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Validity of suicide statistics in Europe in relation to undetermined deaths: developing the 2-20 benchmark
  1. Peeter Värnik1,2,
  2. Merike Sisask1,3,
  3. Airi Värnik1,3,
  4. Ella Arensman4,
  5. Chantal Van Audenhove5,
  6. Christina M van der Feltz-Cornelis6,
  7. Ulrich Hegerl7
  1. 1Estonian-Swedish Mental Health and Suicidology Institute, Estonian Centre of Behavioural and Health Sciences, Tallinn, Estonia
  2. 2The Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
  3. 3Institute of Social Work, Tallinn University, Tallinn, Estonia
  4. 4National Suicide Research Foundation, Cork, Ireland
  5. 5Katholieke Universiteit Leuven, LUCAS, Leuven, Belgium
  6. 6Trimbos-instituut/Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
  7. 7Department of Psychiatry, University of Leipzig, Leipzig, Germany
  1. Correspondence to Peeter Värnik, Estonian-Swedish Mental Health and Suicidology Institute; Estonian Centre of Behavioural and Health Sciences, Õie 39, Tallinn 11615, Estonia; peeterv{at}


Background The suicide rate is a macro indicator of the population's psychosocial wellbeing and an evaluation criterion of the effectiveness of suicide prevention strategies. A high level of injury deaths of undetermined intent (UD) is usually discussed in connection with the validity of suicide statistics. An effort is made to develop a criterion to characterise the quality of suicide statistics.

Methods Standardised rates of suicides (X60–X84) and UD (Y10–Y34) by the International Classification of Disease version 10 as an average for the past five available years were taken from the WHO European mortality database. Rate ratios were computed by dividing rates of UD by suicide rates.

Results There is considerable variation in suicide and UD rates among countries. The highest overall rates of UD were registered in Russia, Ukraine and Belarus, and the lowest in Greece, Spain and Italy. The EU-15 average UD rate of 1.97 and the rate ratio of 0.194 UD to suicides were combined into a ‘2-20 benchmark’, in which the primary indicator is 2.0 UD cases per 100 000 and the secondary indicator is the proportion of UD to suicides 0.20 (20%), which enables countries to be clustered according to the quality of suicide statistics. The following countries satisfied the benchmark: Greece, Norway, Spain, The Netherlands, Luxembourg, France, Austria, Italy, Romania, Hungary, Ireland and Finland.

Conclusion This study used the developed ‘2-20 benchmark’ in Europe to assess suicide registration quality in a particular country, to compare the relative position of countries, and to set a target for those European countries that have not yet achieved the benchmark.

  • Attitudes
  • epidemiology
  • open verdict
  • public health
  • reliability
  • suicide
  • suicide/self-harm
  • undetermined death
  • validity

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  • Funding The research reported in this paper has received funding from the European Community Seventh Framework Programme (FP/2007–2013) OSPI-Europe under grant agreement no 223138, and from the Estonian Ministry of Social Affairs.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The study is based on publicly available data and previously published sources.