Trends and gender differentials in age-specific suicide mortality, 2004-2020, Cyprus

Abstract Background Cyprus is rarely included in international studies of suicide trends and the only published national data is two decades old. In the context of the first National Strategy for Mental Health, this study assessed suicide trends in 2004-2020, spanning the 2008 global and 2012-2013 Cyprus financial recessions, but falling short of the COVID-19 pandemic due to delays in recording. Methods Suicide deaths were obtained from the Mortality Registry (ICD-10, including “undetermined”). Directly standardized rates were calculated for four gender/age groups. Annual change was estimated in Poisson regression models with interaction terms to assess differential trends over time periods. Results There were 560 deaths (4-times more in men, >80% classified as ‘violent’ in both genders). In men, the suicide rate doubled from 4-5 to 9-10 per 100000, with most of the increase prior to 2012, representing 9% annual change (Rate Ratio 1.09, 95% CI 1.03, 1.15; p = 0.002). From 2013, the trend reversed (effect modification p-value < 0.001) with 4% annual decrease (95% CI -9%, 1%). Declines were not uniform across age-groups; rates in males aged 45-64 continued to rise, surpassing the previously high rate in males 25-44. In women, rates presented a declining trajectory from 4-5 per 100000 to 2-3 over this period, widening the gender differential. M-to-F ratio was 5.33 (95% CI 3.46, 8.19) in 2017-2020 compared to 2.73 (1.88, 3.95) in 2004-2008. A shift to violent methods was observed, with hanging now ranking as most common in both females (1 in 3) and males (1 in 2). Conclusions While relatively lower compared to other European countries, the gender differential in suicide mortality has widened in Cyprus, with steep rises in all male age-groups up to 2012 and continuing rises in males 45-64, but declines in female rates over the same period. Further analysis of trends in relation to unemployment and other socio-economic indicators is warranted as well as continuous monitoring of trends. Key messages • After steep rises in suicide across all male age-groups up to 2012, against a declining trajectory in female rates, rates in males 45-64 continued to rise, further widening the gender differential. • The age profiling and shift towards more violent methods in both genders should inform the first National Strategy for Mental Health, while continuous monitoring of trends is warranted.