Currently submitted to: JMIR Public Health and Surveillance
Date Submitted: Mar 31, 2026
Open Peer Review Period: Mar 31, 2026 - May 26, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Non-Fatal Intentional Poisoning Incidents as a Proxy for National Suicide Mortality Trends in Malaysia (2006–2024): A Clinicoeconomic Simulation for Proactive Prevention
ABSTRACT
Background:
Suicide is a major public health concern in Malaysia. Relying solely on official mortality statistics often introduces significant reporting delays, hindering immediate public health response. In Malaysia, while the Suicide Mortality Rate (SMR) is the paramount metric for national health planning, official statistics suffer from a significant 1–2 year reporting lag, rendering prevention reactive.
Objective:
This study aimed to assess the utility of non-fatal intentional poisoning data—collected in near real-time by the National Poison Centre (NPC-USM)—as a sentinel proxy for estimating national SMR trends.
Methods:
Annual Incidence Rates (AIR) of NPC Suicidal Cases (2006–2024) were calculated using national population estimates. The NPC AIR was correlated with published Age-Standardized SMR (Lew et al., 2022) for the 2006–2019 period using Spearman’s Rank Correlation (rs). Simple Linear Regression (SLR) was utilized to model the associative relationship and generate scenario-based estimates for 2024.
Results:
A very strong positive correlation was found between the NPC AIR and the overall SMR (rs =0.800, p<0.001), and specifically with the Male SMR (rs =0.813, p<0.001), indicating strong trend alignment. SLR modeling showed the NPC AIR explained a significant portion of SMR variance (R2=0.763, p<0.001), resulting in a projected Age-Standardized SMR of 6.94 per 100,000 [95% CI: 6.12–7.76] for 2024. Analysis of age group distribution revealed that the 20–74 years demographic drives the strongest correlation with overall SMR (rs =0.769). The divergence between non-fatal attempts (+9.4%) and official fatalities (+81.0%) during the 2021 pandemic peak suggests a potential method substitution toward higher lethality, highlighting the NPC's utility as a responsive surveillance tool.
Conclusions:
We present an illustrative Clinicoeconomic Sensitivity Analysis demonstrating that the two-year strategic window provided by the NPC data allows for proactive prevention strategies. A conservative intervention scenario (10% reduction in mortality) suggests a potential societal value preservation of approximately RM 1.2 Billion. These findings suggest that NPC data is a robust, timely supportive indicator that should be integrated into Malaysia's national suicide prevention framework to bridge the gap in official mortality reporting.
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