Every year around 740,000 suicides are recorded worldwide: that means one death every 43 seconds, one of the many conclusions from the latest and most comprehensive analysis published today in The Lancet Public Health. Researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington's School of Medicine in Seattle delved deep into the Global Burden of Disease data by region, country, year, age, sex, and suicide from 1990 to 2021.
Over the last three decades, the global age-standardized suicide mortality rate has decreased by almost 40%, from about 15 deaths per 100,000 to 9 deaths per 100,000, indicating that intervention and prevention are working. For women, the rate decreased by over 50%, while for men, it decreased by almost 34%. Regionally, East Asia saw the largest decrease of 66%, with China leading the decline in the region.
Although progress is encouraging, it is not universal. Four regions saw increases in suicide rates for both sexes combined during the same period. Central Latin America saw the highest increase at 39%, with Mexico topping the list with a 123% increase for women only. Andean Latin America followed with a 13% increase, with Ecuador showing the highest increase in the region for both sexes. Tropical Latin America ranked third with a 9% increase, and Paraguay led the list in the region for both sexes combined. North America, with high incomes, saw a 7% increase, with the U.S. leading the region with a 23% increase for women only.
Among the 2021 global causes of death, suicide ranked 21st (above HIV/AIDS) for both sexes combined. Regionally, the highest suicide mortality rates were recorded in Eastern Europe, Southern Sub-Saharan Africa, and Central Sub-Saharan Africa. For males, suicide was the 19th leading cause of death worldwide, with Eastern Europe having the highest mortality rate. For females, suicide ranked 27th, with South Asia having the highest rate.
Understanding who and why is at higher risk
"While the progress made in reducing suicide rates is encouraging, it is clear that suicide continues to affect some countries and populations more than others. Eliminating the stigma of suicide and barriers to accessing mental health support remain crucial, especially among individuals with mental and substance use disorders," said lead author Mohsen Naghavi from IHME.
Previous studies have shown that victims of violence, sexual assault, and childhood traumas are at higher risk of suicide. Research consistently demonstrates that access to lethal means, such as firearms and pesticides, is associated with higher suicide rates. Previous evidence suggests that poverty and social deprivation are also linked to suicide.
The latest figures also highlight a stark difference between men and women globally, regionally, and nationally. Men are more than twice as likely to die by suicide as women, but women are 49% more likely to attempt it. According to researchers, every minute, four men and six women required hospital treatment due to suicide attempts. Overall, the suicide mortality rate was 12.8 per 100,000 inhabitants for males and 5.4 per 100,000 inhabitants for females.
The incidence of suicide attempts requiring medical attention without resulting in death was three times higher among women than men. This difference was more pronounced in North America, where one out of 30.7 attempts resulted in death for women and one out of 6.3 attempts resulted in death for men.
Globally, males were over three times more likely to die by suicide with firearms than females: 10% of male suicides were by firearms, while 3% of female suicides were by firearms. The U.S. recorded the highest number of firearm suicides in the world: nearly 22,000, or 55% of male suicides, were by firearms, while over 3,000, or almost 31% of female suicides, were by firearms.
"Men tend to choose more violent and lethal suicide methods while women are more likely to choose less lethal means," stated Emily Rosenblad, the study's second author and project lead at IHME.
Both men and women worldwide are dying by suicide at older ages. In 1990, the average age of death for males was 43 years, and for females, it was almost 42 years. By 2021, the average age of death had risen to 47 years for males and almost 47 years for females. The highest average age was around 58 years for males and 60 years for females, both in East Asia. In contrast, the youngest average age for suicide was recorded in Oceania, with 36 years for men and 34 years for women.
Throughout the study, existing patterns and trends are identified to develop more effective suicide prevention methods worldwide, which can help policymakers and healthcare personnel tailor strategies and approaches better suited to specific locations and populations.