Published online Mar 19, 2022. doi: 10.5498/wjp.v12.i3.505
Peer-review started: September 7, 2021
First decision: November 8, 2021
Revised: November 18, 2021
Accepted: February 10, 2022
Article in press: February 10, 2022
Published online: March 19, 2022
Processing time: 191 Days and 16.5 Hours
Hanging is one of the most commonly used methods for suicide in both sexes worldwide. In a number of countries, hanging mortality has increased over the last decades. Nevertheless, there is a scarcity of studies that have explored the patterns and trends for mortality of suicide by hanging on global, regional and national levels, as most evaluations are limited to certain populations.
To assess the trends of suicide mortality by hanging, strangulation, and suffocation in Serbia, from 1991 to 2020.
This nationwide study, with epidemiological descriptive study design, was carried out based on official data. The age-standardized rates (ASRs, expressed per 100000 persons) were calculated by direct standardization, using the World Standard Population. Mortality trends from suicide by hanging were assessed using the joinpoint regression analysis: The average annual percent change (AAPC) with the corresponding 95% confidence interval (95%CI) was calculated. Age-period-cohort analysis was performed to address the possible underlying reasons for the observed suicide trends.
Over the 30-year period studied, there were 24340 deaths by hanging (17750 males and 6590 females) in Serbia. In 2020, the ASR of deaths by hanging was 4.5 per 100000 persons in both sexes together (7.6 in males vs 1.7 in females). The trends of suicide mortality by hanging decreased significantly between 1991 and 2020 in both males (AAPC = -1.7% per year; 95%CI: -2.0 to -1.4) and females (AAPC = - 3.5% per year; 95%CI: -3.9 to -3.1). Mortality rates of suicide by hanging had a continuously decreasing tendency in both sexes together in all age groups: The only exception was among males in 40-49 age group, with an increasing trend of suicide by hanging from 1991 to 2011 (by +0.3% per year).
The trends in suicide mortality by hanging have been decreasing in Serbia in the last three decades in both sexes, but this was more pronounced in women than in men. Despite the decreasing trends observed in mortality of suicide by hanging, further research is needed for better clarification of trends and help in suicide prevention in the future.
Core Tip: Although scarce, previous research showed disparities in mortality trends of suicide by hanging across the world. The mortality trends of suicide by hanging decreased significantly in Serbia in the last three decades in both sexes together, but it was more pronounced in women than in men. In 2020, the age-standardized rate of mortality by hanging was 4.5 per 100000 persons in both sexes together (7.6 in males vs 1.7 in females), the male-to-female ratio was almost 5. Further research will allow a clarification of trends and help in a more effective suicide prevention.