[Death certificates for suicides: quality investigation based on police records]

Death certificates are the basis for German mortality statistics, including suicide statistics.

To examine death certificates that are issued in the context of suicide with special focus on the quality of doctors' entries, especially indications of suicide and the stated association between underlying illness and cause of death.

Data from the Allgäu Suicide Study were used. Police records (N = 626) containing the results of suicide investigations as well as death certificates were analysed.

There is great heterogeneity as to how physicians issue death certificates in the context of suicide. Clear indications of suicide are often missing and underlying illnesses are seldom mentioned. Nevertheless, there are only minor differences between the number of suicides recorded by the police compared to official statistics.

To improve the quality of death certificates in the context of suicide, physicians should give clearer indications of suicide and put more focus on logically explaining the causes of death. The mortality of mental illnesses might be underestimated when mental illnesses are not regularly mentioned as a potential cause for suicide.