Assessing non-fatal intentional poisoning incidents as a national sentinel indicator for suicide mortality trends in Malaysia (2006 to 2021): a mechanistic and economic impact estimation

A 16-year ecological time-series study found that non-fatal intentional poisoning reported to Malaysia’s National Poison Centre was only weakly associated with official suicide mortality trends from 2006 to 2021. In the study abstract, the overall Spearman correlation was weak (rs = 0.182), with substantial divergence during the latter half of the period. The authors described National Poison Centre data as a potentially sensitive sentinel indicator for acute changes in suicide-related behavior and method lethality, rather than as a direct parallel measure of overall suicide mortality.

The analysis combined National Poison Centre records with suicide fatality data from the Department of Statistics Malaysia. Researchers used Spearman correlation, Durbin–Watson statistics and an autoregressive integrated moving average with exogenous predictor model, ARIMAX(1,0,0), to account for longitudinal autocorrelation. The reported ARIMAX result was an AIC of -1.12, while the Durbin–Watson diagnostic was 0.61. An economic impact estimation was also formulated using Malaysia’s official Value of Statistical Life as a proxy, although the supplied abstract does not report the estimated economic value.

The clearest divergence occurred between 2019 and the 2021 pandemic peak. National Poison Centre reports of non-fatal intentional poisoning attempts fell by 29.2%, from 1,212 cases to 857, while Department of Statistics Malaysia suicide fatalities rose by 85.7%. The authors interpreted this pattern as supporting a hypothesis of method substitution toward more lethal means during the pandemic; the observational analysis does not, however, establish that such substitution caused the increase in fatalities. Age-specific analysis identified people aged 20 to 39 as the strongest age-group anchor, with a correlation of rs = 0.826.

These findings are based on an ecological and time-series design covering national aggregate data over 16 years, and the available summary does not describe individual-level exposure, intent ascertainment, completeness of fatal and non-fatal case capture, or possible changes in reporting and service use. The data also cover intentional poisoning only and therefore cannot represent all suicide methods. The study’s conclusion is consequently bounded: integrating toxicovigilance information with national psychiatric surveillance may offer a cost-effective way to monitor acute behavioral shifts, but the observed weak overall correlation means that non-fatal poisoning reports should not be treated as interchangeable with official suicide mortality statistics.

Subject of Research: National time-series assessment of non-fatal intentional poisoning as a sentinel indicator for suicide mortality trends in Malaysia, 2006–2021

Article Title: Assessing non-fatal intentional poisoning incidents as a national sentinel indicator for suicide mortality trends in Malaysia (2006 to 2021): a mechanistic and economic impact estimation

Article References: Ismail, S. A., Shamsuddin, S., Md Nor, N., Crüts, B., Gamerschlag, L., Hussain, H., Sh-Hussain, S. H., Kamaruzaman, N. A., Mohd Zaini Makhtar, M., Ramdan, M. I., Ishak, N. A., Saputra, H., Che Dom, N., & Noorhisham, N. H. (2026). Assessing non-fatal intentional poisoning incidents as a national sentinel indicator for suicide mortality trends in Malaysia (2006 to 2021): a mechanistic and economic impact estimation. BMC Public Health. https://doi.org/10.1186/s12889-026-29733-8

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29733-8

Keywords: Malaysia, suicide mortality, intentional poisoning, toxicovigilance, time-series analysis, sentinel indicator, method substitution, pandemic, economic impact, Assessing, non-fatal, intentional