REGIONAL AND GENDER DIFFERENCES IN SUICIDE ATTEMPTS AND SUICIDE: A BRAZILIAN DEMOGRAPHIC ANALYSIS
Suicide attempt; Suicide; Demography; Gender; Mortality; Violence; Mental health.
Suicidal behavior results from a complex interaction between individual and contextual factors. Gender emerges as a critical determinant in this analysis, reflecting the so-called “gender paradox of suicide”, in which men and women engage in suicidal behavior in distinct ways, mediated by socially constructed roles and traditional gender norms. Within this context, the present study aimed to analyze the temporal trends in suicide attempt rates (2014–2023) and completed suicides (2010–2023) in Brazil, stratified by gender and geographic region. An ecological time series study was conducted with individuals aged 10 years or older. Data on suicide deaths were obtained from the Mortality Information System (SIM/DATASUS), and data on suicide attempts were extracted from the Notifiable Diseases Information System (SINAN/DATASUS). Rates were calculated per 100,000 inhabitants and age-standardized according to the age structure of the 2022 Brazilian Census. Trend analysis was performed using Prais–Winsten regression, with calculation of the Annual Percent Change (APC) and respective 95% confidence intervals (95% CI). Statistical analyses were conducted using R software (v4.4.1), adopting a significance level of p < 0.05.The findings revealed that suicide attempt rates were higher among women, whereas completed suicides were more prevalent among men, reflecting gendered patterns in the lethality of methods used. A sustained increase in reported suicide attempts was observed nationwide between 2014 and 2023. Although no statistically significant differences between sexes were found, upward trends were identified in both groups, with greater intensity among adolescents and young adults (10–19 years) compared to older adults.Regarding completed suicides, an upward trend was observed across all regions of the country. Although men exhibited the highest absolute suicide rates, the most pronounced growth occurred among young women, particularly by hanging: APC of 12.70% (95% CI: 9.86-15.60) among those aged 10-14, and 9.51% (95% CI: 7.60–11.50) among those aged 15-19. Among men, the corresponding APCs were 6.03% (95% CI: 4.44-7.64) and 5.29% (95% CI: 3.05-7.57), respectively. Among older adults, although suicide rates were higher, trends were stable or declining. Notably, a decrease in self-poisoning rates among women aged 60 years or older was observed (APC = -2.74; p < 0.001). These findings highlight age-, region-, and gender-based disparities in suicidal behavior in Brazil, with particular concern regarding the rise among young women, especially due to the use of highly lethal methods such as hanging. The results underscore the urgent need for intersectoral public policies incorporating a gender-, youth- and territory-sensitive approach, focused on prevention, qualified surveillance, and continuous psychosocial care.