Indonesia's first suicide statistics profile: an analysis of suicide and attempt rates, underreporting, geographic distribution, gender, method, and rurality.

Background: Timely and accurate data are critical for effective suicide prevention. Indonesia-the fourth most populous country in the world-has limited data availability and thus, limited data-driven interventions. Through a national government partnership, we obtained critical non-public data for attempts and suicides that could be analysed for the first time in Indonesia's history. Methods: We obtained and analysed data from five sources from 2016 to 2021: police data, death registry data, a provincial survey, a sample registry system, and the WHO's Global Health Observatory (WHO GHO) data. Using these data, we estimated underreporting, identified provinces with the highest suicide and suicide attempt rates, assessed gender ratios, identified methods used, and compared urban and rural suicides. Findings: The analysis yielded an underreporting rate of 859.10% for suicides, while verbal autopsies and increased quality control only increased coverage from 12.80% to 51.40%. Provinces with the highest rates of suicide were Bali, Riau Islands, Special Region of Yogyakarta, Central Java, and Central Kalimantan. Gender analysis revealed a ratio of 1: 2.11 for female to male suicides. Suicide methods analysis revealed that hanging and self-poisoning were the most used method, and rural suicides occurred at a rate 4.47 times higher than urban suicides. Interpretation: The analysis revealed the highest underreporting rate in the literature from a national sample and vast heterogeneity among provinces with high suicide rates-including provinces with strong mystic beliefs, suggesting the need for a culturally sensitive sub-national tailored approach. Through our study, we provide critical information which will allow for data-driven suicide prevention. Funding: The data collection for this was part of a project funded by the Australian Department of Foreign Affairs and Trade, Australian-Indonesian Institute (AII2020322).