Drs. Oquendo and Mann Reply

To the editor: We would like to clarify the methods of our study in response to Ms. Munson’s comments. We were interested in understanding the relationship between the lifetime prevalence of major depression in five ethnic groups and the rates of suicide in those same groups. Our assumptions were not about the association of these two phenomena at the individual level; rather, we attempted to see if the same associations that were reported at the group level for majority populations also existed in five ethnic populations. The ECA study and the Hispanic Health and Nutrition Epidemiological Survey assessed the frequency of suicide attempts but not of completed suicide. Suicide attempts and completions are related—but not the same—behavior; we were interested in the relationship of major depression to suicide completion.

In addition, we obtained our suicide figures from a report based on a separate database. We did not use depression as a proxy for suicide. We analyzed the relationship between these two variables, each from a separate database, at the population level.

Ms. Munson comments that our data suggested that depression cannot be used as a proxy for suicide. Part of the basic hypothesis of this article—namely, that ethnic groups may have different relationships between depression rates and suicide rates—reflects our belief that factors other than mood disorders contribute to suicide. Some of these factors may be protective, and others may add risk; these factors may vary between ethnic groups.