Are Suicide Attempts Under-Reported?

Trigger warning: this post involves frank discussion of suicide and a suicide attempt.

I've been considering the idea that suicide attempts are underreported. The theory of this is simple, the only way a suicide attempt gets reported is if a person gets medical help for it and admits to it but how many people have attempted suicide and not gotten medical help for it or have denied that it was a suicide attempt? I know one person -- me. I didn't get help for my suicide attempt. My attempt isn't part of the statistics about suicide attempts in bipolar disorder. So are suicide attempts underreported in general?

My Unreported Suicide Attempt

Back in 2010, things were horrendous for me. I was in one of the deepest darkest depressions I had ever been stuck in. I won't take you back there, but suffice it to say, I was being denied access to psychiatric treatment because of processes that were clearly made without care. I knew that if I couldn't get psychiatric treatment then I couldn't get help, and if I couldn't get better, then I couldn't get better, and if I couldn't get better, then what was the point of going on? And one day this weighty reality was just too much for me. Drugs, alcohol and other things were involved in this suicide attempt but for reasons I won't get into, it didn't result in my death. It resulted in me waking up on my kitchen floor.

And I never told anyone about it until I started telling my story to crowds. It's an odd thing to admit to an audience before you sit down and tell your best friend.

Underreporting of Suicide and Suicide Attempts

I am not exactly alone in not reporting my suicide attempt. I've talked to many others who have attempted suicide, survived and then told no one. This isn't what I would recommend, but it's something that really does happen out here in the imperfect, real world.

It is known that suicides themselves are underreported and some scientists have tried to figure out by how much. One study from the United Kingdom estimated that only approximately 47-65 perfect of probable suicides were actually classified as suicides by coroners. It is thought that in the United States, the numbers are similar. In the United States, suicides are thought to be misclassified due to "incomplete data or stigma, particularly in teens and minorities."¹ 

Suicide attempts can easily be misclassified for the same reasons: people show up in the Emergency Room after an attempt and due to lack of information, stigma, and patient denial, the incident is not classified as a suicide attempt. This, of course, doesn't even take into account situations like mine where I didn't even end up in an Emergency Room.

The military has conducted surveys both anonymous and not, and have shown that in post-deployment officers, 5.1 percent of people report suicidal ideation when a survey is anonymous whereas during their actual post-deployment health assessment, only 0.9% of people reported suicidal ideation.² That means that 5.7 times more people report suicidal ideation when it's anonymous. Suicide ideation doesn't equal a suicide attempt, of course, but what we know is that the suicide rate in the veteran population is sky-high and this may be part of the reason. (In 2015, veterans accounted for 14.3 percent of all deaths by suicide in adults [adge 18 and up] in the United States and constituted 8.3 percent of the adult population in the United States.³)

The Implications of Underreported Suicide and Suicide Attempts

There are so many things that happen when a suicide or a suicide attempt is not supported. The first thing that comes to mind is a hindrance to understanding and program funding. For example, current numbers state that about 11 percent of people with bipolar disorder die by suicide while up to half of those with bipolar attempt suicide.⁴ However, if these numbers are falsely low, it matters in our understanding of the illness and our understanding of how to help people with the illness. Risk management in bipolar is key, but if we don't really understand the risk, how can we manage it?

And yes, funding really matters. If you can show politicians that more of their electorate are dying, they will, theoretically, care more and set aside more money to help those people.

But apart from all of that, you have the human cost. You have the cost to all those who do not get appropriate help after attempting suicide (like me) and the cost to all those families who will never know the truth about their loved one's death. And what I know is that those costs are very, very high.

No single one of us can change these realities. People are always going to be scared of reporting suicidal ideation and suicide attempts. Coroners are always likely to veer away from noting the cause of death as suicide. This is just humanity for you.

But September is National Suicide Awareness Month and now is the time when we need to talk about these things. We need to talk about suicide. We need to talk about suicide attempts. We need to honor those who have died by suicide by making sure that not one more avoidable death happens. Our open and honest conversations about suicide can do that. We can normalize suicidal ideation and, more importantly, normalize getting help for suicidal ideation. We can teach people what to look for when it comes to suicidality. We can know who to turn to if we or someone else needs help. This is our time. This is our moment.

Don't let this moment slip away. Start talking suicide. It will cost you nothing and yet can save everything.

If you feel that you may hurt yourself or someone else, call 9-1-1 immediately.

For more information on suicide, see our suicide information, resources and support section. For additional mental health help, please see our mental health hotline numbers and referral information section.

Sources

1. Shepard, D., Gurewich, D., et al, "Suicide and Suicidal Attempts in the United States: Costs and Policy Implications." Suicide & Life-Threatening Behavior, October 2015.
2. Vannoy S., Andrews B., et al, "Under Reporting of Suicide Ideation in US Army Population Screening: An Ongoing Challenge." Suicide & Life-Threatening Behavior, December 2017.
3. United States Department of Veteran Affairs, "Facts About Veteran Suicide." June 2018.
4. Soreff, S., Bipolar Disorder. Medscape, May 30, 2019.