Hidden suicides: focus on England and Wales - comparison with other nations

Area of Science:

• Public Health
• Epidemiology
• Mortality Statistics

Background:

• Accurate mortality statistics are vital for public health strategies.
• Misclassified suicides, or 'hidden' suicides, are deaths assigned incorrect or inappropriate ICD codes.
• Under-counting of suicides occurs due to misattribution to natural disease, accident, or undetermined intent.

Purpose of the Study:

• To highlight the issue of misclassified suicides in global mortality data.
• To emphasize the impact of inaccurate coding on public health strategies.
• To recommend methods for improving the accuracy of suicide classification.

Main Methods:

• Analysis of misclassification patterns in mortality data.
• Review of ICD coding practices for external causes of death.
• Recommendation for the use of psychological or verbal autopsies.

Main Results:

• Suicides are significantly under-counted globally due to misclassification.
• Misattribution often occurs to natural disease, accident, or undetermined intent (R99).
• The proportion of misclassified suicides varies between nations.

Conclusions:

• Improving the accuracy of death certification and coding is essential.
• Psychological or verbal autopsies are recommended for uncertain external deaths, including some R99 codes.
• Addressing hidden suicides is critical for accurate public health surveillance and intervention, as seen in North America's drug death rates.