How Reliable Are Official Annual Suicide Numbers in Sri Lanka?
Weerasinghe M., Karunarathne A., Metcalfe C., Konradsen F., Jayawickrama H., Hawton K., Miller M., Kumarasinghe N., Hashini P., Rajapaksha S., Chang S-S., Agampodi S., Agampodi T., Eddleston M.
Background: The World Health Organization (WHO) emphasizes surveillance of suicide and suicide attempts as a core component of national suicide prevention strategies. Aims: In Sri Lanka, police registers serve as the main source for national suicide reporting. This study evaluated the completeness of police suicide records by linking them with hospital and civil registration data and examining the extent to which suicide deaths identified across these sources were captured in police registers. Method: A secondary analysis was conducted on a case series of suicides identified through a prospective surveillance system established for a randomized controlled trial in Anuradhapura District, Sri Lanka (April 2019-September 2023). Police records were linked with hospital and civil registration data. Sensitivity and 95% confidence intervals (CIs) were calculated overall and stratified by hospital admission status and method of suicide. Results: A total of 663 suicide deaths were identified across the three sources, with 310 reported by all. Police registers recorded 615 deaths, with a sensitivity of 91.0% (95% CI: 86.8%-93.8%) for hospital deaths and 94.0% (95% CI: 91.2%-95.8%) for nonhospital deaths. Method-specific sensitivity was 93.2% (95% CI: 89.1%-95.8%) for pesticide ingestion (n = 237), 70.7% (95% CI: 55.5%-82.6%) for nonpesticide poisoning (n = 41), 97.3% (95% CI: 94.8%-98.7%) for hanging (n = 336), and 77.6% (95% CI: 63.6%-87.0%) for other methods (n = 49). Limitations: Findings are limited to one district and may not be generalizable nationally. Conclusions: Police registers are a largely comprehensive source of suicide data in Sri Lanka, although some cases are missed, particularly for less common methods. This underreporting suggests national suicide rates may be slightly underestimated. In countries lacking a WHO-recommended robust civil registration and vital statistics system, police data remain an important source for suicide surveillance and public health planning.