A scholarly paper titled “How many people die by suicide each year? Not 727,000: a systematic review and meta-analysis of suicide underreporting across 71 countries over 122 years” was recently published in Frontiers in Psychiatry (1). Researchers from Padova, Italy conducted a study aimed at synthesizing evidence on suicide underreporting and estimating a global underreporting rate.

The authors performed a systematic review of suicide underreporting, complemented by a meta-analytical synthesis. Quantitative data were extracted from individual studies to generate a global estimate of suicide underreporting. In total, 42 studies covering 71 countries from an initial pool of 770 unique studies (spanning 1900–2021) were included. Most relied on retrospective institutional datasets, using methods such as reclassification of undetermined deaths or cross-database comparisons. Demographic and geographic disparities in reporting were also assessed.

Of the 42 studies included, all provided quantitative data on suicide underreporting in general or specific populations, and 14 contributed data suitable for meta-analysis. The global suicide underreporting rate was estimated at 17.9% (95% CI: 10.9–28.1%), with substantial variation between countries of high versus low/very low data quality. Based on this estimate, the most recent WHO suicide figures—after correction for underreporting—would exceed one million deaths per year (1,000,638; 95% CI: 859,511–1,293,006), rather than the commonly cited 727,000.

Underreporting was notably higher in low- and middle-income countries with incomplete death registration systems, such as India and China (34.9%; 95% CI: 20.3–53%), whereas high-income countries showed lower rates (11.5%; 95% CI: 6.6–19.3%). Contributing factors included stigma, religiosity, limited forensic capacity, and inconsistent application of International Classification of Diseases (ICD) coding. Gender and age disparities were also observed: suicides among women and among younger or older individuals were more likely to be misclassified.

Reference

1. Meda N, Angelozzi L, Poletto M, Patane’ A, Zammarrelli J, Slongo I, Sambataro F, De Leo D. How many people die by suicide each year? Not 727,000: a systematic review and meta-analysis of suicide underreporting across 71 countries over 122 years. Front Psychiatry. 2025 Aug 12;16:1609580. doi: 10.3389/fpsyt.2025.1609580.