Suicides present a significant burden for societies around the world. According to the 2019 estimates from the World Health Organization (WHO), suicides caused over 700,000 deaths worldwide, representing about 1.3% of all deaths globally, making it the 17th leading cause of death in 2019.
In 2016, suicide was among the top 10 leading causes of death in Eastern Europe, Central Europe, Western Europe, Central Asia, Australasia, Southern Latin America, and in high-income areas of North America. Globally, for both sexes, suicide was the 4th leading cause of death in young people aged 15-29 years in 2019. In 2019, in several countries (such as Australia, Belarus, Canada, Finland, Germany, Japan, Kazakhstan, Mongolia, Montenegro, Netherlands, Norway, Republic of Korea, Russian Federation, Singapore, Sweden, Switzerland, and the United Kingdom), self-harm was the 1st leading cause of death in people aged 15-34 years for both sexes.
The majority of suicide deaths (77%) occurred in low- and middle-income countries in 2019. For both sexes in 2016, the lowest suicide death rates were found in countries in North Africa and the Middle East (4.8/100000). During the last decades of the 20th century, declining suicide mortality trends were observed in Eastern Europe, the European Union, the United States of America, and in Japan, while suicide mortality increased sharply in the Russian Federation.
WHO and the United Nations Sustainable Development Goals aim to reduce suicide mortality by one third by 2030. Reducing the global suicide mortality rate by a third is both an indicator and a target (the only one for mental health) in the United Nations (UN)-mandated Sustainable Development Goals (SDGs). How the coronavirus disease 2019 pandemic is affecting the burden of suicide is not clear yet, considering the lockdown, increased mental stress, possible delays in mental and other illness diagnoses, etc.
Nevertheless, there is a scarcity of studies that explored the mortality of suicide in different areas, as most evaluations are limited to certain populations. For this descriptive epidemiological study, annual underlying cause of death data was used to describe trends in mortality from suicide for the period 2000-2019.
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Figures of suicide mortality were extracted from the WHO database and from the GBD Study. Mortality estimates of suicide covered site codes X60-X84 and Y87.0, based on the 10th revision of the International Classification of Diseases and Related Health Problems to classify death, injury and cause of death. The WHO and GBD databases provide a comprehensive and comparable assessment of mortality of suicide.
These databases provide high-quality death statistics by national vital registries worldwide, which were derived from death certificates. According to the WHO guidelines, the definition of the underlying cause of death includes a disease or injury that has started a series of diseases or an injury that has triggered a series of disease states that directly led to death. Mortality was recorded at a local civil registry with information on the cause of death. The information was collected by the health authority and reported to the WHO annually. Only mortality cases that were medically certified were reported.
The WHO estimates only comprised national mortality data series that meet the minimal inclusion criteria according to the WHO-defined medium data quality level, based on the degree of population coverage, completeness and accuracy. This manuscript presents data for 183 WHO Member States, i.e., only members/countries with a population of 90000 or greater in 2019.
We extracted data for suicide in men and women for 183 countries worldwide, over the period 2000-2019. Also, suicide mortality was presented within six WHO regions: Africa, the Americas, South-East Asia, Europe, Eastern Mediterranean, and Western Pacific. For this purpose, ASRs (per 100000) calculated by direct method of standardization by age and sex, using the world standard population, were used.
The magnitude and direction of temporal trends for suicide mortality were assessed using the joinpoint regression analysis (Joinpoint regression software, Version 4.5.0.1 - June 2017, available through the Surveillance Research Program of the United States National Cancer Institute), proposed by Kim et al. The joinpoint regression analysis detected point(s), the so-called “joinpoints”, where the statistically significant changes of suicide mortality rates occurred (increase or decrease), and determined the trends between joinpoints.
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The analysis starts with a minimum of zero joinpoints (i.e., a straight line) and tests whether a change in the trend was statistically significant by testing more joinpoints up to the maximum of four joinpoints (five segments). The annual percentage change (APC) for each of the identified trends of suicide rates using the calendar year as a regression variable was determined. For countries worldwide (including the global and regional level), the average APC (AAPC) over the entire considered period was calculated; for each AAPC estimate, the corresponding 95% confidence interval (CI) was determined.
The terms “significant increase” or “significant decrease” were used in describing the direction of temporal trends, in order to signify that the slope of the trend was statistically significant (P < 0.05, on the basis of the statistical significance of the AAPC compared to zero). For non-statistically significant trends (P > 0.05, while AAPC with a 95%CI including zero), the terms “non-statistically significant increase” (for AAPC > 0.5%), and “non-statistically significant decrease” (for AAPC < -0.5%) were used, while the term “stable” was used for AAPC between -0.5% and 0.5%.
Disparities in suicide mortality trends according to age and sex were tested by using a comparability test. The objective of the comparability test was to determine whether the two regression mean functions were identical (test of coincidence) or parallel (test of parallelism). This study was approved by the Ethics Committee of the Faculty of Medical Sciences, University of Kragujevac (No.
A total of 759028 (523883 male and 235145 female) suicide deaths were reported worldwide in 2019 (Figure 1). Per annum, the number of suicides ranged from 839548 in 2000 to 742962 in 2015. During the observed period, there were 15.7 million deaths from suicide in the world (10.6 million men and 5.1 million women).
Figure 2 shows the global distribution of suicide deaths in 2019 by WHO regions and by sex. In both sexes, most suicide deaths (230453; 31% of the total) were recorded in the South-East Asia region, followed by the region of the Western Pacific (184918; 24%). Almost one fifth of suicide deaths (137266) occurred in the European region. Compared to the distribution for both sexes, the differences in suicide deaths by regions in males are less obvious. In contrast, in females the dominant participation of suicides is evident in the region of South-East Asia (93552; 40% of the total).
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A map of global suicide rates, age-standardized per 100,000 population, 2021.
The global ASR of mortality from suicide was 9.0/100000 population in both sexes (Figure 3). The highest rates were found in the region of Africa (11.2/100000), followed by Europe (10.5), South-East Asia (10.2), the Americas (9.0) and Western Pacific (7.2), while the lowest rates were reported in the Eastern Mediterranean (6.4). The global ASR of suicide mortality in 2019 was more than a two-fold higher in males than in females (12.6 in men vs 5.4 in women). Suicide mortality in men was the highest in Africa (18.0) and Europe (17.1). The region of South-East Asia (with a rate of 8.1) tended to predominate in the suicide mortality of women across the world.
There were significant international variations in suicide mortality by sex in 2019 (Figure 4). In men, the suicide mortality rate was the highest in Lesotho (146.9/100000), followed by populations in Eswatini, Guyana, Kiribati (with rates of 78.7, 65.0 and 53.6, respectively), whereas the lowest mortality rates (1.0 or less per 100000 people) were registered in Barbados, Grenada, Antiqua and Barbuda (Figure 4A).
Globally, from 2000 to 2019, ASRs of mortality of suicide had a decreasing tendency in both sexes together [AAPC = -2.4% per year; 95%CI: (-2.6)-(-2.3)] (Figure 5A). Overall suicide mortality rates peaked at 14.0/100000 in 2000, and declined thereafter to 9.0/100000 in 2019. Joinpoint analysis identified two joinpoints, in 2009 and 2016, with three consequent trends. The first and second period showed significantly decreasing trends, with APC of -2.2% [95%CI: (-2.5)-(-2.0)] and -3.0% [95%CI: (-3.4)-(-2.5)], respectively. The trend since 2016 was stable, with APC of -0.5% [95%CI: (-1.9)-0.9].
Suicide mortality rates in males decreased from 18.9/100000 in 2000 to 12.6/100000 in the last year observed; AAPC = -2.2%, 95%CI: (-2.3)-(-2.1) (Figure 5B). Joinpoint analyses of suicide mortality in males identified two joinpoints in the year 2005 and 2016, with three trends. The first and second period showed significantly decreasing trends, with APC of -1.4% [95%CI: (-2.0)-(-0.9)] and -2.5% [95%CI: (-2.7)-(-2.3)], respectively. The trend since 2016 was characterized by a non-significant decrease, with APC of -1.3% [95%CI: (-2.6)-0.0].
In females, suicide mortality rates decreased from 9.5/100000 in 2000 to 5.4/100000 in the last year observed; AAPC = -3.0%, 95%CI: (-3.2)-(-2.8). Also, joinpoint analyses of suicide mortality in females identified two joinpoints in the year 2011 and 2016, with three trends. The first and second period showed significantly decreasing trends, with APC of -3.0% [95%CI: (-3.3)-(-2.7)] and -3.8% [95%CI: (-5.2)-(-2.4)], respectively. The trend since 2016 was stable, with APC of -0.2% [95%CI: (-2.5)-2.2].
When the suicide mortality trend was analyzed by six WHO regions, in males (Figure 6A) significantly decreasing trends were observed in five regions: In Africa (AAPC = -1.5%), South-East Asia (-2.1%), Europe (-3.4%), Eastern Mediterranean (-0.6%), and Western Pacific (-2.9%); the only exception was the region of the Americas, with a significantly increasing suicide mortality trend (+0.6%).
In comparison to males, suicide mortality rates were lower in females in countries across the world in 2019: The only exception was for females in Grenada and Antigua and Barbuda in whom suicide mortality rates higher than in men were recorded (Table 1). In both sexes together, a total of 133 of 183 countries showed a significantly decreasing trend in suicide mortality. Among the 133 countries where a decline in mortality of suicide was observed, Barbados (AAPC = -10.0%), Grenada (AAPC = -8.5%), Serbia (AAPC = -7.6%), and Venezuela (AAPC = -6.2%) had the most marked reductions.
In total, 26 countries had a significant increase in mortality of suicide and 24 countries reported stable trends. Out of all 26 countries with a rise in suicide mortality, Lesotho (AAPC = +6.0%), Cyprus (AAPC = +5.1%), Paraguay (AAPC = +3.0%), Saudi Arabia (AAPC = +2.8%), Brunei (AAPC = +2.6%), Greece (AAPC = +2.6%), Georgia (AAPC = +2.1%), and Mexico (AAPC = +2.0%), were among those with the highest increase in mortality.
Trends in suicide mortality were increasing significantly in both sexes in several countries - Brazil, Dominican Republic, Greece, Guinea, Jamaica, Lesotho, Mexico, Micronesia, the Netherlands, Papua New Guinea, Paraguay, Philippines, Saudi Arabia, Solomon Islands, Tajikistan, and United States of America.
Some countries have shown a significant increase in suicide mortality trends only in females - Australia, Canada, Equatorial Guinea, Nepal, Portugal, and Sierra Leone. In much of the world, suicide is stigmatized and condemned for religious or cultural reasons. In some countries, suicidal behavior is a criminal offense punishable by law.
Suicide rates vary by country but occurs in all regions of the world. In a 2024 WHO report, 73% of reported suicides were in low and middle-income countries. Mental illness and suicide are linked, though many suicides are impulsive and occur due to crisis. Groups subject to discrimination, including refugees, indigenous populations, and LGBTQ people, experience high suicide rates.
Societal and cultural taboos around the discussion of topics of suicide and lack of quality suicide data are impeding factors in suicide prevention. Male and female suicide rates are out of the total male population and total female population, respectively, i.e. total number of male suicides divided by the total male population. Age-standardized rates account for the influence that different population age distributions might have on the analysis of crude death rates, statistically addressing the prevailing trends by age-groups and populations' structures, to enhance long term cross-national comparability.
Based on age-groups' deviation from standardized population structures, rates are rounded up or down (age-adjustment). Basically, the presence of younger individuals in any given age structure carries more weight. Most countries listed above report a higher male suicide rate. Worldwide, there are about 3 male suicides out of 4, or a factor of 3:1.
Though age-standardization is common statistical process to categorize mortality data for comparing purposes, this approach by WHO is based on estimates which take into account issues such as under-reporting, resulting in rates differing from the official national statistics prepared and endorsed by individual countries. Revisions are also performed periodically. Age-adjusted rates are mortality rates that would have existed if all populations under study had the same age distribution as a "standard" population. Plain, crude estimated rates are available at here and here.
Countries with large internal discrepancies are complicated to assess. Canada, a country with a comparatively low suicide rate overall at 10.3 incidents per 100,000 people in 2016, exhibits one such discrepancy. When comparing the suicide rate of Indigenous peoples in Canada, the rate of suicide increases to 24.3 incidents per 100,000 people in 2016, a rate among the ten highest in the world.
Recently released figures by official Belgian authorities suggest a considerably higher rate of 17.0 persons (total) per 100,000 people per annum in 2009 (5,712 cases in a population of 10,749,000 (=10,666,866 as of 1 January 2008 increasing by 0,77% per annum.) as of 1 January 2009).
The number of death in Belgium in 2008 due to suicide "zichzelf schade toebrengen" was reported at 2000 out of a total of 103.760 death. These death comprise 1453 men and 547 women. This puts the suicide rate at about 19 per 100.000. Taiwan is not a member of the WHO. The Taiwanese government adopted the WHO standard in 2007.
In 2021, the global rate of suicide deaths for men was 12.3 per 100,000, more than double the rate for women, which stood at 5.9 per 100,000 population.
Globally, some progress on women’s rights has been achieved. the adolescent birth rate is 3.9 per 1,000 women aged 15-19 as of 2018, down from 5.31 per 1,000 in 2017. However, work still needs to be done in Chad to achieve gender equality.
As of Dec-20, only 34.4% of indicators needed to monitor the SDGs from a gender perspective were available, with gaps in key areas, in particular: unpaid care and domestic work, key labour market indicators, such as the gender pay gap and information and communications technology skills. In addition, many areas - such as gender and poverty, physical and sexual harassment, women’s access to assets (including land), and gender and the environment - lack comparable methodologies for regular monitoring.
For this score, we use the 72 gender-specific SDG indicators in the Women Count Data Hub’s SDG Dashboard for the 193 UN Member States. For each indicator, we calculate the 33rd and 66th percentiles of the distribution and, based on those two values, countries are classified as belonging to high performance, medium performance and low performance categories.
Suicide mortality data for the period 2000-2019 were obtained from the mortality database of the World Health Organization and the Global Burden of Disease Study. Age-standardized rates (ASRs; expressed per 100000) were presented.
A total of 759028 (523883 male and 235145 female) suicide deaths were reported worldwide in 2019. The global ASR of mortality of suicide was 9.0/100000 population in both sexes (12.6 in males vs 5.4 in females). In both sexes, the highest rates were found in the region of Africa (ASR = 11.2), while the lowest rates were reported in Eastern Mediterranean (ASR = 6.4).
Globally, from 2000 to 2019, ASRs of mortality of suicide had a decreasing tendency in both sexes together [AAPC = -2.4% per year; 95%CI: (-2.6)-(-2.3)]. The region of the Americas experienced a significant increase in suicide mortality over 2000-2019 unlike other regions that had a declining trend. Out of all 133 countries with a decline in suicide mortality, Barbados (AAPC = -10.0%), Grenada (AAPC = -8.5%), Serbia (AAPC = -7.6%), and Venezuela (AAPC = -6.2%) showed the most marked reduction in mortality rates.
Decreasing trends in suicide mortality were observed in most countries across the world. Unfortunately, the mortality of suicide showed an increasing trend in a number of populations. Despite a decline in mortality during the last decades, suicides are one of the main health challenges worldwide. About 750000 suicide deaths were recorded in 2019 across the world. Globally, the rate of suicide mortality in 2019 was 9.0/100000 for both sexes together (12.6 in males vs 5.4 in females). Despite the decreasing trends recorded in both sexes in most countries in the world, the mortality of suicide showed an increasing trend in certain populations.
Surge in child suicide attacks in Lake Chad conflict & other topics (Daily Briefing 4/12/2017)
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