. Once the database is fully set up, it will be capable of providing data for further research into suicide. Other researchers can use the data to capture data on other violent deaths.

The development of the project, which started in January, is a collaboration between the Psychiatry and Mental Health Services, and the Forensic Pathology Services, with the Clinical Research centre of Hospital Kuala Lumpur providing the etchnical expertise.

It is currently collecting data on suicides from mortuaries in all government hospitals as suicide cases come in. Dr Nor Hayati said the NSRM is also seeking the involvement of university and army hospitals, so that a more accurate picture can be obtained.

In determining suicides, the registry will be depending on a clinical diagnosis of suicides instead of a legal one. The clinical diagnosis of suicide, as defined by the World Health Organisation through its ICD-10 (International Classification of Diseases) refers to suicide as "Intentional Self-Harm [fatal], while the National Violent death Reporting System of the USAdefines it as: "Deaths resulting from the intentional use of force against oneself. A preponderance of evidence should indicate that the use of force was intentional.

"Under normal circumstances, suicidal death is determined by the court through a coronial inquest, but this usually takes three years to determine.

"By that time, whatever trend that needs immediate rectification will be identified much too late.

"Data must be captured by the year of death, not the year of registration of the coroner’s report," said Dr Nor Hayati, who is a psychiatrist at HKL.

"Immediacy of reporting is crucial. That is why we have gone to the mortuaries. That is where the data is."To speed up the reporting process, an online system, which is provided by the Clinical Research Centre (CRC), is expected to run from the second-half of the year, so that data can be input directly from the various hospitals into the database.

At present, paper forms have to be filled in and physically delivered to the secretariat at HKL. The first phase of the project will end in December, but the project is expected to continue with five-yearly reviews, subject to funding. Currently, funding is facilitated by the government through the CRC. "We should keep it (the database) running for at least five years. Only then will it provide a more accurate picture," said Dr Nor Hayati. "Currently, statistics on suicide are unclear because no data is collected.

"In its report "Suicide Prevention in Malaysia", the Health Ministry estimate for suicide rates in 2004 was 9-12 per 100,000 population. Last year, Health Minister Datuk Dr Chua Soi Lek announced that it was 13 persons per 100,000 population.

Estimates in 2002 stated that about seven suicides occurred everyday in Malaysia, amounting to more than 2,000 deaths per year.

Yet, because of the stigma of suicide, it is thought that the under-reported figures of suicides could be many times that of official figures. The number of persons who made non-fatal suicide attempts is estimated to be at least 15 times the number of suicides.

However, since there has not, until now, been a co-ordinating agency to collect suicide data, these statistics remain only estimates.