This blog is a summary of our newly released article The accuracy and reliability of suicide statistics: Why it matters.
Suicide reporting is complicated. Unlike with other deaths, suicide can be difficult to determine, as it may not be known whether the person had the intent to die. A death is only ever determined as a suicide if there is very clear evidence that the person who died had the intent to do so.
Because of these intricacies, death investigations may take some time to complete, so suicide death data takes two years or more to become finalized. Even when it is finalized, we must use caution when interpreting data. Suicide rates are meant to be read as trends – there is meaning to be found in a 5 or 10 year analysis of suicide rates, but not in the comparison of one year to the next.
Even if clear evidence exists or may exist, suicides are often not declared as such. Suicide is underreported for many reasons, including:
- Lack of evidence that death was intentional
- Limited frequency and extent of autopsies
(Tollefsen et al., 2012)
Stigma is one major factor for the underreporting of suicide – people are still uncomfortable with the idea that a person may die by suicide. If the coroner or medical examiner happens to be uncomfortable with this idea, they may be reluctant to declare a death a suicide.
Lack of evidence that death was intentional
In many cases, in order for a death to be determined a suicide, it must unquestionably be a death by suicide – there must be either a past suicide attempt, a suicide note (which is present in less than 20% of suicides), or an obvious method of suicide used. This means that deaths that are more ambiguous, such as overdose deaths, may be classified as ‘undetermined,’ instead of as suicides, and therefore are not included in suicide stats.
Limited frequency and extent of autopsies
In Canada, in 2018, autopsies were conducted in only 5.6% of deaths, half of the number of autopsies conducted 25 years ago (Statistics Canada, 2021). Whenever autopsies are conducted more frequently, suicide death numbers are increased.
Psychological autopsies are a different type of autopsy that can be used to determine whether or not a death was a suicide. They usually include extensive interviewing close acquaintances of the person who died and collecting and reviewing their medical and psychiatric records.
These autopsies are not widely accepted, mostly because there is a lack of standardized protocol, but also because of the perceived bias among people who are interviewed as part of the autopsy (Knoll, 2008).
How can we solve the problem of suicide underreporting?
One way is by continuing to break down the stigma surrounding suicide, and by being open to having conversations about this very real cause of death – one that can also be prevented with the reduction of stigma.
Increasing the number of psychological autopsies, and autopsies in general, would also contribute to more accurate suicide reporting.
Another solution is to collect more specific data on people living in Canada – currently, only a few provinces and territories collect data on ethnicity, for example. Having more specific data could help us target prevention efforts to the demographics that need them the most.
Why is accurate reporting important?
Detailed and accurate suicide reporting can inform suicide prevention efforts. It can help ensure that those who are thinking about suicide have access to mental health supports, and that their communities have access to information about suicide, reducing stigma. This increases the chance that community members will reach out to someone they’re worried about, and creates safe spaces for those with thoughts of suicide to find help.
To find out more about suicide reporting and underreporting, check out The accuracy and reliability of suicide statistics: Why it matters.
Knoll, J. (2008). The psychological autopsy, part 1: Applications and methods. Law and Psychiatry, 14(6), 393-397.
Statistics Canada. (2021). Deaths subject to autopsy. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310071601
Tollefsen, I., Hem. E. & Ekeberg, O. (2012). The reliability of suicide statistics: A systematic review. BMC Psychiatry. https://doi.org/10.1186/1471-244X-12-9