Citation

Snowdon J. J. Suicidol. (Taipei) 2023; 18(2): 529-539.

Copyright

(Copyright © 2023, Taiwanese Society of Suicidology, Publisher Airiti)

DOI

10.30126/JoS.202306_18(2).0005

PMID

unavailable

Abstract

BACKGROUND: Suicides are under-counted to a varying extent around the world: studies show a substantial proportion to have been inappropriately classified as accidental. In various countries, high proportions of self-killings are coded as 'undetermined deaths' because of uncertainty about whether the decedent intended to die. Some experts declare that the mortality classification code 'ill-defined or unknown cause' is commonly a haven for 'hidden suicides'.

AIM: The aim of this review is to examine to what extent differences between nations in their reported suicide rates are attributable to misclassification of cause of death as accidental, 'undetermined intent' or 'ill-defined or unknown'.

DISCUSSION: Reports suggest that accidental death is the ICD-10 category to which suicides are most often misclassified. Commonly (for example in drug poisoning deaths) those certifying deaths have no definite information to point to intentional self-killing, but this may be because assessment and investigations were inadequate. Misclassifying suicides as 'undetermined' is relatively common in some nations, but occurs rarely or not at all in some others. Most 'ill-defined or unknown' cause deaths are 'natural' and (except in Britain) occur mainly in late old age.

CONCLUSION: Well-resourced nations should be using psychological autopsy and intensive investigations (including forensic autopsy and toxicology, as in Finland) in cases where there is doubt about cause of death. If resources are limited, comparable studies on representative samples of nonelderly decedents should be undertaken, with studies of selected elderly decedents as well, if funds permit.

Language: zh

Keywords

accidental death; ICD-10 codes; suicide rates; undetermined death; unknown cause death