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Concerns over reliability of suicide rates

The increasing reliance on the use of 'narrative verdicts' by coroners in England and Wales casts doubt on the accuracy of suicide rates, researchers claim.

Research published in the British Medical Journal claims "a growing number" of coroners are electing to pass 'narrative verdicts' following inquests into unnatural or unexpected deaths.

The number of 'narrative verdicts' grew from 111 in 2001 to 3,012 in 2009. Researchers claim figures for 2010 indicate "numbers will continue to rise".

'Narrative verdicts' record, in several sentences, how, and in what circumstances, a death occurred.

Researchers led by Professor David Gunnell from the University of Bristol claim suicide statistics for the years when 'narrative verdicts' increased "should be treated with caution".

As 'narrative verdicts' do not mention intent, the study warns they can be "difficult" for the Office of National Statistics (ONS) to code.

The ONS estimates that if all deaths from hanging and poisoning given narrative verdicts by coroners and coded as accidents were, in fact, suicides, the 2009 suicide rate would have been underestimated by 6%.

This is a difference equivalent to almost a third of the National Suicide Prevention Strategy's 20% reduction target.

Gunnell et al warn "as the number of narrative verdicts rises, so too may the underestimation of suicide."

"Reliable statistics are crucial to public health surveillance," said the researchers.

"Changes are needed urgently, but the current government's proposed abolition of the post of chief coroner is likely to delay the implementation of recommended improvements and the development of consistent practice across the country."

'Narrative verdicts' could also lead to misleading evaluations of national and local prevention activity, and the masking of the effects of the current economic crisis on suicide.

The ONS has said it is currently reviewing its coding of 'narrative verdicts' and the Coroners' Society of England and Wales is also looking to investigate how it can improve the situation.

Official figures from the ONS show suicide accounted for 4,648 deaths in England and Wales in 2009.

This is based on suicide and open verdict deaths given by coroners after inquests into unnatural or unexpected deaths. 

The research is part-funded by the National Institute for Health Research.