World Health Organization age-, sex- and cause-specific mortality data for
the United States and 19 other democratic higher-income countries were util
ized to assess the reliability and sensitivity of suicide certification for
purposes of cross-national research. Data are found to be highly reliable
across age and sex (r(s) > 0.92; P < 0.001). Relative discrepancies between
official suicide rates (putative lower limits) and projected upper limits
vary widely internationally. Austrian and Dutch suicide certification is th
e most sensitive. Least sensitive is certification for certain subpopulatio
ns in Finland, Greece, Ireland, Israel, and the United Kingdom. We recommen
d similar analyses be performed for routine, low-cost surveillance of suici
de data quality, and to guide choice of population groups for multivariate
comparative research.