Size Estimation of Under-Reported Suicides and Suicide Attempts Using Network Scale up Method.

Area of Science:

• Public Health
• Epidemiology
• Forensic Medicine

Background:

• Kermanshah Province, Iran, exhibits a high suicide rate.
• Accurate data on suicide deaths (SDS) and suicide attempts (SAS) is essential for effective public health interventions.
• Underreporting in vital statistics systems can significantly skew understanding of disease burden.

Purpose of the Study:

• To estimate the extent of underreporting (UR) for suicide deaths (SDS) and suicide attempts (SAS) in Kermanshah Province.
• To assess the accuracy of current suicide data collection methods in a high-risk region.

Main Methods:

• Utilized the network scale-up method (NSU) to estimate underreporting.
• Collected data on SDS and SAS from forensic medicine and health centers.
• Randomly sampled 500 individuals aged 18-65 from the general population, stratified by age and sex, to estimate coverage. Bootstrapping was used for confidence intervals.

Main Results:

• Average coverage for suicide deaths (SDS) was 58.4%, with significant variation by method (self-immolation 34.2%, hanging 81.2%).
• Coverage for suicide attempts (SAS) was 82.4% for self-immolation and 77.2% for deliberate self-poisoning.
• Most frequent SAS methods included medication poisoning (61.7%), chemical poisoning (20.6%), and self-immolation (7.7%).

Conclusions:

• The study highlights substantial underreporting in suicide registers, necessitating improved data accuracy.
• Accurate registration of all deaths, including those coded as accidents or undetermined, is vital.
• Implementing thorough death investigations, correcting coding errors, and survivor interviews can enhance register coverage and reduce suicide denial.