Pesticide use intensity and hospitalized suicide attempts among agricultural populations in France: ecological associations across French departments, 2020–2022

Suicide risk is elevated in agricultural populations, and pesticide use intensity has been proposed as a potential contributing factor. However, nationwide ecological evidence linking pesticide use intensity to suicidal behavior remains limited. This study examined ecological associations between pesticide use intensity and hospitalized suicide-attempt rates among agricultural populations in France. Department-level pesticide use indicators were obtained from French Ministry of Agriculture open databases, and hospitalized suicide-attempt data were obtained from the French agricultural health insurance system (MSA) for 2020–2022. Associations between pesticide use intensity and hospitalized suicide-attempt rates were examined using Poisson regression models adjusted for MSA population size and historical standardized suicide mortality. Additional sensitivity analyses adjusted for territorial covariates. Higher pesticide use intensity was consistently associated with higher suicide-attempt rates across the three study years. Associations remained robust in sensitivity analyses adjusting for MSA population structure, healthcare-access indicators, socioeconomic indicators, rurality, and overall departmental suicide-attempt rates in the general population. Associations were strongest for conventional chemical pesticide use, whereas herbicide-specific associations were weaker and less consistent. Greater agricultural pesticide use intensity was associated with higher hospitalized suicide-attempt rates among MSA affiliates in France. Limitations include the ecological design, the absence of individual exposure and method-specific suicide-attempt data, and the inability to identify the underlying mechanism. Further individual-level and longitudinal research is needed to clarify the pathways underlying this association.