Background Four Western countries (Greece, Ireland, Italy and Portugal) with strong Orthodox and Catholic traditions have been associated with the underreporting of death by suicide, and underreported suicides are sometimes found among deaths recorded as ‘undetermined’ or ‘accidental’. Aims This population-based study tests whether there are any significant difference in patterns of suicides, undetermined deaths and accidental deaths between these four Western countries and 21 predominately Islamic countries. Method World Health Organization age-standardised death rates per million population were used to compare suicide rates with combined undetermined death and accidental death (UnD+AccD) rates, from which odds ratios were calculated. Substantial odds ratios (OR > 2.0) were taken as indicative of likely underreporting of suicides. The Islamic countries come from four different historico-cultural regions, described as: less-traditional Islamic countries; former USSR countries; Gulf Arab states; and Middle Eastern and North African countries. χ2-tests were used to determine any significant differences between the Western comparator countries and the Islamic regions. Results For the Western comparator countries, the average suicide rate was 66 per million population, the average undetermined death rate 56 per million and the average accidental death rate 58 per million, yielding a suicide:UnD+AccD odds ratio (OR) of 1.73. The average values for the other three groups were as follows. Less-traditional Islamic countries: suicide rate, 31 per million; UnD+AccD rate, 101 per million; suicide:UnD+AccD OR = 3.3. Former USSR countries: suicide rate, 61 per million; UnD+AccD rate, 221 per million; suicide:UnD+AccD OR = 3.6. Gulf Arab states: suicide rate, 10 per million; UnD+AccD rate, 76 per million; suicide:UnD+AccD OR = 8.6. Middle Eastern and North African countries: suicide rate, 6 per million; UnD+AccD rate, 151 per million; suicide:UnD+AccD OR = 25.2. The patterns of these mortalities in the Islamic countries was significantly different from Western comparator countries. Conclusions The results indicate underreporting of suicides in Islamic countries. This might inadvertently lead to reduced access to mental health preventive services in both Western and Islamic countries.

Purpose This paper aims to consider the relationship between disability hate crime and safeguarding adults. It critically considers whether safeguarding responses to disability hate crime have changed following the implementation of the Care Act 2014. Historically, protectionist responses to disabled people may have masked the scale of hate crime and prevented them from seeking legal recourse through the criminal justice system (CJS). This paper investigates whether agencies are working together effectively to tackle hate crime. Design/methodology/approach The research presented draws on semi-structured interviews with key informants who work with disabled people and organisations as part of a wider study on disability hate crime. Findings Prior to the Care Act, safeguarding practice often failed to prioritise criminal justice interventions when responding to reports of disability hate crimes. Improving engagement within multi-agency safeguarding hubs and boards has the potential to increase hate crime awareness and reporting. Research limitations/implications This research was limited in scope to 15 participants who worked in England within safeguarding teams or with victims of hate crime. Practical implications Raising the profile of disability hate crime within safeguarding teams could lead to achieving more effective outcomes for adults at risk: improving confidence in reporting, identifying perpetrators of hate crimes, enabling the CJS to intervene and reducing the risk of further targeted abuse on the victim or wider community. Originality/value This paper is original in its contribution in this field as there is a dearth of research on the relationship between safeguarding and disability hate crime.

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