Suicide in Canada: impact of injuries with undetermined intent on regional rankings

The impact of underreporting or misclassifying suicides as injuries with undetermined intent is rarely evaluated. We assessed whether undetermined injury deaths influenced provincial rankings of suicide in Canada, using 2 735 152 Canadians followed for mortality from 1991 to 2001. We found that suicide rates increased by up to 26.5% for men and 37.7% for women after including injuries with undetermined intent, shifting provincial rankings of suicide. Attention to the stigma of suicide and to coding suicides as injuries with undetermined intent is merited for surveillance and prevention.