Steady Drop in Suicide Deaths Across Europe

Liam Davenport

March 28, 2023

PARIS ― Mortality rates from suicide dropped significantly in Europe between 2011 and 2019, with 15 countries showing a significant reduction and 22 others with stabilized rates, new research shows.

Presented here at the European Psychiatric Association (EPA) 2023 Congress, the study also revealed that suicide rates increased in Turkey and that there are gender differences, including a significant increase in suicide deaths among women living in the UK.

"The differences in trends from country to country of course reflect local society, but may also reflect the adoption of measures to prevent suicide in each country," study investigator Anna Gimenez, PhD, Department of Psychiatry, Clínic Barcelona, Barcelona, Spain, said in a release.

"Previous research has shown that introducing these measures can be effective, so our next step is to confirm that the improvement is linked to this direct action," she added.

Study presenter Giovanna Fico, MD, Bipolar and Depressive Disorders Unit, Hospital Clínic Barcelona, Barcelona, Spain, noted that the study only captured data up to 2019, before COVID and the ongoing war in the Ukraine, which may affect suicide trends. Nevertheless, she added, the overall trend is that in Europe, there were fewer completed suicides.

National Antisuicide Plans

Fico told Medscape Medical News that countries such as Italy, France, and the UK have structured national antisuicide plans, but countries such as Turkey do not. She believes this could "influence the increase or decrease of suicide rates."

However, she noted that the study was limited by the fact that many European countries do not report detailed suicide rates. For example, in Ukraine, suicides among women are not currently recorded in the country's national registry.

The overall reduction in suicide rates across Europe are in stark contrast to those in the US, where the Centers for Control and Prevention (CDC) reports that suicide rates increased by 36% between 2000 and 2018 before falling by 5% between 2018 and 2020.

Fico speculated that the difference may be related to differences in healthcare systems in Europe and the US and to issues involving access, particularly for lower-income individuals. W. Vaughn McCall, MD, Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, suggested easy access to guns could account for a significant proportion of this difference.

Fico said suicide is "one of the major causes of premature death." It claims the lives of approximately 700,000 individuals around the world each year, at a rate in 2019 of 10.7 per 100,000 people.

The "overwhelming proportion of these cases," she said, are related to psychiatric disorders.

Fico noted that in 2020, 12.2 million adults in the US seriously contemplated suicide, 3.2 million planned a suicide attempt, and 1.2 million attempted suicide, of whom 45,979 died. The CDC calculates that this equates to one death every 11 minutes.

To provide a picture of recent trends in suicide mortality rates across Europe, the researchers gathered data on annual national suicide statistics for the years 2011 to 2019 in 38 European countries from the Eurostat public database.

20% Reduction

Estimating the suicide mortality rate per year per 100,000 population, the team found there was a significant reduction in mortality rates across Europe as a whole during the study period.

The total suicide rate across the region decreased from 20 deaths per 100,000 people in 2011 to 16 per 100,000 people in 2019 ― a reduction of 19.4%.

The largest significant drop in suicide rates was in Lithuania, which initially had the highest suicide rate in Europe.

This was followed by Latvia and Poland. Italy reported the lowest significant reduction among countries in which suicide rates decreased. In contrast, suicide rates increased significantly in Turkey.

Overall, 15 countries showed a reduction in annual suicide rates over the course of the study period. There was no change in 22 countries, including France, Spain, and the UK.

Stratifying the results by gender revealed that, among women, suicide mortality rates decreased significantly between 2011 and 2019 in Hungary, Serbia, Belgium, and Austria, while they increased significantly in the UK.

Among men, suicide rates decreased significantly in 17 countries. The largest decreases were reported in Lithuania and Hungary, while the smallest significant decrease was in Albania. Male suicide rates increased significantly in Turkey.

Fico said that going forward, all European countries have agreed to work with the World Health Organization to implement suicide reduction measures, such as limiting access to the means of committing suicide, and encouraging responsible reporting of suicide in the media.

Other measures include fostering socio-emotional life skills among adolescents and the early identification, assessment, and management of individuals affected by suicidal behavior.

Most Common Cause of US Suicides

Commenting on the findings for Medscape Medical News, McCall said he is "surprised" by the results, especially as the US data "look very different."

He said that "secular trends and social determinants of health no doubt play a role in suicide rates."

Highlighting the steady rise in US suicide rates, followed by the slight reduction during the COVID pandemic, McCall said that "no one knows for sure why it dropped, other than perhaps in times of universal distress humanity may rise to the occasion."

However, he said he wouldn't be surprised if suicide rates started to climb again now that the pandemic has eased.

Reflecting on the possible reasons for the differences in suicide rates between Europe and the US, McCall suggested that "perhaps the biggest difference" is "accessibility to guns."

He said that "guns are the most common cause of suicide in the US" and that reducing access to them "is a cornerstone of suicide prevention."

Beyond that, McCall noted that while the US public "has become more comfortable talking about most mental health topics, we have not become comfortable in talking about suicide."

"It seems that comfort in public discussions of suicide would be necessary towards prevention."

Also commenting Philip Gorwood, MD, PhD, head of the Clinique des Maladies Mentales et de l’Encéphale at Centre Hospitalier Sainte Anne, Paris, France, noted in a release that as "countries cope differently to reduce the burden of mental disorders, it is interesting to know which measures are efficient, and actually translate into something as crucial as a decrease of the suicidal mortality rate.

"This European study is very interesting, showing that there are large heterogeneities between countries and that for a relatively important number of countries, it is indeed possible to reduce the number of deaths by suicide per year," he said.

Fico was supported by a fellowship from La Caixa Foundation and has relationships with Angelini, Janssen-Cilag, and Lundbeck.

European Psychiatric Association (EPA) 2023 Congress: Abstract O0059. Presented March 27, 2023.

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