Estimating the burden of disease attributable to non-assisted suicide in Switzerland from 2009 to 2021: a secondary data analysis

Abstract

Context and goal: This research addresses the issue of suicide and attempted suicide, which have a significant impact on global premature mortality and disability. Particularly noteworthy is the prevalence among adolescents, in whom suicide ranks among the top four causes of death according to the World Health Organization (WHO). In Switzerland, suicide has remained the leading cause of death in individuals under 50 since 1990. At the same time, the burden of attempted suicides remains poorly understood. Although the legality of assisted suicide in Switzerland influences the overall suicide data, this analysis focuses solely on non-assisted suicides, as they are relevant for accurately assessing the burden of disease of suicide and attempted suicide. Amid challenges posed by limited reporting infrastructure, this analysis aims to contribute to the existing literature by investigating the cumulative impact of non-assisted suicide and attempted suicide on the population living in Switzerland.

Methodology: Pre-existing data from 2009 to 2021 were collected and analysed, drawing from a variety of sources including official health records from the federal offices of statistics and public health, surveys and retrospective studies. From this data, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life-years (DALYs) were calculated in order to estimate the burden of disease. Sensitivity analyses were conducted to determine the robustness of the data and the effect of variables (suicide attempt incidence, sex distribution, disability weight, average duration) on the DALYs.

Results: The analysis of the data spanning from 2009 to 2021 revealed a decrease in suicide. The present study determined that, in 2021, 32,771 DALYs were attributable to non-assisted suicide and attempted suicide and 6.4% of all years of life lost (n = 30,516) were attributable to suicide, not including assisted suicide. Using a reference incidence of 33,000 attempted suicides per year in Switzerland, the morbidity associated with attempted suicides was 2255 YLDs (range: 552-6557 YLDs). Further analysis of the data highlighted a stark sex gap in the prevalence of non-assisted suicide: male suicides account for around 2% of all male deaths, whereas female suicides account for approximately 0.8% of all female deaths. Sensitivity analyses found that incidence and sex distribution of attempted suicide were the most impactful factors, while disability weights and average duration of disability had little impact on the variation in YLD estimates.

Conclusion: In conclusion, this study provides a detailed analysis of the burden of non-assisted suicide and attempted suicide in Switzerland. With non-assisted suicide accounting for 6.4% of all years of life lost and 30% of deaths in people aged 20-24 in Switzerland in 2021, it emerges that suicide contributes significantly to the country's overall disease burden, particularly in terms of years of life lost. The stark sex disparity in suicide rates further underscores the need for sex-sensitive approaches. These insights can help guide policy-making and the allocation of resources towards reducing the incidence and impact of suicide and attempted suicide, both in Switzerland and in broader international contexts where similar patterns prevail.