Social Psychiatry and Psychiatric Epidemiology

, Volume 45, Issue 2, pp 143–152

‘Hidden’ suicides amongst deaths certified as undetermined intent, accident by pesticide poisoning and accident by suffocation in Taiwan

  • Shu-Sen Chang
  • Jonathan A. C. Sterne
  • Tsung-Hsueh Lu
  • David Gunnell
Original Paper

DOI: 10.1007/s00127-009-0049-x

Cite this article as:
Chang, SS., Sterne, J.A.C., Lu, TH. et al. Soc Psychiat Epidemiol (2010) 45: 143. doi:10.1007/s00127-009-0049-x



To identify cause-of-death categories in which suicides might be misclassified in Taiwan.


We plotted secular trends (1971–2007) in sex- and method-specific rates of deaths classified as suicide, undetermined intent and accident for the Taiwanese population aged 15+ and compared the sex, age and marital status profiles of deaths in these three categories by method of death.


The demographic profiles of registered suicides generally resembled those for deaths of undetermined intent and accidents by pesticide poisoning/suffocation but differed from those for accidents from non-pesticide poisoning/drowning/falling/poisoning by non-domestic gas. For the period 1990–2007, suicide rates based on suicides alone (14.8 per 100,000) would increase by 23, 7 and 1%, respectively, when including deaths of undetermined intent, accidental pesticide poisonings and accidental suffocations.


Suicide rates may be underestimated by more than 30% in Taiwan because some suicides are ‘hidden’ amongst deaths certified as due to other causes.


SuicideCause of deathClassificationMethodsTaiwan

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Shu-Sen Chang
    • 1
    • 2
  • Jonathan A. C. Sterne
    • 1
  • Tsung-Hsueh Lu
    • 3
  • David Gunnell
    • 1
  1. 1.Department of Social MedicineUniversity of BristolBristolUK
  2. 2.Ju Shan HospitalTaoyuanTaiwan
  3. 3.Institute of Public Health, College of MedicineNational Cheng Kung UniversityTainanTaiwan