Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Mar 19, 2022; 12(3): 505-520
Published online Mar 19, 2022. doi: 10.5498/wjp.v12.i3.505
Trends in suicide by hanging, strangulation, and suffocation in Serbia, 1991-2020: A joinpoint regression and age-period-cohort analysis
Milena Ilic, Irena Ilic
Milena Ilic, Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
Irena Ilic, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
Author contributions: All authors equally contributed to this paper with conception and design of the study, data acquisition and analysis, drafting and critical revision and editing, and approval of the final version.
Supported by Ministry of Education, Science and Technological Development, Republic of Serbia, 2011–2020, No. 175042.
Institutional review board statement: This study is approved by the Ethics Committee of the Faculty of Medical Sciences, University of Kragujevac, No. 01-14321.
Informed consent statement: The data used for inputs and analysis were retrieved from the official database. Official data for deaths of suicide by hanging, strangulation and suffocation were obtained from the national statistical office (unpublished data). The data are fully aggregated, without any identification data. No patient approvals were sought nor required for this study. Our research question for estimating the trends of suicide mortality was based on the number of suicide mortality figures in Serbia from 1991 to 2020. However, as our model-based analysis used aggregated data, patients were not involved in the design, or conduct or reporting or dissemination plans of the research.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement–checklist of items, and the manuscript was prepared and revised according to the STROBE Statement–checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Milena Ilic, MD, PhD, Professor, Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, S. Markovica 69, Kragujevac 34000, Serbia. drmilenailic@yahoo.com
Received: September 7, 2021
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
Abstract
BACKGROUND

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.

AIM

To assess the trends of suicide mortality by hanging, strangulation, and suffocation in Serbia, from 1991 to 2020.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Suicide; Hanging; Mortality; Trends; Joinpoint analysis

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.