Suicide Misclassification in an International Context: Revisitation and Update

International misclassification of suicide, particularly undercounting, has long been a scientific concern. An important question is whether official national suicide data are sufficiently reliable and valid to justify their use in international comparative studies or longitudinal intervention studies. Is cross-national variation in rates of suicide, in part or whole, an artifact of such factors as medicolegal ascertainment practices and procedures, legal prohibitions, and sociocultural condemnation? In a revisitation and update of a conference paper, this essay addresses the process of suicide case ascertainment, known sources of suicide misclassification, and explores approaches for assessing misclassification and potential misclassification. Validity of suicide certification, particularly sensitivity, appears more problematic than reliability for users of international suicide data. However, a poisoning pandemic and declining autopsy rates may be depressing data reliability as well as sensitivity.