@article{3106618,
    title = "Global, regional, and national burden of suicide mortality 1990 to 2016: Systematic analysis for the Global Burden of Disease Study 2016",
    author = "Orpana, H.M. and Marczak, L.B. and Arora, M. and Abbasi, N. and Abdulkader, R.S. and Abebe, Z. and Abraha, H.N. and Afarideh, M. and Afshari, M. and Ahmadi, A. and Aichour, A.N. and Aichour, I. and Aichour, M.T.E. and Akseer, N. and Al‐raddadi, R.M. and Alahdab, F. and Alkerwi, A. and Allebeck, P. and Alvis‐guzman, N. and Anber, N.H. and Anjomshoa, M. and Antonio, C.A.T. and Arora, A. and Aryal, K.K. and Asgedom, S.W. and Awasthi, A. and Quintanilla, B.P.A. and Badali, H. and Barker‐collo, S.L. and Bärnighausen, T.W. and Bazargan‐hejazi, S. and Benjet, C. and Bensenor, I.M. and Berfeld, N. and Beuran, M. and Bhutta, Z.A. and Biadgo, B. and Bililign, N. and Borges, G. and Borschmann, R. and Brazinova, A. and Breitborde, N.J.K. and Brugha, T. and Butt, Z.A. and Carrero, J.J. and Carvalho, F. and Malta, D.C. and Castañeda‐orjuela, C.A. and Catalá‐lópez, F. and Ciobanu, L.G. and Dachew, B.A. and Dandona, L. and Dandona, R. and Dargan, P.I. and Daryani, A. and Davitoiu, D.V. and Davletov, K. and Degenhardt, L. and Demoz, G.T. and Jarlais, D.C.D. and Dharmaratne, S.D. and Djalalinia, S. and Doan, L. and Doku, D.T. and Dubey, M. and El‐khatib, Z. and Eskandarieh, S. and Esteghamati, A. and Esteghamati, S. and Faro, A. and Farzadfar, F. and Fekadu, W. and Fernandes, E. and Ferrari, A.J. and Filip, I. and Fischer, F. and Foreman, K.J. and Fukumoto, T. and Gebre, A.K. and Grosso, G. and Gupta, R. and Haagsma, J.A. and Bidgoli, H.H. and Haj‐mirzaian, A. and Hamidi, S. and Hankey, G.J. and Haro, J.M. and Hassen, H.Y. and Hay, S.I. and Heidari, B. and Hendrie, D. and Rad, E.H. and Hosseini, S.M. and Hostiuc, S. and Irvani, S.S.N. and Islam, S.M.S. and Jakovljevic, M. and James, S. and Jayatilleke, A.U. and Jha, R.P. and Jonas, J.B. and Jozwiak, J.J. and Kadel, R. and Kahsay, A. and Kasaeian, A. and Kassa, G.M. and Kawakami, N. and Kefale, A.T. and Kemp, G.R. and Khader, Y.S. and Khafaie, M.A. and Khalil, I.A. and Khan, E.A. and Khan, M.A. and Khan, M.S. and Khang, Y.-H. and Khubchandani, J. and Kiadaliri, A.A. and Kieling, C. and Kim, Y.-E. and Kisa, A. and Knudsen, A.K.S. and Kokubo, Y. and Koyanagi, A. and Krish, V.S. and Defo, B.K. and Kumar, G.A. and Kumar, M. and Lamichhane, P. and Lang, J.J. and Latifi, A. and Lee, P.H. and Leung, J. and Lim, L.-L. and Lopez, A.D. and Lorkowski, S. and Lotufo, P.A. and Lozano, R. and Lunevicius, R. and Mahesh, P.A. and Majdan, M. and Majdzadeh, R. and Malekzadeh, R. and Manda, A.-L. and Mansournia, M.A. and Mantovani, L.G. and Maravilla, J.C. and Martinez‐raga, J. and Mathur, M.R. and Maulik, P.K. and McGrath, J.J. and Mehrotra, R. and Mekonen, T. and Mendoza, W. and Meretoja, T.J. and Mestrovic, T. and Miller, T.R. and Mini, G.K. and Mirrakhimov, E.M. and Mitchell, P.B. and Moazen, B. and Mohammad, K.A. and Mohammadi, M. and Mohammed, S. and Mokdad, A.H. and Monasta, L. and Moosazadeh, M. and Moradi, G. and Moradi‐lakeh, M. and Moradinazar, M. and Velásquez, I.M. and Morisaki, N. and Morrison, S.D. and Moschos, M.M. and Mousavi, S.M. and Mustafa, G. and Nagel, G. and Naheed, A. and Naik, G. and Najafi, F. and Negoi, I. and Negoi, R.I. and Nguyen, H.L.T. and Nguyen, L.H. and Nixon, M.R. and Ofori‐asenso, R. and Ogbo, F.A. and Oh, I.-H. and Olagunju, A.T. and Olagunju, T.O. and Øverland, S. and Owolabi, M.O. and Panda‐jonas, S. and Parry, C.D.H. and Pati, S. and Patten, S.B. and Patton, G.C. and Petzold, M. and Phillips, M.R. and Plana‐ripoll, O. and Postma, M.J. and Pourshams, A. and Poustchi, H. and Qorbani, M. and Radfar, A. and Rafay, A. and Rafiei, A. and Rahim, F. and Rahimi‐movaghar, A. and Rahimi‐movaghar, V. and Rahman, M.A. and Rai, R.K. and Rezaeian, S. and Roever, L. and Ronfani, L. and Roshandel, G. and Rostami, A. and Sachdev, P.S. and Safari, H. and Safiri, S. and Salamati, P. and Salimi, Y. and Salomon, J.A. and Samy, A.M. and Santos, I.S. and Santric‐milicevic, M.M. and Sartorius, B. and Sarvi, S. and Satpathy, M. and Sawhney, M. and Schwebel, D.C. and Sepanlou, S.G. and Shaikh, M.A. and Sharif, M. and Shibuya, K. and Shigematsu, M. and Shiri, R. and Shiue, I. and Siabani, S. and Siddiqi, T.J. and Sigfusdottir, I.D. and Silva, J.P. and Singh, J.A. and Filho, A.M.S. and Sobhani, S. and Stein, D.J. and Stein, M.B. and Sufiyan, M.B. and Sunguya, B.F. and Tabarés‐seisdedos, R. and Tabb, K.M. and Tavakkoli, M. and Tehrani‐banihashemi, A. and Temsah, M.-H. and Topor‐madry, R. and Tran, B.X. and Tran, K.B. and Ullah, I. and Unutzer, J. and Usman, M.S. and Uthman, O.A. and Valdez, P.R. and Vasankari, T.J. and Vasconcelos, C. and Vlassov, V. and Vos, T. and Vujcic, I.S. and Waheed, Y. and Wang, Y.-P. and Weiderpass, E. and Werdecker, A. and Westerman, R. and Whiteford, H.A. and Wyper, G.M.A. and Yaseri, M. and Yimer, E.M. and Yisma, E. and Yonemoto, N. and Yoon, S.-J. and Yotebieng, M. and Yousefifard, M. and Yu, C. and Zaidi, Z. and Zamani, M. and Murray, C.J.L. and Naghavi, M.",
    journal = "BMJ (Online)",
    year = "2019",
    volume = "364",
    publisher = "BMJ Publishing Group",
    doi = "10.1136/bmj.l94",
    keywords = "adolescent;  adult;  aged;  Article;  Asia;  Australia and New Zealand;  Central Asia;  Central Europe;  child;  controlled study;  demography;  Eastern Europe;  education;  Europe;  female;  fertility;  global disease burden;  groups by age;  highest income group;  human;  male;  mortality rate;  North America;  priority journal;  school child;  sex ratio;  social aspect;  South and Central America;  suicide;  uncertainty;  very elderly;  Western Europe",
    abstract = "Objectives To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016. Design Systematic analysis. Main outcome measures Crude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education). Results The total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%). Conclusions Age standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates. © Published by the BMJ Publishing Group Limited."
}