Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 1, pp 111–119 | Cite as

The influence of undetermined deaths on suicides in Shanghai, China

  • Feng Li
  • Xuesong Lu
  • Ying Ou
  • Paul S. F. YipEmail author
Original Paper



In global forensic practice, some suicides were misclassified as undetermined deaths, leading to suicide underreporting. In this study, we aimed to explore the influence of undetermined deaths on suicides in Shanghai, China.


The police records on suicide verdicts and undetermined deaths in Pudong, Shanghai, from 2004 to 2016 were used. In this study, undetermined deaths have been classified into three levels of suicide possibilities namely, probable, possible, and highly unlikely. Probable suicides were presumed as misclassified suicides. Poisson regression was used to calculate the rate ratio (“RR”) of probable suicides compared to suicide verdicts. Poisson regression was also used to calculate the annual percentage change (“APC”) of the original suicide rates (crude suicide rates based on the suicide verdicts) and adjusted suicide rates (crude suicide rates based on the suicide verdicts and probable suicides).


Among the 1,318 underdetermine deaths, 560 (42.5%) were classified as probable suicides. The overall RR was 0.23 (95% CI 0.21–0.26): 0.15 (0.13–0.17) for the locals’ RR and 0.22 (0.19–0.26) for the migrants’ RR. The APCs of the original and adjusted suicide rates were − 2.0 (− 3.1 to − 0.9) and − 2.9 (− 3.8 to − 2.0), respectively, for the overall population.


The number of suicides could be 23% higher than the reported cases. Suicides were more likely to be underreported in migrants than in the locals. Thus, it is important to improve suicide monitoring and the surveillance systems in China.


Suicide Underreporting Undetermined death China 


Author contributions

XL had full access to all the data in the study and takes responsibility for the integrity and the accuracy of the data. Concept and design: FL and XL. Drafting of the manuscript: all authors.


No funding was received.

Compliance with ethical standards

Conflict of interest

All authors declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Feng Li
    • 1
  • Xuesong Lu
    • 2
  • Ying Ou
    • 1
  • Paul S. F. Yip
    • 3
    Email author
  1. 1.Social Work and Social Administration DepartmentThe University of Hong KongPokfulamChina
  2. 2.Criminal Science InstitutePudong District of Shanghai Municipal Public Security BureauShanghaiChina
  3. 3.Hong Kong Jockey Club Centre for Suicide Research and PreventionThe University of Hong KongPokfulamChina

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