Official figures may mask hundreds of suicides

Coroners’ escalating use of narrative verdicts, which do not mention the deceased’s likely intent, makes coding suicides more difficult and may be leading to a significant underestimation of the true number of cases, say authors of an editorial on bmj.com today. They say this renders official suicide statistics unreliable, and makes it harder to target and evaluate suicide reduction strategies.

They explain that the Office for National Statistics figures take account only of ‘short form’ suicide and open verdicts given by coroners after an inquest into an unnatural or unexpected death. In 2009, the ONS recorded 4648 cases of suicide cases in England and Wales.

However, ONS suicide figures exclude deaths for which coroners produced a narrative verdict, which gives a longer explanation of the circumstances and cause of death but often doesn’t mention intent. This makes coding more difficult, because without clear intent the death may be recorded as ‘accidental’.

The number of narrative verdicts has risen dramatically – from 111 in 2001 to 3012 in 2009 – and they now make up more than one in ten inquest verdicts. The writers say that some coroners may avoid giving a short form verdict of suicide, instead recording an open or accidental death verdict, believing this might reduce a family’s distress.

The ONS has estimated that if all deaths in 2009 from hanging and poisoning in which coroners had given narrative verdicts had instead been recorded as suicide, its figures for the number of suicides would have been underestimated by 6% – and this figure doesn’t even include other common methods of suicide. The authors point out that this underestimate is equivalent to almost a third of the 20% national target for suicide reduction.

They caution that official suicide figures can no longer be used to evaluate the success of local and national suicide prevention strategies. They add that the figures’ inaccuracy also makes it difficult to get a true picture of the impact of the current economic crisis on suicide rates.

The ONS and the Coroners’ Society of England and Wales are both investigating ways in which the accuracy of suicide figures might be improved.