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Public health strategies depend on provision of accurate mortality statistics. Suicides are under-counted, largely through misattribution to natural disease, accident, ill-defined or unknown cause (code R99) or an event of undetermined intent. Proportions of suicides misclassified to each of these codes vary between nations. It is recommended that psychological or verbal autopsies be used when investigating external deaths of uncertain cause or intention, and some R99 deaths. This applies in Britain and wherever unusual patterns of deaths could signal hidden suicides \u2013 exemplified by high rates of drug deaths in North America.<\/jats:p>","DOI":"10.1192\/bjp.2025.20","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T04:47:31Z","timestamp":1742359651000},"page":"567-571","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Hidden suicides: focus on England and Wales \u2013 comparison with other nations"],"prefix":"10.1192","volume":"227","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9554-3187","authenticated-orcid":false,"given":"John","family":"Snowdon","sequence":"first","affiliation":[{"name":"Sydney University"},{"name":"Concord Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"key":"S0007125025000200_ref23","doi-asserted-by":"publisher","DOI":"10.1186\/s12963-015-0048-y"},{"key":"S0007125025000200_ref4","volume-title":"WHO Mortality Database","year":"2024"},{"key":"S0007125025000200_ref11","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.66"},{"key":"S0007125025000200_ref14","first-page":"48","article-title":"Suicide misclassification in an international context: revisitation and update","volume":"2","author":"Rockett","year":"2011","journal-title":"Suicidol Online"},{"key":"S0007125025000200_ref24","first-page":"7","article-title":"Comparing rates and patterns of male suicide and \u2018hidden suicide\u2019 between nations and over time","volume":"17","author":"Snowdon","year":"2021","journal-title":"J Mens Health"},{"key":"S0007125025000200_ref3","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2020.1801789"},{"key":"S0007125025000200_ref31","doi-asserted-by":"publisher","DOI":"10.1186\/s12963-018-0176-2"},{"key":"S0007125025000200_ref22","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-015-1119-x"},{"key":"S0007125025000200_ref1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1998.tb10069.x"},{"key":"S0007125025000200_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.lansea.2024.100368"},{"key":"S0007125025000200_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(18)30138-5"},{"key":"S0007125025000200_ref21","unstructured":"21 National Centre for Suicide Research and Prevention. 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ONS, 2021 (https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/methodologies\/suicideratesintheukqmi#methods-used-to-produce-the-suicides-in-the-uk-data [cited 20 Oct 2024])."},{"key":"S0007125025000200_ref27","doi-asserted-by":"publisher","DOI":"10.1007\/s11469-022-00932-9"},{"key":"S0007125025000200_ref25","doi-asserted-by":"publisher","DOI":"10.23907\/2013.029"},{"key":"S0007125025000200_ref16","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.178.5.465"},{"key":"S0007125025000200_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60171-4"},{"key":"S0007125025000200_ref32","doi-asserted-by":"publisher","DOI":"10.1177\/10398562241245548"},{"key":"S0007125025000200_ref20","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-020-01948-z"},{"key":"S0007125025000200_ref8","first-page":"194","article-title":"Global, regional, and national burden of disease suicide mortality 1990 to 2016. 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