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The influence of undetermined deaths on suicides in Shanghai, China

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

In global forensic practice, some suicides were misclassified as undetermined deaths, leading to suicide underreporting. In this study, we aimed to explore the influence of undetermined deaths on suicides in Shanghai, China.

Methods

The police records on suicide verdicts and undetermined deaths in Pudong, Shanghai, from 2004 to 2016 were used. In this study, undetermined deaths have been classified into three levels of suicide possibilities namely, probable, possible, and highly unlikely. Probable suicides were presumed as misclassified suicides. Poisson regression was used to calculate the rate ratio (“RR”) of probable suicides compared to suicide verdicts. Poisson regression was also used to calculate the annual percentage change (“APC”) of the original suicide rates (crude suicide rates based on the suicide verdicts) and adjusted suicide rates (crude suicide rates based on the suicide verdicts and probable suicides).

Results

Among the 1,318 underdetermine deaths, 560 (42.5%) were classified as probable suicides. The overall RR was 0.23 (95% CI 0.21–0.26): 0.15 (0.13–0.17) for the locals’ RR and 0.22 (0.19–0.26) for the migrants’ RR. The APCs of the original and adjusted suicide rates were − 2.0 (− 3.1 to − 0.9) and − 2.9 (− 3.8 to − 2.0), respectively, for the overall population.

Conclusions

The number of suicides could be 23% higher than the reported cases. Suicides were more likely to be underreported in migrants than in the locals. Thus, it is important to improve suicide monitoring and the surveillance systems in China.

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Funding

No funding was received.

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Authors and Affiliations

  1. Social Work and Social Administration Department, The University of Hong Kong, Pokfulam, China

    Feng Li & Ying Ou

  2. Criminal Science Institute, Pudong District of Shanghai Municipal Public Security Bureau, Shanghai, China

    Xuesong Lu

  3. Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China

    Paul S. F. Yip

Authors
  1. Feng Li
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  2. Xuesong Lu
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  3. Ying Ou
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  4. Paul S. F. Yip
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Contributions

XL had full access to all the data in the study and takes responsibility for the integrity and the accuracy of the data. Concept and design: FL and XL. Drafting of the manuscript: all authors.

Corresponding author

Correspondence to Paul S. F. Yip.

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All authors declare that we have no conflict of interest.

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Li, F., Lu, X., Ou, Y. et al. The influence of undetermined deaths on suicides in Shanghai, China. Soc Psychiatry Psychiatr Epidemiol 54, 111–119 (2019). https://doi.org/10.1007/s00127-018-1596-9

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  • DOI: https://doi.org/10.1007/s00127-018-1596-9

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