Trends in suicide rates in Brazil from 1997 to 2015

Epidemiological profile, temporal analysis, and future projections of suicide cases in rural cities in the extreme south of Brazil

The present study aimed to verify the time series (2000-2017) of death rates by suicide and its associated factors in 4 municipalities in the extreme south of Brazil. Data were obtained through the analysis of medical reports and police report bulletins at the Instituto Médico Legal, in the city of Rio Grande. The suicide rate in the Rio Grande region varied from 4 to 11 suicides per 100,000 inhabitants and it is estimated that by 2030 this rate could reach 16.5 suicides per 100,000 inhabitants. The rural cities of Santa Vitória do Palmar and Chuí present even higher suicide averages when compared to Rio Grande, the most populous city of the four. The death rate from suicide increased gradually in the period analyzed, with the prevalence rising among the youngest and the elderly population. A more comprehensive understanding of the influences of environmental issues on suicidal decisions constitutes an important action that needs to be taken, both because of regional vulnerabilities and the target population identified. Evidence indicates that knowledge of factors affecting individuals residing in this Brazilian region where increased suicide rates are recorded needs to be recognized as a priority.

Decrease in suicide rates in Brazil during the COVID-19 pandemic

Natural disasters such as public health epidemics may potentially affect suicide rates. The global COVID-19 pandemic poses an unprecedented challenge for healthcare systems and general populations worldwide. In this retrospective ecological study, we aimed to examine any changes in the suicide rates during the COVID-19 pandemic and to assess the relationship between COVID-19 death rates and deaths by suicide in Brazil. Data on suicide and COVID-19 case numbers were extracted from the Ministry of Health agencies and grouped weekly. We performed a time series analysis of suicide rates, a comparison of mean suicide rates between the pre-COVID-19 period and the COVID-19 period, and conducted a Poisson regression to examine the relationship between deaths due to COVID-19 and suicide rates. Our results showed decreased suicide rates during the COVID-19 pandemic. We also found that deaths owing to COVID-19 impact those owing to suicide after 10 weeks in the upward direction; however, we did not observe for enough time to see a change in the suicide rate curve. These findings are fundamental to understand suicidal behaviors in epidemic situations. However, the field needs more studies evaluating the impact of significant public health events on suicidality, incorporating extended follow-up periods.

Analytical reference framework to analyze non-COVID-19 events

BACKGROUND

The COVID-19 pandemic has disrupted the healthcare system, leading to delays in detection of other non-COVID-19 diseases. This paper presents ANE Framework (Analytics for Non-COVID-19 Events), a reliable and user-friendly analytical forecasting framework designed to predict the number of patients with non-COVID-19 diseases. Prior to 2020, there were analytical models focused on specific illnesses and contexts. Then, most models have focused on understanding COVID-19 behavior. There is a lack of analytical frameworks that enable disease forecasting for non-COVID-19 diseases.

METHODS

The ANE Framework utilizes time series analysis to generate forecasting models. The framework leverages daily data from official government sources and employs SARIMA models to forecast the number of non-COVID-19 cases, such as tuberculosis and suicide attempts.

RESULTS

The framework was tested on five different non-COVID-19 events. The framework performs well across all events, including tuberculosis and suicide attempts, with a Mean Absolute Percentage Error (MAPE) of up to 20% and the consistency remains independent of the behavior of each event. Moreover, a pairwise comparison of averages can lead to over or underestimation of the impact. The disruption caused by the pandemic resulted in a 17% gap (2383 cases) between expected and reported tuberculosis cases, and a 19% gap (2464 cases) for suicide attempts. These gaps varied between 20 and 64% across different cities and regions. The ANE Framework has proven to be reliable for analyzing several diseases and exhibits the flexibility to incorporate new data from various sources. Regular updates and the inclusion of new associated data enhance the framework's effectiveness.

CONCLUSIONS

Current pandemic shows the necessity of developing flexible models to be adapted to different illness data. The framework developed proved to be reliable for the different diseases analyzed, presenting enough flexibility to update with new data or even include new data from different databases. To keep updated on the result of the project allows the inclusion of new data associated with it. Similarly, the proposed strategy in the ANE framework allows for improving the quality of the obtained results with news events.

Suicide among Indigenous peoples in Brazil from 2000 to 2020: a descriptive study

Background

Previous studies in Australia, Canada, and Brazil, found that suicide among ethnic minority groups is higher than in the general population. Indigenous peoples in Brazil have been reported to have a high suicide rate, with reports of suicide clusters occurring in several communities. The objective of this study was to report trends in countrywide suicide rates among Indigenous peoples in Brazil between 2000 and 2020, and to compare these with the non-Indigenous population.

Methods

This ecological study used Indigenous suicide data collected from all regions of Brazil during a 21-year period, between 2000 and 2020. We used suicide estimates from the Mortality Information System (SIM), available at the Brazilian Health Ministry website (DATASUS). Suicide mortality rates by state and region were calculated using the estimated Indigenous population from the 2010 census, and estimated population proportions for the other years. We performed a trend analysis and compared trends in suicide between the Indigenous and non-Indigenous population during the period studied.

Findings

Suicide rates among Indigenous Brazilians have reached more than two and a half times the levels for the overall Brazilian population in 2020 (17.57 suicide deaths versus 6.35 suicide deaths per 100,000 inhabitants, respectively). The Central-West region of Brazil had the highest suicide rates among Indigenous Brazilians over the study period, reaching 58.8 deaths/100,000 inhabitants in 2008. The younger age group (10-24 years old) had the highest suicide rates for all the years studied. Time-series analyses showed a trend of statistically significant increases in suicide rates in Brazil for both the Indigenous and non-Indigenous population during the study period. The North region, and specifically Amazonas state, has shown a decisive increase in suicide rates among the Indigenous populations. The suicide rate for Indigenous people in Brazil, excluding cases in Amazonas and Mato Grosso do Sul states, were similar to those for the entire Brazilian population, showing that the Indigenous peoples who are the most vulnerable to suicide reside in these locations.

Interpretation

While there were statistically significant increases in suicide rates for all Brazilians over the study period, they remained alarmingly high among Indigenous people, compared to their non-Indigenous counterparts. The high suicide rates among Indigenous people, and younger individuals in particular (aged between 10 and 24), reinforces the need for specific prevention strategies for these populations. Further studies should be concentrated on determining risk factors in distinct ethnic groups, specifically within regions experiencing an elevated risk, such as the states of Amazonas and Mato Grosso do Sul.

Funding

Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award number R01MH128911-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Development and validation of a questionnaire to measure association factors with suicide

Background and Aims

Our goal was to develop an online questionnaire to survey the prevalence of suicidal behavior.

Methods

We developed a questionnaire with 51 variables and proceeded with validations. Validations were performed using face validity, content validity, and construct validity. Reliability was performed by test-rest.

Results

The face validity was 1.0 and the content validity was 0.91. The exploratory factor analysis got Kaiser-Meyer-Olkin = 0.86 and extracted one principal factor. The confirmatory factor analysis demonstrates root mean square error of approximation = 0.000 and comparative fit index = 1.000. The test-retest had an intraclass correlated coefficient of 0.98.

Conclusion

The adequate development questionnaire was validated, and we have an instrument to survey suicide behaviors during the pandemic time.

Patient or Public Contribution

The general population of Marília voluntarily responded to the questionnaire, as well as patients from the principal investigator's office.

Suicide among women in Brazil: a necessary discussion from a gender perspective

Suicide among women is a matter of public health, and there is a lack of scientific literature on this issue. In this theoretical essay, we sought to discuss suicide among women in Brazil from a gender perspective. For that purpose, we adopted the idea that gender extrapolates the concept of sex, considering that differences between people are produced by culture and arrangements through which society transforms biological sexuality into the realizations of human life. Therefore, this article is organized in a way to indicate some explanatory models of suicide among women, discussing gender inequalities and approaching the matter of intersectionality from a protective view. Moreover, we believe that the theme is extremely complex, considering that stigma still resists, as does prejudice related to this issue. Hence, it is of utmost importance to view the structural questions that refer to suicide in women, such as violence and gender inequalities.

Epidemio-toxicological profile of suicide cases: analysis from a forensic unit in Brazil

The suicide phenomenon involves complex interactions between psychological, biological, cultural and socio-environmental factors. This study aimed to assess the epidemiological and toxicological profiles of officially confirmed suicide victims. A retrospective study was performed using autopsy reports, forensic anthropology examinations and police summaries of all suicide cases that underwent toxicological analysis at an Official Forensic Laboratory (Minas Gerais, Brazil) in 1 year. The sample set was composed of 351 suicide victims, predominantly men (70.32%), most of them were adults between 31 and 64 years old (62.11%), with mixed skin colour (48.89%) and low educational level (66.44%). The most common suicide method was hanging (57.79%), followed by intoxication (30.45%). Most victims presented positive toxicological results (56.41%), especially for the presence of medicines (37.6%), illicit drugs (36.3%) and pesticides (26.1%). Our study corroborated previous data that most suicide victims have low educational levels. The most common toxicological findings were medicines, especially prescription drugs, followed by illicit drugs and pesticides. We hope this study contributes to reflections and planning of preventive suicide programmes, considering the described profiles of victims.

Spatial patterns and epidemiological characterization of suicides in the Chapecó micro-region, Santa Catarina, Brazil: an ecological study, 1996-2018

OBJECTIVE

to identify spatial clusters of suicide and its epidemiological characteristics in the Chapecó (SC) micro-region from 1996 to 2018.

METHODS

this was an exploratory ecological study, using data from the Mortality Information System; specific suicide rates and relative risks (RR) were calculated with a 95% confidence interval (95%CI); the scan statistic was used for spatial analysis.

RESULTS

there were 1,034 suicides (13.7/100,000 inhabitants), with a male/female ratio of 3.79; the ≥ 60 age group was at higher risk for both sexes; a high risk cluster was found in the southwest region (RR = 1.57) and a low risk cluster in the southeast region, including Chapecó itself (RR = 0.68); risk of suicide among widowed (RR = 3.05; 95%CI 1.99;4.67), separated (RR = 2.48; 95%CI 1.44;4.27), and married (RR = 1.97; 95%CI 1.54;2.51) people was higher than among single people. The main methods were hanging (81.2%) and firearms (9.7%).

CONCLUSION

there was a higher risk of suicide in the elderly, male and widowed people. Hanging was the most frequent method and risk clustering was found in the southwest.

The influence of the age-period-cohort effects on male suicide in Brazil from 1980 to 2019

Suicide is a complex and multi-determined phenomenon. Higher rates are observed in men and are related to multiple risk factors, including mental disorders, financial crises, unemployment, and easy access to highly lethal means of perpetration, such as firearms. We studied the effects of age, period, and cohort (APC) on total and firearm-related suicides in men in Brazil and its major regions from 1980 to 2019. Death records were extracted from the Brazilian Ministry of Health's Mortality Information System. Estimable functions were used to estimate APC models, through the Epi library of the R statistical program, version 4.2.1. During the study period, Brazil had an average rate of 10.22 deaths per 100,000 men. Among regions, rates ranged from 8.62 (Northeast) to 16.93 (South). The same profile was observed in suicides by firearms. After estimating the APC models, we observed a temporal trend of increasing total suicides for Brazil and regions, except for the South region, where the trend was stationary. The trend was downward for firearm suicides for all locations. A positive gradient was observed in the mortality rate with advancing age for total suicides; and peak incidence between 20-29 years, with subsequent stabilization, for suicides perpetrated by firearms. There was a reduction in the risk of death for suicides perpetrated by firearms in relation to the reference period (1995-1999) for all locations, except in the North region, where the effect was not significant. The younger generations from the 1960s onwards had a higher risk of death from total suicide and a lower risk for those perpetrated by firearms in relation to the reference cohort (1950-1954). We observed a reduction in the mortality trend for suicides perpetrated by firearms, a reduction in the risk of death in the 2000s and for men born after 1960. Our results suggest reducing the risk of death from suicide by firearms in Brazil and regions. However, there is an upward trend in mortality from total suicides in the study period (1980-2019) and for younger cohorts.

Health inequalities in Brazil: proposed prioritization to achieve the Sustainable Development Goals

This study aimed to develop a prioritization index to speed up the achievement of national health targets proposed in the 2030 Agenda. This is an ecological study that addressed the Health Regions in Brazil. The index incorporated 25 indicators with analytical proximity to the official indicators of the 2030 Agenda whose data are available from public municipal sources for the period of 2015-2019. According to our study, the index was a powerful method to support health management decisions. The results showed the most vulnerable territories are located in the North Region of the country, and therefore, these are priority areas for resource allocation. The analysis of subindices highlighted local health bottlenecks, reinforcing the need for municipalities in each region to set their own priorities while making decisions for health resource allocation. By indicating Health Regions and priority themes for more investments, this investigation shows paths to support the implementation of the 2030 Agenda, from the local to the national level, in addition to providing elements that can be used by policy makers to minimize the effects of social inequalities on health, prioritizing territories with worse indices.

[Trends in suicide rates in Brazil from 2011 to 2020: special focus on the COVID-19 pandemicTendencia de las tasas de suicidio en Brasil, 2011-2020, con especial atención a la pandemia de COVID-19]

Objective

To describe the trends in suicide rates in Brazil from 2011 to 2020 and determine whether these rates are associated with COVID-19 pandemic-related variables.

Method

This ecological time series study analyzed mortality from suicide with a focus on 2020, the first year of the COVID-19 pandemic. The suicide mortality rate per 100,000 population was the primary outcome. The trends in suicide rates were estimated using generalized Prais-Winsten regression. An autoregressive integrated moving average (ARIMA) model was used to predict suicide rates in 2020. The association between suicide rates and death rates from COVID-19, unemployment, receiving emergency financial aid, and rates of social distancing was investigated.

Results

From 2011 to 2020, 115 469 deaths by suicide were recorded in Brazil (60.5 deaths/100 000 population). The suicide rate in 2020 was 6.68/100 000 population. An increasing trend in suicide rates was observed from 2011 to 2020 in both sexes, with annual percent change of 0.23 (95%CI: 0.141; 0.322) in women; and 1.19 (95%CI: 0.714; 1.810) in men. Mortality by suicide increased in all regions, with the highest increase recorded in the South. There was no evidence of increase in deaths by suicide in relation to the expected number during the first year of the COVID-19 pandemic.

Conclusions

Suicide rates increased for both sexes and in all Brazilian states. In the first pandemic year, the number of deaths by suicide did not increase in relation to the expected number, with a stability trend during the months of 2020.

Differential impact on suicide mortality during the COVID-19 pandemic in Brazil

OBJECTIVES

To compare suicide rates observed in Brazil after the onset of the COVID-19 pandemic with the estimated rate based on suicide deaths between 2010 and 2020, and identify sociodemographic variables associated with this outcome.

METHODS

Ecological time-series study. Data were obtained from Brazilian Unified Health System Department of Information Technology (DATASUS), with the structural break of the data set in March 2020. The number of actual suicides observed and the number of expected suicides if there were no COVID-19 pandemic were analyzed through bayesian structural time series modeling.

RESULTS

The overall incidence of suicides in Brazil remained stable after the start of the COVID-19 pandemic compared to what would be expected. However, there was a significant increase in suicide deaths among women (6.9%) and older adult (9.1%). Analysis by macro-regions of the country showed significant increases in suicide deaths in the Center-West (7.4%), Northeast (5.7%), and Southeast (10%). Stratified analyses revealed differences according to age, sex, education, and skin color.

CONCLUSIONS

Despite stability in the overall number of suicides, this phenomenon occurs heterogeneously among different population groups and regions of Brazil. Rates have increased in populations with a history of poor access to health, which may have been more severely impacted by the pandemic.

Dinâmica temporal e espacial e fatores relacionados à mortalidade por suicídio entre idosos

RESUMO Objetivo: Analisar a dinâmica temporal e espacial e os fatores associados à mortalidade por suicídio entre idosos (≥60 anos de idade) no Nordeste do Brasil. Métodos: Estudo ecológico que analisou os óbitos por suicídio ocorridos entre idosos na região Nordeste do Brasil, no período de 2010 a 2019. Foram realizadas análise temporal por Joinpoint , análise espacial segundo município de residência e análise multivariada pelo modelo Ordinary Least Squares Estimation , considerando-se p < 0,05. Resultados: No período analisado, foi observado crescimento significativo de 3,0% (IC95%: 1,1-4,9; p < 0,001) ao ano na mortalidade por suicídio. Espacialmente, as taxas mais elevadas foram observadas prioritariamente em municípios do Piauí, Ceará e Rio Grande do Norte. Foram identificados quatro clusters de suicídio estatisticamente significativos (p < 0,001). O cluster primário (2010-2019) abrangeu 141 municípios do Ceará, Rio Grande do Norte e Paraíba, que apresentaram risco 2,3 vezes maior de ocorrência de suicídio quando comparados aos demais municípios da região. Os indicadores índice de Gini (β = 14,02; p = 0,01), taxa de analfabetismo (β = 0,20; p < 0,001) e taxa de envelhecimento (β = 0,36; p = 0,02) apresentaram associação positiva com o suicídio entre idosos, enquanto razão de dependência (β = -0,31; p < 0,001) e taxa de desocupação (β = -0,25; p < 0,001) apresentaram associação negativa. Conclusão: Houve aumento significativo do suicídio entre idosos na região Nordeste, com maior concentração em quatro clusters espaciais localizados prioritariamente no Ceará, Paraíba, Piauí e Rio Grande do Norte. A associação com indicadores socioeconômicos reforça aspectos de vulnerabilidade dos idosos a esse tipo de agravo e auxilia na formulação de propostas de intervenções que promovam a sua redução.

Suicide mortality among older adults in Brazil between 2000 and 2019 - estimates from the Global Burden of Disease Study 2019

INTRODUCTION

Older adults present a higher risk of suicide, and Brazil is experiencing a fast population aging. To understand the impact of demographic transition, we compared Brazilian suicide mortality rates (MR) among adults (50+ years) with global rates, those from one high-income country, and those from one middle-income country. Looking for regional disparities, the MR was analyzed among older adults (60+ years) by Brazilian states.

METHODS

This was an ecological study based on estimates from the Global Burden of Disease Study, from 2000 to 2019. Age-standardized MR and age-specific MR per 100,000 inhabitants were described, with 95% uncertainty intervals (UI).

RESULTS

During the period, the annual estimates and the declining trend in mortality were higher in the world than in the studied countries. In 2019, global age-standardized MR was 9.39 (95% UI 8.48-10.29), compared to 5.68 (95% UI 5.40-6.19), 6.01 (95% UI 5.10-7.04), and 6.63 (95% UI 6.43-6.95) in Brazil, Mexico, and England, respectively. In Brazil, despite a significant decline in national rates, stability was observed in 15 states. An increase in aging was only found for men, who presented 3-4 times higher MR than women. The states' rates presented large differences: in 2019, the rates among men aged 60-64 years varied from 7.24 (95% UI 5.31; 9.85) to 26.32 (95% UI 20.21; 34.50).

CONCLUSIONS

The smaller decline in suicide mortality among older Brazilian adults, the increasing risk with aging, and the higher mortality among men indicate the need for specific prevention policies. The variation within states suggests differences in the data quality or in socio-cultural and historical aspects, which requires further investigation.

Sobreviventes enlutados por suicídio e as possibilidades para posvenção no contexto da saúde pública brasileira

Resumo Após um suicídio, diversas pessoas são afetadas negativamente. Muitos dos denominados sobreviventes enlutados, em algum momento, precisarão de cuidados e apoio, a conhecida posvenção do suicídio. O objetivo deste estudo é discutir as suas possibilidades no contexto da saúde pública brasileira. Metodologicamente, o texto configura-se como um ensaio teórico apoiado na literatura da área, assim como em documentos institucionais e marcos legais. No cenário internacional, a posvenção do suicídio está mais bem estruturada do que no Brasil que, atualmente, tem o enfoque em grupos de apoio aos sobreviventes enlutados centrados em organizações não governamentais. É preciso lançar o olhar para os serviços de saúde de base territorial e comunitária, a exemplo dos Centros de Atenção Psicossocial, e vislumbrar ações de posvenção acessíveis e resolutivas, como as linhas telefônicas gratuitas de acolhimento, as visitas domiciliares precoces, as escutas terapêuticas e o aconselhamento para o luto.

Suicidal ideation and behavior in youth in low- and middle-income countries: A brief review of risk factors and implications for prevention

Although global rates of suicide have dropped in the last 30 years, youth in low- and middle-income countries (LMICs) continue to be highly represented in suicide statistics yet underrepresented in research. In this review we present the epidemiology of suicide, suicidal ideation, and suicide attempts among youth in LMICs. We also describe population-level (attitudes toward suicide, socioeconomic, and societal factors) and individual-level clinical and psychosocial risk factors, highlighting specific considerations pertaining to youth in LMICs. These specific considerations in risk factors within this population can inform how multi-level prevention strategies may be targeted to meet their specific needs. Prevention and intervention strategies relying on the stepped-care framework focusing on population-, community-, and individual level targets while considering locally- and culturally relevant practices are key in LMICs. In addition, systemic approaches favoring school-based and family-based interventions are important among youth. Cross-culturally adapted multimodal prevention strategies targeting the heterogeneity that exists in healthcare systems, suicide rates, and risk factors in these countries should be accorded a high priority to reduce the burden of suicide among youth in LMICs.

Time series analysis of suicide from a monthly perspective in the south of Brazil: an ecological study

INTRODUCTION

Suicide is the cause of death of almost 800 thousand people worldwide every year. In Brazil, Rio Grande do Sul is one of the states with the highest suicide rates. This study aimed to assess whether there is a significant monthly time pattern of suicide in Rio Grande do Sul, by gender and age ranges, and whether suicide characteristics in the state are coherent with findings from previous studies.

METHODS

All data were collected from official secondary sources maintained by the national Brazilian and Rio Grande do Sul governments, covering a period from 2015 to 2019. Data included suicide deaths and population, divided by gender and age range. Sum totals, frequencies, odds ratios, and time series analyses were performed.

RESULTS

From 2015 to 2019, 6,287 people committed suicide in Rio Grande do Sul. Most of them were men and the most prevalent age band was from 50 to 59 years old. Men had higher suicide rates then women in all age ranges (p < 0.001) and in all months of the year, with an approximately 4-fold higher risk of committing suicide when compared to women. Men had a trending peak of suicide in January and December (p < 0.001), whereas women's suicide rates peaked in March and December (p = 0.001).

CONCLUSION

There are monthly time trends and seasonal patterns of suicide rates in Rio Grande do Sul, varying by gender and age range. Gender differences occurred mainly in the first three months of the year, and the age pattern was more evident among individuals aged 60 years or older.

Estimates of suicide mortality in women residents in northeast brazilian states from 1996 to 2018

The objective of this study was to analyze the temporal trend of suicide mortality in women in the states of Northeastern Brazil. This is an ecological study of a time series stratified by states in Northeast Brazil from 1996 to 2018, with data extracted from the Mortality Information System (SIM). The temporal trend was evaluated by negative binomial regression (p values≤0.05). There was a higher proportion of deaths in black and brown women (73.9%), single (57.3%), with the place of death occurring in the home (53.4%). Hanging and strangulation stood out as the perpetration means (47.6%). Most states showed an upward temporal trend, except for Pernambuco, Rio Grande do Norte, Sergipe and Maranhão, which showed a steady trend (p>0.05). An upward temporal trend was identified in the analysis of deaths by suicide in women in five states in northeastern Brazil between 1996 and 2018. The information presented can support planning and decision-making for the prevention of suicide among women in northeastern Brazil.

Sociodemographic Analysis of Suicide Rates Among Older Adults Living in Ecuador: 1997-2019

Background: Despite most suicides occurring in low-and-middle-income countries (LAMICs), limited reports on suicide rates in older adults among LAMICs are available. In Ecuador, high suicide rates have been reported among adolescents. Little is known about the epidemiology of suicides among older adults in Ecuador.

Aim: To examine the sociodemographic characteristics of suicides among older adults living in Ecuador from 1997 to 2019.

Methods: An observational study was conducted using Ecuador's National Institute of Census and Statistics database from 1997 to 2019 in Ecuadorians aged 60 and older. International Classification of Diseases 10th Revision (ICD-10) (X60-X84)-reported suicide deaths were included in addition to deaths of events of undetermined intent (Y21-Y33). Sex, age, ethnicity, educational level, and method of suicide were analyzed. Annual suicide rates were calculated per 100,000 by age, sex, and method. To examine the trends in rates of suicide, Joinpoint analysis using Poisson log-linear regression was used.

Results: Suicide rates of female older adults remained relatively stable between 1997 and 2019 with an average annual percentage increase of 2.4%, while the male rates increased between 2002 and 2009, 2014 and 2016, and maintained relatively stable within the past 3 years (2017–2019). The annual age-adjusted male suicide rate was 29.8 per 100,000, while the female suicide rate was 5.26 per 100,000 during the study period. When adding deaths of undetermined intent, the annual male rate was 60.5 per 100,000, while the same rate was 14.3 for women. The most common suicide method was hanging (55.7%) followed by self-poisoning (26.0%). The highest suicide numbers were reported in urban districts, men, and those with lower education status.

Conclusion: This study contributes to building the baseline for further studies on suicide rates of older adults in Ecuador. Results highlight priority areas of suicide prevention. By examining suicide trends over 23 years, findings can help inform policy and future interventions targeting suicide prevention.

Secular Trends of Suicide in the City of São Paulo, 1904-2017

Background: Few reports from developing countries have described long-term trends in suicide. Aims: To investigate the age-, sex-, and method-specific trends in suicide over the period 1904-2017 in São Paulo. Method: Mortality data were obtained from SEADE, DATASUS, and PRO-AIM. Results: Suicide peaked in the mid-1910s and mid-1950s, being higher among men. There was an upward trend from the 1920s for men and from the 1930s for women. Suicide rates have declined since the mid-1950s, reaching lower rates in the past 40 years. Men aged 60+ had higher rates at the beginning and a decreasing trend. Suicide rates among men aged 20-39 and 40-59 peaked in the mid-1950s and declined until the late 1970s, thereafter remaining stable. Women aged 20-39 years had the highest rates with decreasing trends from the mid-1950s. No trends were detected for the age group 40-59, and women aged 60+ presented a decreasing trend. Rates among women aged 0-19 declined after the late 1970s. Suicide by poisoning peaked in the 1950s, and there was a downward trend for firearms and an upward trend for hanging. Conclusion: Suicide trends vary by sex, age group, and method. Accurate monitoring of these trends is an important task for suicide prevention and public health agencies and personnel.

Suicide cases in developed and emerging countries: an analysis using wavelets

ABSTRACT Objective The aim of this study was to use a wavelet technique to determine whether the number of suicides is similar between developed and emerging countries. Methods Annual data were obtained from World Health Organization (WHO) reports from 1986 to 2015. Discrete nondecimated wavelet transform was used for the analysis, and the Daubechies wavelet function was applied with five-level decomposition. Regarding clustering, energy (variance) was used to analyze the clusters and visualize the clustering process. We constructed a dendrogram using the Mahalanobis distance. The number of groups was set using a specific function in the R program. Results The cluster analysis verified the formation of four groups as follows: Japan, the United States and Brazil were distinct and isolated groups, and other countries (Austria, Belgium, Chile, Israel, Mexico, Italy and the Netherlands) constituted a single group. Conclusion The methods utilized in this paper enabled a detailed verification of countries with similar behaviors despite very distinct socioeconomic, geographic and climate characteristics.

[Toxicology of suicide cases in the state of Rio Grande do Sul, Brazil, 2017 to 2019Perfil toxicológico de los casos de suicidio en Rio Grande do Sul (Brasil), 2017-2019]

Objetivo.

Descrever o perfil toxicológico de todas as vítimas de suicídio no Rio Grande do Sul, Brasil, de 2017 a 2019.

Métodos.

Neste estudo descritivo e transversal, foram consultados todos os laudos periciais e as ocorrências policiais relacionados aos óbitos por suicídio no estado. Foram realizadas análises de correspondência múltipla e construídos modelos independentes de regressão logística, tendo como variáveis dependentes o etanol, os ansiolíticos, os antidepressivos, as substâncias ilícitas e os agentes tóxicos não medicamentosos.

Resultados.

Foram realizados 2 978 exames de alcoolemia, com resultado positivo em 28,5%. A chance de resultados positivos para alcoolemia foi 0,5 (IC95%: 1,1 a 2,2) vez maior para suicídio durante a noite, 1,0 (IC95%: 1,4 a 2,9) vez maior para suicídio aos finais de semana e 0,9 (IC95%: 1,3 a 2,7) vez maior na presença de antecedentes criminais. A pesquisa de psicotrópicos (2 900 amostras) detectou algum medicamento em 30,4%. Os ansiolíticos foram a classe mais frequente, com chance 1,5 (IC95%: 1,6 a 4,1) vez maior em mulheres e 0,8 (IC95%: 1,2 a 2,7) vez maior para suicídios ocorridos no outono-inverno. As substâncias ilícitas (n = 338) tiveram chance 4,1 (IC95%: 1,9 a 14,4) vezes maior de detecção na macrorregião de Pelotas em relação à de Passo Fundo e 1,2 (IC95%: 1,3 a 3,6) vez maior em pessoas com resultados positivos para etanol. Não houve diferença significativa entre adolescentes e adultos.

Conclusões.

Embora sem evidência de causalidade, os resultados mostram um vínculo entre o suicídio e diversos psicoativos. Os médicos legistas devem ser orientados quanto à necessidade de realização de exames toxicológicos em todos os casos de suicídio.

Temporal trend of mortality by suicide among adults in Brazil: 2000 to 2015

OBJECTIVE

To analyze temporal trends of mortality due to suicide among adults in Brazil, by macroregion and gender, from 2000 to 2015.

METHODS

A retrospective study of temporal trends in suicide mortality rates in adults aged 20 to 64 years, by macroregion and gender, from 2000 to 2015. Data from the Brazilian Mortality Database (SIM) and from the Brazilian Institute of Geography and Statistics (IBGE) were used. The mortality rate trends analysis was performed using simple linear regression, with Stata 14 software.

RESULTS

There was an upward trend in mortality due to intentionally inflicted self-harm in the Brazilian adult population in the North, Northeast, and Southeast regions for both genders (p<0.001), with predominance in the male population in these three regions and throughout the country (p<0.001). A downward trend was observed in the South and Midwest (p=0.003 and p=0.040).

CONCLUSION

Mortality due to intentionally inflicted self-harm has increased in Brazil, but has undergone important variations in different parts of the country. Even a regional analysis is insufficient to achieve a thorough evaluation of these contrasts because of the country's continental proportions and data collection biases. Further studies focused on this topic are required.

Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment

Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan.

Systematic review registry number: CRD42020206517

Trends in suicidal behavior at a general hospital emergency department in southern Brazil

OBJECTIVE

To assess the prevalence of and factors associated with suicidal behavior in patients seen at the emergency department (ED) of a general hospital in southern Brazil.

METHOD

Descriptive, observational, cross-sectional study. The records of all patients who had an emergency psychiatric consultation at the ED conducted by the emergency psychiatric consultation service at Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul in 2016 and 2017 were analyzed and stratified by sex and by age groups (15-29 years, 30-49 years, 50-69 years, and 70 years and older). Suicidal behavior was characterized by factors such as thoughts of death, suicidal thoughts, and suicidal risk. Suicidal behavior was compared by sex and between age groups with chi-square tests. Multivariate analysis of suicidal behavior and gender, age, and specific diagnoses were compared with Poisson regression.

RESULTS

A total of 1,172 records from January 2016 to December 2017 were examined. There were more ED visits by females (63.1%) than males. Younger patients (15-29 years) had a higher severe risk of suicide than elderly (≥ 70 years) patients (54.1 vs. 19%; p < 0.01). Indicators of suicide behavior stratified by sex and by age group revealed marked differences between age groups for all variables among female patients. Overall, age group patterns for males were very similar in terms of suicidal behavior variables.

CONCLUSIONS

A high prevalence of suicidal behavior was observed in this sample, particularly among young adults and especially associated with female gender and diagnoses of depression and personality disorders.

Patterns and management of musculoskeletal injuries in attempted suicide by jumping from a height: a single, regional level I trauma center experience

BACKGROUND

Suicide is a common cause of death in Brazil, with an overall increase of 62.5% during the last 30-year period. The study aims to determine overall patient characteristics and symptomatic indicators of complications among survivors.

METHODS

In this retrospective cross-sectional study, we collected and analyzed clinical information of all patients aged > 10 years who presented to our hospital with a history of attempted suicide by jumping from a height in a 7-year period. Records were searched for primary demographic data, radiographs and CT scans were reviewed to determine injury characteristics, and records and operative notes were searched to look for symptomatic indicators of complications among survivors. Baseline demographics and the distribution on skeletal injuries were compared between the survivor and non-survivor patients using the Chi-squared for categorical variables and the Student's t-test for continuous variables. Among survivors, univariate and multivariate analysis were performed to investigate independent risk factors of attempted suicide and complications.

RESULTS

A total of 222 patients attempted suicide by jumping from a height. At multivariate analysis, the middle-aged patient was the unique identified risk factor for suicide by jumping from a height. Overall mortality was 67.6%. The main independent cause for death was traumatic brain injury. Among survivors, there was a higher incidence of foot and ankle fractures, and pelvic ring injuries. The overall complication rate for survivor patients was 51.4%, with acute infection being the most prevalent complication. At multivariate analysis, middle-aged men, foot and ankle injuries, open pelvic injuries, and open fractures were identified as risk factors for acute complications.

CONCLUSION

Middle-aged people are at significant risk for attempting suicide by jumping from a height in Brazil, independently of gender, with 67.6% deaths. Traumatic brain injury, higher ISS, and more than 3 skeletal injuries are independent variables related to this fatal outcome. Acute complications occur in approximately 50% of survivors. Middle-aged men, foot and ankle injuries, open pelvic injuries, and open fractures are risk factors for complications.

[Synthesis of evidence: Guidance for the diagnosis and treatment of Chagas diseaseSíntese de evidências: Guia de diagnóstico e tratamento da doença de Chagas]

Introducción.

La enfermedad de Chagas o tripanosomiasis americana es causada por el protozoo flagelado Trypanosoma cruzi, transmitido principalmente por insectos vectores (denominados popularmente en las diferentes zonas de la Región de las Américas “vinchucas”, “pitos”, “chinches”, “chirimachas” o “kissing bugs”). El parásito es transmitido por vía transplacentaria, transfusiones y, menos frecuentemente, por vía oral o trasplante de órganos. La implementación de políticas públicas y el manejo de la condición clínica requiere ser fortalecido debido a las dificultades diagnósticas y terapéuticas que presenta esta parasitosis sistémica. Para contribuir con ello, la Organización Panamericana de la Salud (OPS) desarrolló una guía para el manejo de la tripanosomiasis americana.

Objetivos.

Sintetizar las recomendaciones incluidas en la Guía para el diagnóstico y el tratamiento de la enfermedad de Chagas, publicada por la Organización Panamericana de la Salud en 2018, con el fin de presentar el adecuado diagnóstico y tratamiento de la enfermedad de Chagas y abordar aspectos sobre su implementación.

Métodos.

Se llevó a cabo una síntesis de la guía y sus recomendaciones. Adicionalmente, se realizó una búsqueda sistemática en PubMed, Lilacs, Health Systems Evidence, Epistemonikos y literatura gris de estudios desarrollados en las Américas con el fin de identificar barreras, facilitadores y estrategias de implementación.

Resultados.

Se presentan 10 recomendaciones aplicables a pacientes adultos y pediátricos con sospecha de enfermedad de Chagas, exposición a T. cruzi y diagnóstico confirmado de enfermedad de Chagas aguda, crónica y congénita. Se identificaron reportes que abordaron aspectos de implementación.

Conclusiones.

Las recomendaciones buscan proveer estrategias para el diagnóstico y tratamiento oportunos de la enfermedad de Chagas, así como consideraciones para su implementación.

Suicide mortality in the city of São Paulo: epidemiological characteristics and their social factors in a temporal trend between 2000 and 2017. Retrospective study

BACKGROUND

Suicide is one of the leading causes of death worldwide, accounting for one million deaths annually. Greater understanding of the causal risk factors is needed, especially in large urban centers.

OBJECTIVE

To ascertain the epidemiological profile and temporal trend of suicides over two decades and correlate prevalence with social indicators.

DESIGN AND SETTING

Descriptive population-based longitudinal retrospective study conducted in the city of São Paulo, Brazil.

METHODS

A temporal trend series for suicide mortality in this city was constructed based on data from the Ministry of Health's mortality notification system, covering 2000-2017. It was analyzed using classic demographic variables relating to social factors.

RESULTS

Suicide rates were high throughout this period, increasing from 4.6/100,000 inhabitants in the 2000s to 4.9/100,000 in 2017 (mean: 4.7/100,000). The increase in mortality was mainly due to increased male suicide, which went from 6.0/100,000 to the current 8.0/100,000. Other higher coefficients corresponded to social risk factors, such as being a young adult (25-44 years old), being more educated (eight years of schooling) and having white ethnicity (67.2%). Suicide was also twice as likely to occur at home (47.8%).

CONCLUSION

High suicide rates were seen over the period 2000-2017, especially among young adults and males. High schooling levels and white ethnicity were risk factors. The home environment is the crucial arena for preventive action. One special aspect of primary prevention is the internet and especially social media, which provides a multitude of information for suicide prevention.

Mental disorders in adolescents, youth, and adults in the RPS Birth Cohort Consortium (Ribeirão Preto, Pelotas and São Luís), Brazil

Although depression and anxiety are known to result in disabilities and workplace and health system losses, population-based studies on this problem are rare in Brazil. The current study assessed the prevalence of mental disorders in adolescents, youth, and adults and the relationship to sociodemographic characteristics in five birth cohorts (RPS) in Ribeirão Preto (São Paulo State), Pelotas (Rio Grande do Sul State), and São Luís (Maranhão State), Brazil. Major depressive episode, suicide risk, social phobia, and generalized anxiety disorder were assessed with the Mini International Neuropsychiatric Interview. Bootstrap confidence intervals were estimated and prevalence rates were stratified by sex and socioeconomic status in the R program. The study included 12,350 participants from the cohorts. Current major depressive episode was more prevalent in adolescents in São Luís (15.8%; 95%CI: 14.8-16.8) and adults in Ribeirão Preto (12.9%; 95%CI: 12.0-13.9). The highest prevalence rates for suicide risk were in adults in Ribeirão Preto (13.7%; 95%CI: 12.7-14.7), and the highest rates for social phobia and generalized anxiety were in youth in Pelotas, with 7% (95%CI: 6.3-7.7) and 16.5% (95%CI: 15.4-17.5), respectively. The lowest prevalence rates of suicide risk were in youth in Pelotas (8.8%; 95%CI: 8.0-9.6), social phobia in youth in Ribeirão Preto (1.8%; 95%CI: 1.5-2.2), and generalized anxiety in adolescents in São Luís (3.5%; 95%CI: 3.0-4.0). Mental disorders in general were more prevalent in women and in individuals with lower socioeconomic status, independently of the city and age, emphasizing the need for more investment in mental health in Brazil, including gender and socioeconomic determinants.