Adolescent suicide attempts in Brazil and impact of COVID-19 pandemic: A temporal analysis

Suicide is a leading cause of adolescent mortality worldwide. Exogenous poisoning-defined as exposure to toxic substances such as medications or chemicals- is a common method, but large-scale epidemiological data in Brazil are limited. This study describes sociodemographic profiles, temporal trends, regional disparities, and the COVID-19 pandemic's impact on adolescent suicide attempts by exogenous poisoning in Brazil from 2018 to 2023. We conducted a study, the SINAN database, on reported suicide attempts by exogenous poisoning in adolescents aged 10-19 years nationwide. Descriptive analyses were performed by sex, age group, toxic agent, and care setting. Temporal trends were evaluated with LOESS decomposition, the Mann-Kendall trend test, and interrupted time-series analysis (ITSA) assessed the impact of COVID-19 on suicide attempt rates. A total of 142 251 attempts were identified; notification was substantially more common among the 15-19 age group (75.4%) and females in both groups. Medications accounted for most reported agents, and most events occurred at home. Nationwide incidence rose steadily from 2018, peaked in 2019, declined significantly in 2020 (p < 0.01), and resumed increasing through 2022. Upward trends were observed in all regions, with the 10-14-year group exhibiting the largest relative increase. The Southeast region maintained the highest cumulative incidence. ITSA indicated underreporting during the pandemic, with a 66.5% decrease in ages 10-14 and a 56.2% drop in ages 15-19. The high and rising incidence of adolescent suicide attempts by exogenous poisoning in Brazil highlights the need for strengthened mental health interventions, enhanced pharmacovigilance, and targeted prevention, especially post-pandemic.