The findings in this report are subject to at least four limitations. First, the findings are subject to variation among state coroners/medical examiners regarding determination of manner of death, especially for poisoning, as recorded on the death certificate (9). Second, suicide rates likely are an underestimate of the actual prevalence because suicides might be undercounted in NVSS (9). Third, NVSS lacks information about factors such as physical and mental health history at the time of suicide and recent stressors that might have contributed to risk for suicide. The National Violent Death Reporting System collects more comprehensive information on suicide circumstances but the system currently is limited to 18 states.§ Finally, suicide rates might be affected by death certificate race/ethnicity misclassification, particularly for AI/ANs.¶
