title: Are suicide deaths under-reported? Nationwide re-evaluations of 1800 deaths in Scandinavia.
abstract: OBJECTIVE
  Valid mortality statistics are important for healthcare planning and research. Suicides and accidents often present a challenge in the classification of the manner of death. The aim of this study was to analyse the reliability of the national suicide statistics by comparing the classification of suicide in the Scandinavian cause of death registers with a reclassification by 8 persons with different medical expertise (psychiatry, forensic pathology and public health) from each of the 3 Scandinavian countries.
  
  
  METHODS
  The cause of death registers in Norway, Sweden and Denmark retrieved available information on a sample of 600 deaths in 2008 from each country. 200 were classified in the registers as suicides, 200 as accidents or undetermined and 200 as natural deaths. The reclassification comprised an assessment of the manner and cause of death as well as the level of certainty.
  
  
  RESULTS
  In total, 81%, 88% and 90% of deaths registered as suicide in the official mortality statistics were confirmed by experts using the Swedish, Norwegian and Danish data sets, respectively. About 3% of deaths classified as accidents or natural deaths in the cause of death registers were reclassified as suicides. However, after a second reclassification based on additional information, 9% of the natural deaths and accidents were reclassified as suicides in the Norwegian data set, and 21% of the undetermined deaths were reclassified as suicides in the Swedish data set. In total, the levels of certainty of the experts were 87% of suicides in the Norwegian data set, 77% in the Swedish data set and 92% in Danish data set; the uncertainty was highest in poisoning suicides.
  
  
  CONCLUSIONS
  A high percentage of reported suicides were confirmed as being suicides. Few accidents and natural deaths were reclassified as suicides. Hence, reclassification did not increase the overall official suicide statistics of the 3 Scandinavian countries.
authors.affiliation: Department of Acute Medicine, Oslo University Hospital Ullevaal, Oslo, Norway Faculty of Medicine, Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
authors.forename: Ingvild Maria
authors.initials: IM
authors.lastname: Tøllefsen
authors.affiliation: Department of Social Medicine and Public Health Research, Copenhagen University, Copenhagen, Denmark.
authors.forename: Karin
authors.initials: K
authors.lastname: Helweg-Larsen
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Ingemar
authors.initials: I
authors.lastname: Thiblin
authors.affiliation: Faculty of Medicine, Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Oslo, Norway.
authors.forename: Erlend
authors.initials: E
authors.lastname: Hem
authors.affiliation: Amalievej 23, Frederiksberg, Denmark.
authors.forename: Marianne C
authors.initials: MC
authors.lastname: Kastrup
authors.affiliation: Department of Clinical Neuroscience, Stockholm Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ullakarin
authors.initials: U
authors.lastname: Nyberg
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Sidsel
authors.initials: S
authors.lastname: Rogde
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Zahl
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Gunvor
authors.initials: G
authors.lastname: Østevold
authors.affiliation: Faculty of Medicine, Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Oslo, Norway.
authors.forename: Øivind
authors.initials: Ø
authors.lastname: Ekeberg
mesh_terms: D000059:Accidents / Q000401:mortality*; D000328:Adult; D000368:Aged; D001344:Autopsy; D002423:Cause of Death; D066264:Datasets as Topic; D003644:Death Certificates; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D015203:Reproducibility of Results; D013405:Suicide / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology
keywords: PUBLIC HEALTH