Fazel, S., Runeson, B., & Ropper, A.H.
The World Health Organization (WHO) estimated that the 2016 suicide rate was 10.6 suicides per 100,000 persons, with 80% of suicides occurring in low- and middle-income countries.2 Across the six WHO regions, the incidence of suicide differed by a factor of 4 between the region with the highest rate (Europe) and the region with the lowest rate (the Eastern Mediterranean, including the Middle East). Explanations for this variation include differences in the classification of suicide, sociocultural attitudes toward suicide, access to lethal means of dying by suicide, and the adequacy of treatment for mental disorders. Worldwide, suicide rates vary according to age and sex, with the highest rates among older people and with higher rates among men (15.6 suicides per 100,000) than among women (7.0 per 100,000).2 Suicide rates have been declining over recent decades in most of these regions, with an estimated 18% reduction from 2000 to 2016. The exception is the Americas; in theUnited States, rates have increased by 1.5% annually since 2000,3 and rates among men 45 to64 years of age increased from 21 suicides per 100,000 in 1999 to 30 per 100,000 in 2017.4
Ecologic studies, which can explain time trends within countries, suggest a contribution of restrictive alcohol policies in lowering suicide rates.5 Changes in suicide rates have also been attributed to restriction of common means of suicide, such as detoxification of domestic gas (i.e., the reduction and eventual elimination of the carbon monoxide content