1. Suicidologi 2002, årg. 7, nr. 2
A global perspective
in the epidemiology of suicide
By José Manoel Bertolote, and Alexandra Fleischmann
Global suicide rates and trends are presented, highlighting particularities of different countries in different regions
of the world. The global data are examined with regards to sex, age and in relation to cultural factors
(i.e. the prevailing religion) in countries. With regards to the prevention of suicide, the necessity of a local system
of monitoring suicide trends is stressed.
Introduction point is acknowledged, which only rein- quite distinct in relation to these charact-
Since its foundation in 1948, the World forces the gravity of the global picture of eristics, such as Sri Lanka and Cuba.
Health Organization (WHO) has been suicide. Another question that is frequent- Curiously enough, when the data are
collaborating with its Member States in ly raised refers to the comparability of data separated by WHO region, the highest
view of perfecting methods for obtaining, across countries. The information present- rates in each region with the exception
processing and analysing data on mor- ed here reflects the official figures made of Europe, are found in island countries,
tality and morbidity. As a result, WHO available to WHO by its Member States; such as Cuba, Japan, Mauritius and Sri
maintains a data bank on mortality accor- these, in turn, are based on real death Lanka. Also, according to the WHO
ding to the data provided by its Member certificates signed by legally authorized regional distribution, the lowest rates as
States. Deaths from all causes are reported, personnel, usually doctors and, to a lesser a whole are found in the Eastern Medi-
usually split by sex and age, along with extent, police officers. Generally speaking, terranean Region, which comprises mostly
mid-year population data. The actual these professionals do not misrepresent countries that follow Islamic traditions;
number of deaths in each demographic the information, and the real dimension this is also true of some Central Asian
category is then transformed into rates. of eventual distortions introduced by mis- republics that had formerly been inte-
The WHO data bank on mortality has reporting remains to be demonstrated. grated into the Soviet Union.
grown from a few Member States in the It is hoped that the figures presented can
In Figure 1, global suicide rates (per
early 1950s to more than 100 Member provide a solid ground against which
100,000 population) have been calculated
corrections and improvements can be
States that reported at some point in time. starting from 1950. Deaths reported by
Mortality associated with suicide is brought about.
countries in each year were averaged and
part of the data bank. The regularity of Suicide rates projected in relation to the global popu-
reporting on mortality has been varied. lation over 5 years of age at each respec-
According to WHO estimates for the
Some Member States have been reporting year 2020 and based on current trends, tive year. An increase of approximately
data since 1950 (11 countries); others do approximately 1.53 million people will 49% for suicide rates in males and 33%
not report at all. In 1985, the largest die from suicide, and 10–20 times more for suicide rates in females can be obser-
number of countries reported on mortality people will attempt suicide worldwide. ved between 1950 and 1995.
(74 countries) and by 1998 there were This represents on average one death
still 50 countries involved. Almost no Figure 1. Global suicide rates since
every 20 seconds and one attempt every
data is available from the WHO African 1–2 seconds. 1950 and trends until 2020.
Region, scarce information from the WHO 35
Although it is customary in the suicido-
South-East Asia and Eastern Mediterr- logy literature to present rates of suicide
anean Regions, and irregular information 30 Men
for both men and women combined (the
is sent from many countries of the Western so called total suicide rates), it should be 25
Pacific Region and from Latin American noted that the current general epidemi-
countries of the Region of the Americas. ological practice is to present rates accor- 20
From countries of the European Region ding to sex and age, particularly when
data are received mostly on a regular basis. important differences (in terms of figures 15
It is of special relevance to the field of or risk factors) across sex or age groups Women
suicidology that the category name and 10
exist. This is precisely the situation in re-
code of mortality associated with suicide lation to suicide; suicide rates of men and 5
has remained relatively stable through women are consistently different in most
successive editions of the International places, as are rates in different age groups. 0
Statistical Classification of Diseases and The highest suicide rates for both men 1950 1995 2020
Related Health Problems (ICD), from and women are found in Europe, more 900,000 1,53 mio
ICD-6 to ICD-10. particularly in Eastern Europe, in a group deaths reported deaths
Whenever figures on suicide are pre- of countries that share similar historical estimated
sented or discussed there is always the and sociocultural characteristics, such as
question of their reliability, since in some Estonia, Latvia, Lithuania and, to a lesser The increase in these global suicide rates
instances – and for several reasons – suicide extent, Finland, Hungary and the Russian must be interpreted with caution. On the
as a reason for death can be hidden; Federation. Nevertheless, some similarly one hand, it might reflect the fact that
therefore, real figures may be higher. This high rates are found in countries that are since the end of the USSR (which had
6 A global perspective in the epidemiology of suicide

2. Suicidologi 2002, årg. 7, nr. 2
an overall rate below the average), some Absolute numbers of suicide globally speaking. Currently, more sui-
of its former republics (particularly those In spite of the wide (and appropriate) cides (55%) are committed by people
with the highest rates in the world) started use of rates, the information conveyed aged 5–44 years than by people aged 45
to report individually, thus inflating the by them alone can be misleading, partic- years and older (Figure 3). Also, the age
global rate. On the other hand, figures for ularly when comparing data across coun- group in which most suicides are currently
1950 were based on 11 countries only, tries or regions with important differences completed is 35–44 years for both men
and this gradually increased up to 1995, in the demographic structure. As indicated and women.
when the estimates were based on 62 earlier, the highest suicide rates are
countries that reported on suicide. These currently reported in Eastern Europe; Figure 3. Changes in the age
62 countries as a whole probably have however, the largest numbers of suicides distribution of cases of suicide
higher rates, they are more concerned are found in Asia. between 1950 and 1998.
with them and they have a higher ten- Given the size of their population, al-
dency to report on suicide mortality than most 30% of all cases of suicide worldwide
countries where suicide is not perceived are committed in China and India alone, 1950
60% 40%
although the suicide rate of China practi- (11 countries)
as a major public health problem.
cally coincides with the global average
Figure 1 also highlights the relatively and that of India is almost half of the
constant predominance of suicide rates in global suicide rate. The number of suicides
males over suicide rates in females: 3.2:1 in China alone is 30% greater than the
in 1950, 3.6:1 in 1995 and 3.9:1 in 2020. total number of suicides in the whole of
1998
45% 55%
There is only one exception (China), where Europe, and the number of suicides in (50 countries)
suicide rates in females are consistently India alone (the second highest) is equiva-
higher than suicide rates in males, particu- lent to those in the four European coun-
larly in rural areas (Phillips and Zhang, tries with the highest number of suicides 5–44 years 45 + years
2002). together (Russia, Germany, France and
As for age, there is a clear tendency for Ukraine).
Given the relatively narrow differences This ‘ungreying’ of suicide is a relatively
suicide rates to increase with age (Figure
in the population of males and females new phenomenon. It becomes dramatic
2). Against a global suicide rate of 26.9 in each age group, the large predominance when one considers that the proportion
deaths per 100,000 for men in 1998, the of suicide rates among males is also found of the elderly in the total population is
rates for specific age groups start at 1.2 in relation to the actual number of suicides increasing at a greater rate than the one
(in the age group 5–14 years) and gradu- committed. of younger people. Also, it is not the re-
ally increase up to 55.7 (in the age group It is in relation to age, however, that sult of a divergent modification in suicide
over 75 years). The same positive relati- the most striking changes in the picture rates in these age groups: the suicide rate
onship between age and suicide rates is are perceived when we move from rates in young people is increasing at a greater
observed in relation to suicide rates in to total numbers. Although suicide rates pace than it is in the elderly.
females: for an overall rate of 8.2 in 1998, can be between six and eight times higher
specific age group rates grow from 0.5 per among the elderly, as compared with young Suicide and cultural factors: the
100,000 (in the age group 5–14 years) to people, currently more young people than case of religious denomination
18.8 (in the age group over 75 years). elderly people are dying from suicide, A comparison of suicide rates according
Figure 2. Distribution of suicide rates (per 100,000) by gender and age, 1998. to the prevalent religious denomination
in countries brings to light a most remar-
60 kable difference between countries of Islam
and countries of any other prevailing
50 religion (Figure 4). In Muslim countries
Males (e.g. Kuwait), where committing suicide
40
is most strictly forbidden, the total suicide
R A T E
30 rate is close to zero (0.1 per 100,000
population). In Hindu (e.g. India) and
20 Females Christian countries (e.g. Italy), the total
suicide rate is around 10 per 100,000
10 (Hindu: 9.6; Christian: 11.2). In Buddhist
countries (e.g. Japan), the total suicide
0 rate is distinctly higher at 17.9 per
5–14 15–24 25–34 35–44 45–54 55–64 65–74 75+ 100,000 population. At 25.6, the total
Males 1.2 19.2 28.3 34.7 39.7 41.0 41.5 55.7 suicide rate is markedly highest in Atheist
Females 0.5 5.6 7.7 8.4 10.5 11.8 14.1 18.8 countries (e.g. China) which included
A G E G R O U P in this analysis countries where religious
A global perspective in the epidemiology of suicide 7

3. Suicidologi 2002, årg. 7, nr. 2
It is, nevertheless, hoped that the infor-
Figure 4. Suicide rates (per 100,000) according to religion. mation provided here can raise awareness
45 and evoke interest with regards to the
Total Male Female serious public health and community
40 burden represented by suicide.
References
35
Phillips MR, Li X, Zhang Y. Suicide rates in China,
30 1995–99. Lancet 2002; 359: 835-40.
World Health Organization. Primary Prevention
25 of Mental, Neurological and Psychosocial
Disorders. Geneva: WHO, 1998.
20
World Health Organization. Figures and facts
15 about suicide. Geneva: WHO, 1999.
10 José Manoel Bertolote is
Coordinator of the Team on
5 Management of Mental and
Brain Disorders, Department
0 of Mental Health and Sub-
Buddhist Christian Hindu Muslim Atheist
1986 1994 1995 1985,87 1995,96 stance Dependence, World
Health Organization,
Geneva, Switzerland.
observances had been prohibited for a in a country, in relation to suicide deaths, One of his responsibilities is SUPRE, the WHO
long period of time (e.g. Albania). as a major cultural factor in the determi- Global Initiative on Suicide Prevention. He is
With regards to gender, the suicide nation of suicide. also Associate Professor in the Department of
Psychogeriatrics at Lausanne University,
rates according to the prevailing religion Prevention of suicide Switzerland.
in countries are generally higher among Alexandra Fleischmann is a
Global figures and statistics are very Clinical and Health Psycho-
males than females. The highest male: suitable for giving a broad view of a pro- logist working in the Team
female ratio can be found in Atheist and blem, raising awareness about it and pro- on Management of Mental
Christian countries, namely 3.5:1 in both viding a means of comparison with other and Brain Disorders, Depart-
cases; the lowest is seen in Hindu coun- problems. However, they hide important ment of Mental Health and
tries, at 1.3:1. Certainly, these findings Substance Dependence,
regional and local characteristics and World Health Organization
do not take personal levels of religiosity cannot replace a sound local system of (WHO), Geneva, Switzer-
into consideration; however, they might monitoring suicide trends, including land. For the past few years, her main activities
indicate the importance of the religious sociodemographic, psychiatric and have been related to the WHO Global Initiative
context, i.e. the prevalence of a religion psychological variables. on Suicide Prevention.
8 A global perspective in the epidemiology of suicide