Reliability and sensitivity of suicide certification in higher-income countries

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.