Extent of and Reasons for the Underreporting of Suicide Deaths to the Police in India

<b></b> <i>Background:</i> Little is known about the underreporting of suicide deaths to the police in India. <i>Aim:</i> To document the extent and reasons of underreporting suicide deaths to the police by socio-demography of the deceased in India. <i>Methods:</i> Interviews documented if a suicide death was reported to the police for suicide deaths that occurred between 2019 and 2022 in India, identified as part of a national all-cause mortality survey in nine states. Further interviews in three of these states explored the reasons for underreporting of suicide deaths to the police. <i>Results:</i> The prevalence of underreporting suicide deaths to the police in India was 35.5% (95% CI 30.8, -40.6), 34.1% (95% CI 28.5, -40.2), and 38.6% (95% CI 30.1, -47.9) for both sexes combined, male, and female suicide deaths, respectively. The underreporting was significantly higher in 15-19 years (46.7%; 95% CI 32.7, -61.2) and in 50+ years (42.5%; 95% CI 32.1, -53.6) compared to those in 30-39 years (19.0%; 95% CI 10.8, -31.1). Avoidance of postmortem was the most cited reason for underreporting followed by compromise between the affected parties, with variations in reasons seen by sex of the deceased and state. Concerns related to social stigma, maintaining family reputation, and securing custody of young children were mentioned as reasons more for female than male suicide deaths. <i>Limitations:</i> Underreporting estimates rely on self-report subject to recall and social desirability bias. Reasons for nonreporting were collected postevent and may not reflect real-time family or community decision-making. <i>Conclusion:</i> One in three suicide deaths are not reported to the police in India, with variations in this underreporting by age, urbanicity, and state of the suicide deaths. These findings can allow for developing targeted awareness campaigns and community engagement in high underreporting areas rather than a one-size-fits-all approach, and simplifying the police protocols around postmortem can help to reduce this underreporting.