Secular trends of suicide in the city of Sao 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.