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 published by The BMJ today. 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 Organization 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 sociodemographic 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 organizations, 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.

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