Number of suicide deaths increased since 1990

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The total number of deaths from suicide increased by 6.7% globally between 1990 and 2016 to 817,000 deaths in 2016, finds a study. However, when adjusted for age, the global mortality rate from suicide decreased by almost a third (33%) worldwide over the same period.

In general, the findings show that men had higher mortality rates from suicide than women, and that higher rates tended to be linked to higher levels of social and economic deprivation. But they also show that suicide trends vary substantially across countries and between groups, reflecting a complex interplay of factors that warrant further investigation, say the authors.

Suicide is a global public health concern, with around 800,000 deaths reported annually. The World Health Organisation aims to reduce suicide mortality by one third between 2015 and 2030.

Identifying those most at risk is therefore crucial for national prevention efforts. So, an international team of researchers used data from the 2016 Global Burden of Disease Study to describe patterns of suicide mortality and years of life lost globally and regionally, and by age, sex and socio-demographic index (a combined measure of fertility, income, and education) from 1990 to 2016.

The total number of deaths from suicide increased by 6.7% globally over the 27-year study period to 817,000 deaths in 2016. However, when adjusted for age, the global mortality rate decreased by almost a third (33%) worldwide between 1990 and 2016.
Suicide was the leading cause of age standardised years of life lost in the high-income Asia Pacific region and was among the top 10 leading causes of death across eastern Europe, central Europe, high income Asia Pacific, Australasia, and high income North America.

Globally, suicide rates were higher for men (15.6 deaths per 100,000) than for women (7 deaths per 100,000), however, the rate of decrease was lower for men (24%) than for women (49%). Women also experienced higher rates than men in most countries with a low sociodemographic index.

Suicide continues to be an important cause of mortality in most countries worldwide, but it is promising that both the global age standardised mortality rate and years of life lost rate from suicide have decreased by a third between 1990 and 2016, write the authors.
Whether this decline is due to suicide prevention activities, or whether it reflects general improvements to population health, warrants further research, they say.

This is an observational study and the researchers point to some limitations, such as under-reporting or misclassification of cause of death, especially in countries with religious and cultural sanctions against suicide. As such, they say these results might be an underestimate of the true burden.

Taken as a whole, these patterns reflect a complex interplay of factors, specific to regions and nations, say the authors. Research must continue to build the evidence base for effective interventions that are sensitive to regional and national contexts to address this continuing public health concern, they conclude.

In a linked editorial, Ellicott Matthay at the University of California-San Francisco, agrees that these results should be interpreted with some caution, but says these findings “will spur research that could inform future policy.”

Results could prove useful to governments, international agencies, donors, civic organisations, physicians, and the public to identify the places and groups at highest risk of self-harm and to set priorities for interventions, particularly for countries without complete vital registration systems, she writes.

As new data and methods emerge, “regular updating of suicide mortality estimates will be needed to inform research, policies, and recommendations with the best available evidence,” she concludes.

Abstract
Objectives: To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016.
Design: Systematic analysis.
Main outcome measures: Crude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education).
Results: The total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%).
Conclusions: Age standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates.

Authors
Mohsen Naghavi, on behalf of the Global Burden of Disease Self-Harm Collaborators

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