Late-life suicide trends in selected major countries worldwide in 1990-2022: a spatio-temporal analysis from the WHO mortality database

Abstract

Background: Suicide is a major and largely preventable public health issue, with rates increasing among people in later life. We aimed to describe global temporal and geographical patterns of suicide mortality among older adults.

Methods: Using the WHO mortality database (latest update: February 2024), we analysed suicide data for individuals aged 75 or older from 1990 to 2022. We selected countries based data availability, completeness, and number of suicide deaths. We computed annual age-standardised suicide mortality rates (ASR) by sex and country, and performed joinpoint regression analyses on a subgroup of major countries and geographical areas.

Findings: We considered suicide data at age 75+ from 48 countries, the EU (27 Member States) and seven geographical areas, and analysed trends in a subgroup of 20 major countries and the areas. Late-life suicide patterns differed across countries, with rates 3-7 times higher among males than females. Several countries showed steady declines by -2% to -6% annually, while in other countries like Germany, Italy, the Netherlands, the UK and Australia (males), trends slowed or stopped declining after around 2010. Increases were observed in the USA, Brazil (females), and Australia (females). Among males, the most recent highest ASR was 50.9/100,000 (95% CI: 48.1-53.7) in Centre-East Europe, while the lowest one was 12.8/100,000 (95% CI: 11.9-13.7) in North Europe. The male ASR in the EU-27 was 38.9/100,000 (95% CI: 38.0-39.9). Country-specific ASRs ranged from 10.4/100,000 (95% CI: 9.1-11.7) in the UK to 99.3/100,000 (95% CI: 93.3-104.8) in South Korea. Among females, the highest ASR was 14.4/100,000 (95% CI: 13.8-15.1) in Asia and Oceania while the lowest one was 2.4/100,000 (95% CI: 2.1-2.7) in Centre-South America. The EU-27 female rate was 8.1/100,000 (95% CI: 7.7-8.5). Country-specific ASRs ranged from less than 1 death per 100,000 in Mexico to 29.0/100,000 (95% CI: 26.8-31.3) in South Korea.

Interpretation: Suicide mortality shows substantial variations in rates and trends worldwide. However, data are subject to variable misclassification and underreporting in different countries and geographic areas, and therefore require cautious interpretation.

Funding: Ministry of University and Research - Decree No. 1159 of July 23, 2023 - PROBEN call.

Keywords: Global; Late-life; Mortality; Official statistics; Suicide; Trends.

Fig. 1

Maps showing age-standardised (world population) suicide rates (ASR) per 100,000 males (panel A) and females (panel B) aged 75+ years in 2021 or the last available year, in 48 countries worldwide, classified according to the quartile distribution.

Fig. 2

Joinpoint analysis of suicide trends (age 75+ years) from 1990 to 2021 or the last available year, according to geographical areas worldwide, in males (solid dot) and females (empty dot) separately.

Fig. 3

Joinpoint analysis of suicide trends (age 75+ years) from 1990 to 2021 or the most recent available year, in the 20 selected major countries worldwide, in males (solid dot) and females (empty dot) separately, with country-specific scales. Panel A shows European countries; panel B shows non-European countries. The y-axis scales differ across countries to allow better visualization of within-country trends.

Fig. 3

Joinpoint analysis of suicide trends (age 75+ years) from 1990 to 2021 or the most recent available year, in the 20 selected major countries worldwide, in males (solid dot) and females (empty dot) separately, with country-specific scales. Panel A shows European countries; panel B shows non-European countries. The y-axis scales differ across countries to allow better visualization of within-country trends.

Fig. 4

Proportion of suicides (age 75+ years) by method in 16 selected major countries worldwide (i.e., countries with more than 20 million inhabitants and coverage >90%), separately for males and females, in 2021 or the latest available year. Panel A shows European countries; panel B shows non-European countries.

Fig. 4

Proportion of suicides (age 75+ years) by method in 16 selected major countries worldwide (i.e., countries with more than 20 million inhabitants and coverage >90%), separately for males and females, in 2021 or the latest available year. Panel A shows European countries; panel B shows non-European countries.