Background In literature on intentional self-harm behaviour it is often stated that suicide is one of the leading causes of death, nationally or worldwide. Ranking causes of death is a method used to illustrate the relative burden of cause-specific mortality and is often used to present arguments for research funding, prevention and treatment. The purpose of this project is to assess the evidence behind the statement that suicide is a leading cause of death with reference to the methods of ranking causes of death used to convert a rare incident as suicide to one of the leading causes of death.

Methods Cause of death statistics from Europe were used, in addition to global mortality estimates from the World Health Organisation (WHO). We used the European short list of 86 causes of death (Eurostat) to select rank-able and mutually exclusive causes. By applying different rules in the selection we made two lists of rank-able causes for Europe.

Results 1.2% of all deaths were registered due to suicide as the underlying cause of death in the enlarged Europe Union (EU28) in 2012, and 1.5% of all deaths globally (2011) according to the WHO estimates. Suicide was not among the ten leading causes of death totally (all ages), neither in Europe nor globally. In Europe suicide was the 11th and the 15th leading cause in the two different ranking lists we used, and globally the 15th leading cause (based on WHOs ranking list). In Europe, however, suicide for males was ranked at the eighth and the ninth leading cause of death in two ranking lists. For females, suicide was number 13 and 23 in the two ranking lists.

Conclusions Ranking mortality causes is a complex process and depends deeply on the cause list and the rules used for ranking. The ranking may also be affected by the quality of mortality data. Our ranking lists did not find support in stating intentional self-harm (suicide) as one of the ten leading causes of death totally, in Europe and globally.