Hilario Blasco-Fontecilla, M.D., Ph.D., Paula Artieda-Urrutia, M.D., Ph.D., Jose de Leon, M.D.

Our research article, “A proposal for using the ratio of attempted to completed suicides across several countries worldwide” has recently been published in Epidemiology and Psychiatric Sciences online ahead of print (1).

The rates of completed suicide (CS) are available for most developed countries worldwide. On the other hand, there is limited data on rates of attempted suicide (AS) worldwide. This lack of knowledge of AS rates represents a concern because AS is the most relevant risk factor for CS. Accordingly, little is known about the burden of AS. In constructing a ratio for AS/CS rates, we explored all available possibilities considering that the denominator (CS) should be the annual suicide rate per 100,000. The numerator (AS per 100,000) could be: 1) annual prevalence from population surveys, 2) annual prevalence from national clinical registers, or 3) lifetime prevalence from population surveys. We think the only currently viable option is the third one: lifetime prevalence of AS (per 100,000)/annual rate of CS (per 100,000). The numerator and denominator were extracted from a WHO review and from the publicly available data from the WHO, respectively.

We examined the ratio for AS/CS across countries worldwide. Our results indicate two remarkable regional differences. In Europe, Spain and France had greater ratios than Italy (174.4 and 152.5, respectively, versus 64.1). In Asia/Pacific, New Zealand has a higher ratio (345.9) compared to Japan (76.9) and China (75.8).

Our article suggests that the ratio for AS/CS rates might be beneficial in connection with several issues related to the prevention of suicidal behavior (SB), such as: 1) identifying populations with high risk of fatal SB (low index); 2) improving the accuracy of comparing trends in SB among distinct groups (i.e. sexes, ethnicity, culture, etc.) and the burden of SB; and 3) assisting health service managers and governments in implementing evidence-informed decision-making regarding SB and allocating health resources for the prevention of SB (“How can a manager decide where to allocate these limited resources? To AS or CS? Or to both?”). In any case, the ratio for AS/CS rate does not inform on causality.

We concluded that the ratio for AS/CS rates could be considered “a first approximation for the development of a ratio of AS/CS rates using homogeneous and standardized data worldwide”. In other words, the development of a simple working tool is potentially useful in allocating resources for the prevention of SB and generating new hypotheses for future studies.

References

1. Blasco-Fontecilla H, Artieda-Urrutia P, de Leon J. A proposal for using the ratio of attempted to completed suicides across several countries worldwide. Epidemiol Psychiatr Sci. 2018 Oct 25:1-5. doi: 10.1017/S2045796018000628. [Epub ahead of print] PubMed PMID: 30355373.