Characteristics of deaths by suicide in postmortem studies in Brazil: A systematic review and meta-analysis

Introduction Suicide is one of the leading causes of death, with a trend for its increase in Brazil in past decades. This study aimed to review the characteristics of suicides in Brazilian postmortem studies. Methods Studies investigating suicide deaths in Brazil, and based on autopsy or psychological autopsy were included. Proportions were pooled across studies with the use of random and fixed effects models. Results 6777 references were retrieved from six databases (searches up to January, 2023), and 45 studies included. In autopsy studies (k = 37, n = 16,231), substance use at toxicological analysis was found in 36.42% of cases (95% CI: 30.05–43.32), previous suicide attempts in 23.92% (95% CI: 6.73–57.78). In psychological autopsy studies (k = 8, n = 139), previous suicide attempts were reported in 28.09% (95% CI: 19.74–38.28), psychiatric conditions/symptoms in 90.67% (95% CI: 67.79–97.82), family history of suicidality in 21.33% (95% CI: 13.5–32.03). Most suicide deaths were reported in males and took place at the victim's home, hanging was the most frequent suicide method. Included studies presented significant limitations in quality assessment. Conclusion Future studies should present more robust methodology, including bigger samples, the use of controls, and validated methodology.