The evolution of suicide mortality in Europe: decline with persistent disparities in an age-period-cohort analysis.
Level 3 - non-randomized controlled study
Retrospective population-based age-period-cohort analysis of vital statistics registry data
PubMed 42089172 · doi:10.1017/S2045796026100663
What was done
The authors analyzed suicide mortality trends from 1990 to 2019 across European countries with complete age- and sex-specific data in the World Health Organization mortality database. They used the National Cancer Institute's Age-Period-Cohort (APC) Web Tool to partition mortality trends into age, period, and birth-cohort dimensions at national and subregional levels. A secondary analysis examined specific suicide means between 2010 and 2019 among countries with detailed ICD-10 cause-of-death data.
What was found
In 2019, Europe recorded 47,793 male and 13,111 female suicide deaths. Overall rates declined across most subregions between 1990 and 2019. The largest drop occurred among Eastern European men, falling from 77.81 per 100,000 (95% CI: 77.17 to 78.45) in the mid-1990s to 22.93 per 100,000 (95% CI: 22.58 to 23.28) in 2019, though they maintained the highest absolute burden. Age distributions varied: male risk peaked in early adulthood in Eastern Europe, but rose after age 60 in Western and Southern Europe; female risk peaked in early adulthood in Eastern Europe and in midlife elsewhere. Period risk in Eastern Europe was approximately 60% lower in 2015–2019 compared to 2000–2004. However, cohort-specific risks rose among younger generations: in Northern European females, cohort relative risk increased from 0.73 (95% CI: 0.68 to 0.78) in the 1980 cohort to 0.90 (95% CI: 0.70 to 1.04) in the 2000 cohort. Hanging was the primary suicide method for both sexes during 2010–2019.
Why it matters
Aggregate declines in European suicide mortality mask critical increases in vulnerability among recent birth cohorts. Identifying these subregional and demographic shifts enables targeted public health interventions for high-risk younger populations.
Limits
The study was restricted only to countries with complete mortality data in the WHO database, which may introduce selection bias. Completeness of data on suicide means varied across subregions and was limited to a 10-year window (2010–2019). As an ecological registry study, it cannot identify individual-level causal drivers, and results may be affected by differences in national death-investigation systems and potential misclassification of suicide deaths under ICD-10. Total cumulative sample size across all years was not reported in the abstract.
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