Objectives: 'Undetermined' (UnD) and accidental deaths (AccD) are explored as possible sources of 'under-reported-suicides' (URS) in 20 Western countries.
Methods: WHO mortality rates per million of AccD, UnD and suicides analysed. UnD:suicides ratios of <1:5 calculated as likely URS versus ratios >1:10 unlikely URS and all correlated by sex and age.
Results: Male URS likely in 7 countries and in 11 for females. URS in AccD likely in 5 countries for both sexes only UnD and suicide rates the elderly (75+) significantly correlated.
Conclusion: Strong indication of URS in the UK, Portugal, Switzerland, Sweden, Denmark and Germany with likely URS in AccD in Greece, Portugal, Switzerland and USA. These findings have important implications, indicating that, with the exception of France and Japan, official reported suicide rates contain a degree of under-reporting, and especially for women yet it is essential to have accurate suicide data to ensure adequate service provision.