"The large variations in the systems and processes to define mortality causes imply there may be very different numbers of deaths that are registered with a specific cause. This creates a problem for cross-country comparisons of mortality by cause in general, and even more so for deaths of despair, and suicides in particular.
The person responsible for writing the cause of death on the death certificate may be different across countries. In some countries, the police are responsible, while in others a medical doctor, coroner, or judicial investigator takes on this role. Differences in doctors’ training, access to medical records, and autopsy requirements contribute to these discrepancies. The legal or judicial systems that decide causes of death also vary. For instance, in some countries suicide is illegal and is not listed as a classifiable cause of death, leading to underreporting or misclassification of suicides as accidents, violence, or deaths of “undetermined intent.”[25]
Data on suicides, even when reported, can be inaccurate due to social factors as well. In some countries, suicide might be taboo and highly stigmatised, so the families and friends of the person who committed suicide might decide to misreport or not disclose the mortality cause, causing underreporting of its incidence. In other societies, such as Northern Europe, there is less stigma attached to suicides, and alcohol and drug use."
"The large variations in the systems and processes to define mortality causes imply there may be very different numbers of deaths that are registered with a specific cause. This creates a problem for cross-country comparisons of mortality by cause in general, and even more so for deaths of despair, and suicides in particular.
The person responsible for writing the cause of death on the death certificate may be different across countries. In some countries, the police are responsible, while in others a medical doctor, coroner, or judicial investigator takes on this role. Differences in doctors’ training, access to medical records, and autopsy requirements contribute to these discrepancies. The legal or judicial systems that decide causes of death also vary. For instance, in some countries suicide is illegal and is not listed as a classifiable cause of death, leading to underreporting or misclassification of suicides as accidents, violence, or deaths of “undetermined intent.”[25]
Data on suicides, even when reported, can be inaccurate due to social factors as well. In some countries, suicide might be taboo and highly stigmatised, so the families and friends of the person who committed suicide might decide to misreport or not disclose the mortality cause, causing underreporting of its incidence. In other societies, such as Northern Europe, there is less stigma attached to suicides, and alcohol and drug use."
https://www.worldhappiness.report/ed/2025/supporting-others-...