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| Meta Title | Global suicide rates among young people aged 15-19 - PMC |
| Meta Description | Global suicide rates among adolescents in the 15-19 age group, according to the latest World Health Organization (WHO) Mortality Database, were examined. Data for this age group were available from 90 countries (in some cases areas) out of the 130 ... |
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| Boilerpipe Text | . 2005 Jun;4(2):114–120.
Abstract
Global suicide rates among adolescents in the 15-19 age group, according
to the latest World Health Organization (WHO) Mortality Database, were examined.
Data for this age group were available from 90 countries (in some cases areas)
out of the 130 WHO member states. The mean suicide rate for this age group,
based on data available for the latest year, was 7.4/100,000. Suicide rates
were higher in males (10.5) than in females (4.1). This applies in almost
all countries. The exceptions are China, Cuba, Ecuador, El Salvador and Sri
Lanka, where the female suicide rate was higher than the male. In the 90 countries
(areas) studied, suicide was the fourth leading cause of death among young
males and the third for young females. Of the 132,423 deaths of young people
in the 90 countries, suicide accounted for 9.1%. The trend of suicide rates
from 26 countries (areas) with data available during the period 1965-1999
was also studied. A rising trend of suicide in young males was observed. This
was particularly marked in the years before 1980 and in countries outside
Europe. The WHO database is the largest of its kind and, indeed, the only
information source that can currently be used for analysis of global mortality
due to suicide. Methodological limitations are discussed.
Keywords:
Suicide, young people, causes of death
Suicidal behaviour is a major health concern in many countries, developed
and developing alike. At least a million people are estimated to die annually
from suicide worldwide (
1
). Many more
people, especially the young and middle-aged, attempt suicide (
2
).
Over the last few decades, while suicide rates have been reported as stable
or falling in many developed countries, a rising trend of youth suicide has
been observed. In 21 of the 30 countries in the World Health Organization
(WHO) European region, suicide rates in males aged 15-19 rose between 1979
and 1996. For females, suicide rates rose less markedly in 18 of the 30 countries
studied (
3
). Various possible explanations
for these rising suicide trends - loss of social cohesion, breakdown of traditional
family structure, growing economic instability and unemployment and rising
prevalence of depressive disorders - have been presented.
Some worldwide analyses of suicide trends and rates in the world have been
published (
4
-
7
),
but very little is known worldwide about the causes of death and suicide rates
among young people aged 15-19.
The purpose of this study was to present an overall picture of suicide
among adolescents worldwide using available data from the WHO database, and
to evaluate the role of suicide as a cause of death in the 15-19 age group.
METHODS
Data on causes of death and population for each country (area) were downloaded
from the WHO Mortality Database website in February 2004. Statistics on causes
of death and population in the 15-19 age group were available for 90 countries
(areas) in the year 1980 or later. From 71% of these 90 countries (areas),
there were data relating to the year 1995 or later, and roughly half had data
for 2000 or later. For 30%, there were figures dating back to before 1995.
The downloaded data files were converted into SPSS files. Data files with
different versions of the International Classification of Diseases (ICD) were
merged and analysed by gender, age group, cause of death and calendar year.
The following codes for certain suicide in the WHO Mortality Database were
used: in ICD-7 classification, codes A148 and B049, including E963, E970-E979;
in ICD- 8 classification, codes A147 and B049, including E950- E959; in ICD-9
classification, codes B54 and C102, including E950-E959; in ICD-10 classification,
codes X60-X84 (in some countries code 1101, including codes X60-X84).
The mean suicide rate in the 15-19 age group was calculated by collating
the numbers of suicides in the latest year with available figures in the population
from all the 90 countries (areas). Moreover, to avoid confounding country
effects with time effects, only countries that reported data for the same
year were selected. Therefore, suicide rates in 63 countries in 1995 were
also analysed and compared, since the largest number of countries (areas)
reported suicide and population data for that year.
A few countries were excluded from the analyses since the population in
the 15-19 age group numbered less than 10,000.
In order to evaluate suicide trends, suicide rates from all countries (areas)
with data available throughout the period 1965-1999 were examined. Rates in
European and non- European countries were compared.
The total number of deaths for the 90 countries (areas) with the latest
available data was divided by the number of deaths in each diagnostic category
to arrive at percentages for causes of death in each category. The "other
causes of death" category includes many different causes that account for
relatively small numbers of deaths, such as dis- eases of the blood and blood-forming
organs; diseases of the eye, ear, skin and subcutaneous tissue, musculoskeletal
system and connective tissue, and genito-urinary system; certain conditions
originating in the perinatal period; and various symptoms, signs and ill-defined
conditions.
RESULTS
For 90 countries (areas), data were available both on causes of death and
on the population aged 15-19. The numbers of suicides and rates per 100,000
persons aged 15-19 and the latest year in which data were available for each
country (area) are presented in Table
1
.
Table 1.
Suicide numbers and rates per 100,000 young persons aged 15-19 in 90 countries
(areas), according to the WHO Mortality Database, February 2004 (latest available
data for each country or area)
Country (area)
Year
Number
Rate
Males
Females
Total
Males
Females
Total
Sri Lanka
1986
388
424
812
43.9
49.3
46.5
Lithuania
2002
54
12
66
38.4
8.8
23.9
Russian Federation
2002
2,384
499
2,883
38.5
8.3
23.6
Kazakhstan
2002
240
78
318
31.2
10.5
21.0
Luxembourg
2002
3
1
4
23.5
8.2
16.0
New Zealand
2000
31
11
42
22.3
8.2
15.3
El Salvador
1993
44
52
96
13.2
15.8
14.5
Belarus
2001
100
16
116
23.6
3.9
14.0
Estonia
2002
13
1
14
24.1
1.9
13.2
Turkmenistan
1998
41
21
62
16.6
8.8
12.8
Ukraine
2000
375
92
467
19.6
4.9
12.4
Ireland
2000
34
7
41
19.8
4.3
12.3
Mauritius
2000
5
6
11
10.1
12.5
11.3
Norway
2001
21
8
29
15.3
6.2
10.9
Canada
2000
173
52
225
16.3
5.2
10.8
Latvia
2002
16
4
20
16.9
4.4
10.8
Kyrgyzstan
2002
42
13
55
15.2
4.8
10.0
Virgin Islands (USA)
1980
1
0
1
20.0
0.0
9.8
Barbados
1995
1
1
2
9.6
9.8
9.7
Austria
2002
37
9
46
15.1
3.8
9.6
Trinidad and Tobago
1994
6
6
12
8.9
10.5
9.6
Finland
2002
25
6
31
15.0
3.8
9.5
Uzbekistan
2000
170
86
256
12.5
6.4
9.5
Belgium
1997
46
12
58
14.5
3.9
9.3
Cuba
1996
23
45
68
6.1
12.5
9.2
Ecuador
1991
40
64
104
6.9
11.4
9.1
Iceland
1999
1
1
2
9.0
9.3
9.1
Australia
2001
95
25
120
13.8
3.8
8.9
Singapore
2001
10
8
18
9.2
7.8
8.5
Suriname
1990
3
1
4
12.5
4.3
8.5
Poland
2001
242
39
281
14.1
2.4
8.4
Switzerland
2000
27
8
35
12.6
4.0
8.4
Croatia
2002
21
3
24
14.0
2.1
8.2
USA
2000
1,347
269
1,616
13.0
2.7
8.0
Grenada
1988
0
1
1
0.0
15.6
7.8
Slovenia
1987
8
2
10
12.0
3.1
7.6
Hungary
2002
37
12
49
11.2
3.8
7.5
Guadeloupe
1981
2
1
3
8.8
4.6
6.8
Japan
2000
335
138
473
8.8
3.8
6.4
Uruguay
1990
11
5
16
8.3
3.9
6.2
Bulgaria
2002
25
6
31
9.2
2.3
5.8
Czech Republic
2001
33
6
39
9.5
1.8
5.7
Argentina
1996
122
67
189
7.1
4.0
5.6
Costa Rica
1995
13
7
20
7.1
4.0
5.6
Germany
2001
207
54
261
8.7
2.4
5.6
Thailand
1994
189
154
343
6.1
5.1
5.6
Colombia
1994
120
73
193
6.7
4.2
5.5
Venezuela
1994
80
41
121
7.1
3.8
5.5
Republic of Korea
2001
110
85
195
5.9
4.9
5.4
Hong Kong
1999
12
12
24
5.1
5.3
5.2
France
1999
150
48
198
7.5
2.5
5.0
Denmark
1999
13
1
14
9.0
0.7
4.9
Israel
1999
24
2
26
8.7
0.8
4.9
Paraguay (reporting areas)
1987
5
7
12
3.9
5.6
4.7
Romania
2002
59
18
77
7.0
2.2
4.7
Netherlands
2000
35
8
43
7.4
1.8
4.6
Sweden
2001
15
7
22
5.7
2.8
4.3
Brazil (South, South-East and Central West)
1995
286
128
414
5.7
2.6
4.2
Puerto Rico
1992
14
0
14
8.3
0.0
4.2
United Kingdom
1999
122
33
155
6.5
1.8
4.2
Republic of Moldova
2002
13
2
15
7.1
1.1
4.1
China (selected rural and urban areas)
1999
179
253
432
3.2
4.8
4.0
Belize
1995
0
1
1
0.0
7.9
3.9
Slovakia
2002
13
4
17
5.8
1.9
3.9
Chile
1994
38
8
46
6.2
1.3
3.8
Mexico
1995
263
117
380
5.1
2.3
3.7
Spain
2000
71
18
89
5.3
1.4
3.4
Panama
1987
6
2
8
4.6
1.6
3.1
Albania
2001
4
5
9
2.8
3.3
3.0
Dominican Republic
1985
10
12
22
2.7
3.2
2.9
Italy
2000
57
25
82
3.6
1.7
2.7
Macedonia
2000
1
3
4
1.2
3.7
2.4
Tajikistan
1999
11
3
14
3.3
0.9
2.1
Portugal
2000
9
3
12
2.6
0.9
1.8
Greece
1999
10
2
12
2.7
0.6
1.7
Guyana
1984
2
0
2
3.4
0.0
1.7
Armenia
2002
2
1
3
1.3
0.6
1.0
Peru
1983
13
7
20
1.3
0.7
1.0
Jamaica
1985
2
0
2
1.4
0.0
0.7
Azerbaijan
2002
5
0
5
1.1
0.0
0.6
Syrian Arab Republic (part)
1985
5
0
5
1.0
0.0
0.5
Georgia
2000
1
0
1
0.6
0.0
0.3
Egypt
1987
0
1
1
0.0
0.04
0.02
Bahamas
1995
0
0
0
0.0
0.0
0.0
Guatemala
1984
0
0
0
0.0
0.0
0.0
Kuwait
2001
0
0
0
0.0
0.0
0.0
Malta
2002
0
0
0
0.0
0.0
0.0
Philippines
1996
0
0
0
0.0
0.0
0.0
Saint Lucia
1988
0
0
0
0.0
0.0
0.0
Saint Vincent and Grenadines
1986
0
0
0
0.0
0.0
0.0
Total
8,801
3,263
12,064
10.5
4.1
7.4
A total of 12,064 cases of suicide (8,801 males and 3,263 females) from
90 countries (areas) were analysed. The mean suicide rate for 15-19 year-olds
in the 90 countries (areas), based on data in different years for the various
countries, was 7.4/100,000 (10.5 for males and 4.1 for females).
There were 13 countries with suicide rates 1.5 times or more above the
mean: these included Sri Lanka, with the highest suicide rate, followed by
Lithuania, Russia and Kazakhstan. In 24 countries (areas) suicide rates were
above, but less than 1.5 times, the mean: this category included Norway, Canada,
Latvia, Austria, Finland, Belgium and the USA. The remaining 53 countries
(areas) had below-average suicide rates (Table
1
).
The mean suicide rate for males and females together in the 63 countries
(areas) for which data for the year 1995 were available was 8.4/100,000, slightly
higher than that (7.4/100,000) in the 90 countries (areas) described above,
mainly owing to the higher suicide rate in males (Table
2
). Among these, 13 countries (including Russia, New Zealand,
the Baltic states, Kazakhstan, Norway, Canada and Slovenia) reported suicide
rates of 1.5 times the mean or more. Sixteen countries (including Ukraine,
Switzerland, the USA, Austria, Ireland, Belgium, Hungary and Portugal) showed
suicide rates above, but less than 1.5 times, the mean. Thirty-four countries
had below-average suicide rates (Table
2
).
More than two-thirds of the countries listed in Table
2
are European countries.
Table 2.
Suicide numbers and rates per 100,000 young persons aged 15-19 in the 63
countries (areas) for which data are available for the year 1995
Country (area)
Number
Rate
Males
Females
Total
Males
Females
Total
Russian Federation
1,988
509
2,497
36.5
9.6
23.2
New Zealand
45
14
59
33.0
10.6
22.0
Lithuania
42
8
50
32.7
6.4
19.7
Kazakhstan
222
69
291
29.3
9.2
19.3
Latvia
21
5
26
25.1
6.1
15.7
Estonia
12
3
15
23.6
6.2
15.1
Finland
42
6
48
25.1
3.7
14.7
Belarus
89
16
105
23.7
4.3
14.0
Kyrgyzstan
36
26
62
16.1
11.8
14.0
Norway
28
8
36
20.3
6.1
13.4
Canada
217
47
264
21.4
4.9
13.3
Cuba
41
58
99
10.5
15.5
12.9
Slovenia
15
4
19
19.3
5.5
12.6
Mauritius
8
5
13
14.7
9.4
12.1
Ukraine
334
93
427
18.1
5.2
11.7
Switzerland
32
14
46
15.7
7.2
11.6
Czech Republic
72
19
91
16.2
4.5
10.5
USA
1,616
274
1,89
17.4
3.1
10.5
Austria
44
3
47
18.6
1.3
10.2
Ireland
29
5
34
16.9
3.1
10.1
Barbados
1
1
2
9.6
9.8
9.7
Iceland
2
0
2
18.7
0.0
9.5
Bulgaria
43
15
58
13.4
4.9
9.3
Australia
87
27
114
13.4
4.4
9.0
Luxembourg
1
1
2
8.8
9.2
9.0
Belgium
38
17
55
12.1
5.6
8.9
Hungary
65
9
74
15.3
2.2
8.9
Croatia
24
5
29
14.2
3.1
8.8
Poland
234
46
280
14.2
2.9
8.7
Republic of Moldova
21
8
29
11.4
4.4
7.9
Republic of Korea
181
108
289
8.9
5.6
7.3
Sweden
27
9
36
10.3
3.6
7.1
Turkmenistan
27
4
32
12.1
1.8
7.0
China (selected rural and urban areas)
227
373
600
4.9
8.7
6.7
Slovakia
27
5
32
11.1
2.1
6.7
Germany
220
66
286
9.9
3.1
6.6
Singapore
8
5
13
7.7
5.2
6.5
Israel
22
9
31
8.5
3.7
6.1
Costa Rica
13
7
20
7.1
4.0
5.6
Denmark
15
2
17
9.1
1.3
5.3
France
151
51
202
7.7
2.7
5.3
Romania
78
26
104
7.8
2.7
5.3
Uzbekistan
89
34
123
7.6
3.0
5.3
Argentina
113
60
173
6.7
3.6
5.2
Japan
287
136
423
6.6
3.3
5.0
Hong Kong
14
6
20
6.4
3.0
4.7
Brazil (South, South-East and Central West)
286
128
414
5.7
2.6
4.2
United Kingdom
106
31
137
6.0
1.8
4.0
Belize
0
1
1
0.0
7.9
3.9
Spain
100
21
121
6.2
1.4
3.9
Mexico
263
117
380
5.1
2.3
3.7
Tajikistan
15
6
21
5.2
2.1
3.6
Malta
1
0
1
6.8
0.0
3.5
Netherlands
21
11
32
4.4
2.4
3.5
Albania
5
4
9
3.7
2.7
3.2
Italy
81
22
103
4.4
1.2
2.9
Portugal
15
8
23
3.7
2.0
2.9
Greece
9
6
15
2.3
1.6
2.0
Macedonia
1
1
2
1.2
1.2
1.2
Armenia
2
1
3
1.2
0.6
0.9
Kuwait
1
0
1
1.7
0.0
0.9
Azerbaijan
4
0
4
1.2
0.0
0.6
Bahamas
0
0
0
0.0
0.0
0.0
Total
7,859
2,573
10,432
12.4
4.2
8.4
In 26 countries (areas), data were available for the whole period studied,
1965-1999. Table
3
presents suicide
rates for each country (area), broken down by gender, during three periods
(1965-1979, 1980-1989 and 1990-1999). A rising trend of suicide rates in the
15-19 age group was observed in males from both non-European and European
countries, while the trend was fairly stable or declined slightly in females.
Suicide rates among both young males and females were higher in non-European
than in European countries during the whole period 1965-1999 (Table
3
, Figure
1
).
Table 3.
Suicide rates per 100,000 young persons aged 15-19 in 26 countries (areas)
with data available for 1965-1999
Males
Females
Total
1965-79
1980-89
1990-99
1965-79
1980-89
1990-99
1965-79
1980-89
1990-99
Mauritius
5.08
6.16
11.69
9.02
11.06
13.17
7.04
8058
12.42
Canada
13.75
20.74
19.85
3.38
3.65
4.95
8.66
12.40
12.59
USA
10.22
15.30
16.48
2.84
3.66
3.38
6.57
9.59
10.11
Hong Kong
3.01
3.38
5.87
4.65
3.63
4.95
3.81
3.50
5.43
Japan
10.61
7.46
6.60
6.91
3.99
3.24
8.79
5.77
4.96
Singapore
4.99
5.19
6.33
7.48
7.42
4.37
6.20
6.27
5.38
Australia
9.12
14.13
16.89
3.50
3.05
4.15
6.37
8.72
10.68
New Zealand
7.49
17.51
28.60
2.96
4.24
9.80
5.28
11.01
19.33
Non-European countries
10.34
13.17
13.83
4.08
3.78
3.59
7.25
8.58
8.84
Austria
16.67
19.43
16.70
5.26
6.60
3.68
11.08
13.13
10.36
Bulgaria
7.55
10.22
12.20
5.15
5.89
4.25
6.38
8.11
8.32
Denmark
6.14
9.18
8.02
2.99
3.31
2.43
4.61
6.32
5.29
Finland
18.94
24.54
25.90
4.99
5.25
4.65
12.12
15.09
15.51
France
6.54
7.95
7.62
3.25
2.85
2.80
4.92
5.46
5.26
Greece
1.51
2.61
2.17
1.72
1.72
0.76
1.61
2.18
1.49
Hungary
19.59
16.23
13.81
8.01
6.82
3.94
13.92
11.67
9.00
Iceland
9.97
20.91
26.72
0.66
0.00
6.71
5.45
10.67
16.91
Ireland
2.57
6.80
14.96
0.68
1.12
3.09
1.65
4.03
9.17
Italy
2.52
2.93
4.23
1.87
1.05
1.35
2.20
2.01
2.82
Luxembourg
9.24
12.00
13.04
3.20
6.24
4.57
6.28
9.18
8.91
Netherlands
3.78
4.09
5.62
1.22
1.76
2.37
2.53
2.95
4.03
Norway
7.04
15.71
17.37
1.92
3.45
6.63
4.54
9.74
12.12
Portugal
4.83
5.30
2.88
3.77
4.62
1.68
4.30
4.96
2.29
Spain
1.89
4.03
4.85
0.79
1.16
1.43
1.35
2.63
3.18
Sweden
8.69
8.46
8.27
5.48
3.84
4.23
7.12
6.21
6.30
Switzerland
14.87
18.63
13.64
5.35
4.58
4.29
10.16
11.77
9.09
United Kingdom
3.49
4.95
5.92
1.84
1.42
1.65
2.68
3.23
3.85
European countries
5.50
6.61
7.13
2.67
2.35
2.26
4.11
4.53
4.75
All countries
9.12
11.41
12.14
3.73
3.40
3.26
6.46
7.49
7.82
Figure 1.
Suicide rates per 100,000 young persons aged 15-19 in 26 countries (areas)
with data available for 1965-1999
Causes of death were examined for 90 countries (areas). The data covered
the same years as the data presented in Table
1
.
A total of 132,423 deaths from all kinds of causes in the 15-19 age group
in the 90 countries (areas) (Table
4
)
were analysed. The most common cause of death for both males and females was
"transport accidents", which accounted for approximately one-fifth of deaths.
Suicide ranked fourth as a cause of death for males, and third for females.
Suicide accounted for 9.1% of all deaths among male and female adolescents
together: 9.5% and 8.2% respectively (Table
4
).
Table 4.
Causes of death for young persons aged 15-19 in 90 countries (areas), according
to the WHO Mortality Database, February 2004 (latest available data for each
country or area)
Causes of death
Male
Female
Total
N
%
N
%
N
%
Transport accidents
19,643
21.2
6,919
17.4
26,562
20.1
Other accidents
19,274
20.8
5,084
12.8
24,358
18.4
Assault
13,735
14.8
2,108
5.3
15,843
12.0
Suicide
8,801
9.5
3,263
8.2
12,064
9.1
Neoplasms
5,017
5.4
3,585
9.0
8,602
6.5
Diseases of the circulatory system
4,966
5.4
3,484
8.8
8,450
6.4
Diseases of the nervous system
3,765
4.1
2,230
5.6
5,995
4.5
Diseases of the respiratory system
2,878
3.1
2,061
5.2
4,939
3.7
Infective and parasitic diseases
2,580
2.8
2,116
5.3
4,696
3.5
Diseases of the digestive system
1,420
1.5
940
2.4
2,360
1.8
Congenital malformations, deformations
1,061
1.1
817
2.1
1,878
1.4
Endocrine, nutritional and metabolic diseases
850
0.9
859
2.2
1,709
1.3
Mental and behavioural disorders
457
0.5
188
0.5
645
0.5
Other causes
8,296
8.9
6,026
15.2
14,322
10.8
Total
92,743
100.0
39,680
100.0
132,423
100.0
A similar rank order of different categories of causes of death was also
seen from the analysis of mortality data for the 63 countries (areas) from
which data were available for the same year, i.e. 1995 (data not shown).
Suicide rates varied substantially among the countries, by a factor of
up to 100. However, it must been borne in mind that some countries have small
populations and that there can be major random variations in the annual number
of suicides.
Although the data presented here are an acceptable basis for evaluating
the global impact of suicide on young people, it should be kept in mind that
relevant data are still lacking from a number of countries. For a more definitive
and correct view of suicide worldwide, data collection from these countries
is needed.
DISCUSSION
Suicide data are still not available in many countries. In the present
study, data from only 90 countries (areas) out of the world's 192 nations
were available for the 15-19 age group in the WHO Mortality Database, which
is the largest database in the world on this topic. The WHO mortality statistics
are commonly broken down by gender and age. However, some countries do not
report deaths broken down for the 15-19 age group, and there are only 130
member states of WHO.
The reliability of suicide statistics is often questioned (
4
). Suicides are underreported for cultural and religious
reasons, as well as owing to different classification and ascertainment procedures.
Suicide can be masked by many other diagnostic categories of causes of death.
Unfortunately, in cases of young people, death due to suicide is often misclassified
or masked by other mortality diagnoses. This makes the global picture of death
by suicide even graver.
International comparability of data is also discussed. The information
used in this paper, which reflects the official figures reported to WHO by
member states, is based on death certificates signed by legally authorised
personnel - usually doctors or police officers in the respective country.
Usually these professionals have specific routines. How these routines differ
between countries and regions, and how they influence suicide statistics,
remains to be demonstrated through comparative studies of mortality statistics.
Moreover, it should be borne in mind that reporting of mortality statistics
to WHO is subject to delays that vary from one country to the next. Accordingly,
years for which data are available are not always the same. Data from 71%
of the 90 countries (areas) included in the analysis covered the period 1995-2002.
Around half (44 countries) had data for the year 2000 or later. Among these
44, most were in the European region. The remaining countries' data were from
the period 1980-1994. After performing the analyses for the 90 countries (areas),
we repeated the same analyses for the 63 countries (areas) in which the suicide
data and mortality statistics were available for the year 1995. The results
concerning suicide rates and the ranking of suicide as a cause of death were
fairly similar in the two analyses (with a slightly higher global suicide
rate for young people in the analysis for the year 1995).
During the period studied, different ICD classifications were used. This
may have been an additional source of misclassification in the mortality statistics.
The mean suicide rate of 7.4/100,000 (10.5 for males and 4.1 for females)
may be perceived as a reasonable estimate for the 15-19 age group and used
as a basis for evaluating suicide rates among adolescents in different local
communities.
In the calculation of suicide rates, the numbers of suicides in two large
countries with more than 1,000 suicides in the 15-19 age group (Russia, with
2,883 cases in 2002 and USA with 1,616 in 2000) accounted for 37.3% of the
total, thus heavily influencing the mean rate. Interestingly, these two countries'
suicide rates were markedly different. The Russian rate was 23.6/100,000,
more than 3 times the mean (7.4), whereas that in the USA was 8.0, fairly
close to the mean. Sri Lanka had an extraordinarily high suicide rate in the
15-19 age group: at 46.5/100,000, it was more than six times the mean rate.
Unfortunately, data for recent years are not available for Sri Lanka.
Suicide rates for young people in the 15-19 age group are, as for other
age groups, higher in males than in females. Young males' overall suicide
rate was 2.6 times that of females. Exceptions were found in a number of non-European
countries, like Sri Lanka, El Salvador, Cuba, Ecuador and China, where suicide
rates for females 15-19 years old exceeded those of males in the same age
group. This fact urgently calls for further investigations.
Data from the latest 35-year period (1965-1999) show a marked difference
in suicide rates between European and non-European countries. The high rates
in non-European countries call for more attention. One reason for the lower
suicide rates in European countries (although suicide rates in this region
also vary widely from one country to another), beside cultural and psychosocial
factors, may possibly be the physicians' awareness of the importance of adequately
treating people with psychiatric disorders, psychosocial problems and harmful
stress. However, this does not apply to the whole European region, since countries
in transition show very high suicide rates, both for adults and for young
people.
The fact that suicide rates are higher in males than in females has long
been widely recognised. However, this study shows that suicide as a cause
of death in the 15-19 age group is very similar in both sexes: 9.5% in males
and 8.2% in females.
Suicide is one of the leading causes of death among young persons of both
sexes. It is the leading cause of death in this age group after transport
and other accidents and assault for males, and after transport and other accidents
and neoplasms for females.
Scrutiny of the data for individual countries has revealed differences
both in suicide rates and in the ranking of leading causes of death. These
differences seem to be due to social, cultural and other factors, which call
for further investigation.
In conclusion, suicide among young people is a major health problem in
many societies, and preventive measures are strongly recommended (
2
).
Acknowledgements
This paper is a product of the World Psychiatric Association's Presidential
Programme on Global Child Mental Health and Development, carried out in collaboration
with the World Health Organization and the International Association for Child
and Adolescent Psychiatry and Allied Professions. The programme is organized
and managed by a Steering Committee chaired by A. Okasha and co-chaired by
N. Sartorius, whose members are H. Remschmidt (Scientific Director and Chairperson
of the Primary Prevention Task Force), S. Tyano (Vice Director and Chairperson
of the Awareness Task Force), P. Jensen (Chairman of the Service Development
Task Force), T. Okasha (Secretary), B. Nurcombe, M. Belfer and J. Heiligenstein.
The members of the task forces include: A. Seif El-Din (Egypt), C. So (China),
C. Hoven (USA), D. Wasserman (Sweden), D.Y. Song (China), E. Caffo (Italy),
J. Cox (UK), J. Fayyad (Lebanon), J. Bauermeister (Puerto Rico), K. Kelleher
(USA), K. Hoagwood (USA), L.A. Rohde (Brazil), M. Flament (Canada), M. Hong
(Korea), P.-A. Rydelius (Sweden), R. Harrington (UK), S.F. Hung (China), T.
Dmitrieva (Russia) and T.A. Agoussou (Congo). The programme is supported by
an unrestricted educational grant from the Eli Lilly and Company Foundation
and the generous support of several institutions and individuals.
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# Global suicide rates among young people aged 15-19
[DANUTA WASSERMAN](https://pubmed.ncbi.nlm.nih.gov/?term="WASSERMAN%20D"[Author])
### DANUTA WASSERMAN
1Swedish National and Stockholm County Council's Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) at the Karolinska Institute, Department of Public Health Sciences, Box 230, 171 77 Stockholm, Sweden
Find articles by [DANUTA WASSERMAN](https://pubmed.ncbi.nlm.nih.gov/?term="WASSERMAN%20D"[Author])
1, [QI CHENG](https://pubmed.ncbi.nlm.nih.gov/?term="CHENG%20QI"[Author])
### QI CHENG
2Center of Clinical Epidemiology, Ruijen Hospital, Shanghai Second Medical University, Shanghai, China
Find articles by [QI CHENG](https://pubmed.ncbi.nlm.nih.gov/?term="CHENG%20QI"[Author])
2, [GUO-XIN JIANG](https://pubmed.ncbi.nlm.nih.gov/?term="JIANG%20GUOXIN"[Author])
### GUO-XIN JIANG
1Swedish National and Stockholm County Council's Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) at the Karolinska Institute, Department of Public Health Sciences, Box 230, 171 77 Stockholm, Sweden
Find articles by [GUO-XIN JIANG](https://pubmed.ncbi.nlm.nih.gov/?term="JIANG%20GUOXIN"[Author])
1
- Author information
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1Swedish National and Stockholm County Council's Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) at the Karolinska Institute, Department of Public Health Sciences, Box 230, 171 77 Stockholm, Sweden
2Center of Clinical Epidemiology, Ruijen Hospital, Shanghai Second Medical University, Shanghai, China
World Psychiatric Association
[PMC Copyright notice](https://pmc.ncbi.nlm.nih.gov/about/copyright/)
PMCID: PMC1414751 PMID: [16633527](https://pubmed.ncbi.nlm.nih.gov/16633527/)
**This article has been corrected.** See [World Psychiatry. 2006 Feb;5(1):39](https://pmc.ncbi.nlm.nih.gov/articles/PMC1472267/).
## Abstract
Global suicide rates among adolescents in the 15-19 age group, according to the latest World Health Organization (WHO) Mortality Database, were examined. Data for this age group were available from 90 countries (in some cases areas) out of the 130 WHO member states. The mean suicide rate for this age group, based on data available for the latest year, was 7.4/100,000. Suicide rates were higher in males (10.5) than in females (4.1). This applies in almost all countries. The exceptions are China, Cuba, Ecuador, El Salvador and Sri Lanka, where the female suicide rate was higher than the male. In the 90 countries (areas) studied, suicide was the fourth leading cause of death among young males and the third for young females. Of the 132,423 deaths of young people in the 90 countries, suicide accounted for 9.1%. The trend of suicide rates from 26 countries (areas) with data available during the period 1965-1999 was also studied. A rising trend of suicide in young males was observed. This was particularly marked in the years before 1980 and in countries outside Europe. The WHO database is the largest of its kind and, indeed, the only information source that can currently be used for analysis of global mortality due to suicide. Methodological limitations are discussed.
**Keywords:** Suicide, young people, causes of death
***
Suicidal behaviour is a major health concern in many countries, developed and developing alike. At least a million people are estimated to die annually from suicide worldwide ([1](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B1)). Many more people, especially the young and middle-aged, attempt suicide ([2](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B2)).
Over the last few decades, while suicide rates have been reported as stable or falling in many developed countries, a rising trend of youth suicide has been observed. In 21 of the 30 countries in the World Health Organization (WHO) European region, suicide rates in males aged 15-19 rose between 1979 and 1996. For females, suicide rates rose less markedly in 18 of the 30 countries studied ([3](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B3)). Various possible explanations for these rising suicide trends - loss of social cohesion, breakdown of traditional family structure, growing economic instability and unemployment and rising prevalence of depressive disorders - have been presented.
Some worldwide analyses of suicide trends and rates in the world have been published ([4](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B4)\-[7](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B7)), but very little is known worldwide about the causes of death and suicide rates among young people aged 15-19.
The purpose of this study was to present an overall picture of suicide among adolescents worldwide using available data from the WHO database, and to evaluate the role of suicide as a cause of death in the 15-19 age group.
## METHODS
Data on causes of death and population for each country (area) were downloaded from the WHO Mortality Database website in February 2004. Statistics on causes of death and population in the 15-19 age group were available for 90 countries (areas) in the year 1980 or later. From 71% of these 90 countries (areas), there were data relating to the year 1995 or later, and roughly half had data for 2000 or later. For 30%, there were figures dating back to before 1995.
The downloaded data files were converted into SPSS files. Data files with different versions of the International Classification of Diseases (ICD) were merged and analysed by gender, age group, cause of death and calendar year.
The following codes for certain suicide in the WHO Mortality Database were used: in ICD-7 classification, codes A148 and B049, including E963, E970-E979; in ICD- 8 classification, codes A147 and B049, including E950- E959; in ICD-9 classification, codes B54 and C102, including E950-E959; in ICD-10 classification, codes X60-X84 (in some countries code 1101, including codes X60-X84).
The mean suicide rate in the 15-19 age group was calculated by collating the numbers of suicides in the latest year with available figures in the population from all the 90 countries (areas). Moreover, to avoid confounding country effects with time effects, only countries that reported data for the same year were selected. Therefore, suicide rates in 63 countries in 1995 were also analysed and compared, since the largest number of countries (areas) reported suicide and population data for that year.
A few countries were excluded from the analyses since the population in the 15-19 age group numbered less than 10,000.
In order to evaluate suicide trends, suicide rates from all countries (areas) with data available throughout the period 1965-1999 were examined. Rates in European and non- European countries were compared.
The total number of deaths for the 90 countries (areas) with the latest available data was divided by the number of deaths in each diagnostic category to arrive at percentages for causes of death in each category. The "other causes of death" category includes many different causes that account for relatively small numbers of deaths, such as dis- eases of the blood and blood-forming organs; diseases of the eye, ear, skin and subcutaneous tissue, musculoskeletal system and connective tissue, and genito-urinary system; certain conditions originating in the perinatal period; and various symptoms, signs and ill-defined conditions.
## RESULTS
For 90 countries (areas), data were available both on causes of death and on the population aged 15-19. The numbers of suicides and rates per 100,000 persons aged 15-19 and the latest year in which data were available for each country (area) are presented in Table [1](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T1).
### Table 1.
Suicide numbers and rates per 100,000 young persons aged 15-19 in 90 countries (areas), according to the WHO Mortality Database, February 2004 (latest available data for each country or area)
| Country (area) | Year | Number | Rate | | | | |
|---|---|---|---|---|---|---|---|
| Males | Females | Total | Males | Females | Total | | |
| Sri Lanka | 1986 | 388 | 424 | 812 | 43\.9 | 49\.3 | 46\.5 |
| Lithuania | 2002 | 54 | 12 | 66 | 38\.4 | 8\.8 | 23\.9 |
| Russian Federation | 2002 | 2,384 | 499 | 2,883 | 38\.5 | 8\.3 | 23\.6 |
| Kazakhstan | 2002 | 240 | 78 | 318 | 31\.2 | 10\.5 | 21\.0 |
| Luxembourg | 2002 | 3 | 1 | 4 | 23\.5 | 8\.2 | 16\.0 |
| New Zealand | 2000 | 31 | 11 | 42 | 22\.3 | 8\.2 | 15\.3 |
| El Salvador | 1993 | 44 | 52 | 96 | 13\.2 | 15\.8 | 14\.5 |
| Belarus | 2001 | 100 | 16 | 116 | 23\.6 | 3\.9 | 14\.0 |
| Estonia | 2002 | 13 | 1 | 14 | 24\.1 | 1\.9 | 13\.2 |
| Turkmenistan | 1998 | 41 | 21 | 62 | 16\.6 | 8\.8 | 12\.8 |
| Ukraine | 2000 | 375 | 92 | 467 | 19\.6 | 4\.9 | 12\.4 |
| Ireland | 2000 | 34 | 7 | 41 | 19\.8 | 4\.3 | 12\.3 |
| Mauritius | 2000 | 5 | 6 | 11 | 10\.1 | 12\.5 | 11\.3 |
| Norway | 2001 | 21 | 8 | 29 | 15\.3 | 6\.2 | 10\.9 |
| Canada | 2000 | 173 | 52 | 225 | 16\.3 | 5\.2 | 10\.8 |
| Latvia | 2002 | 16 | 4 | 20 | 16\.9 | 4\.4 | 10\.8 |
| Kyrgyzstan | 2002 | 42 | 13 | 55 | 15\.2 | 4\.8 | 10\.0 |
| Virgin Islands (USA) | 1980 | 1 | 0 | 1 | 20\.0 | 0\.0 | 9\.8 |
| Barbados | 1995 | 1 | 1 | 2 | 9\.6 | 9\.8 | 9\.7 |
| Austria | 2002 | 37 | 9 | 46 | 15\.1 | 3\.8 | 9\.6 |
| Trinidad and Tobago | 1994 | 6 | 6 | 12 | 8\.9 | 10\.5 | 9\.6 |
| Finland | 2002 | 25 | 6 | 31 | 15\.0 | 3\.8 | 9\.5 |
| Uzbekistan | 2000 | 170 | 86 | 256 | 12\.5 | 6\.4 | 9\.5 |
| Belgium | 1997 | 46 | 12 | 58 | 14\.5 | 3\.9 | 9\.3 |
| Cuba | 1996 | 23 | 45 | 68 | 6\.1 | 12\.5 | 9\.2 |
| Ecuador | 1991 | 40 | 64 | 104 | 6\.9 | 11\.4 | 9\.1 |
| Iceland | 1999 | 1 | 1 | 2 | 9\.0 | 9\.3 | 9\.1 |
| Australia | 2001 | 95 | 25 | 120 | 13\.8 | 3\.8 | 8\.9 |
| Singapore | 2001 | 10 | 8 | 18 | 9\.2 | 7\.8 | 8\.5 |
| Suriname | 1990 | 3 | 1 | 4 | 12\.5 | 4\.3 | 8\.5 |
| Poland | 2001 | 242 | 39 | 281 | 14\.1 | 2\.4 | 8\.4 |
| Switzerland | 2000 | 27 | 8 | 35 | 12\.6 | 4\.0 | 8\.4 |
| Croatia | 2002 | 21 | 3 | 24 | 14\.0 | 2\.1 | 8\.2 |
| USA | 2000 | 1,347 | 269 | 1,616 | 13\.0 | 2\.7 | 8\.0 |
| Grenada | 1988 | 0 | 1 | 1 | 0\.0 | 15\.6 | 7\.8 |
| Slovenia | 1987 | 8 | 2 | 10 | 12\.0 | 3\.1 | 7\.6 |
| Hungary | 2002 | 37 | 12 | 49 | 11\.2 | 3\.8 | 7\.5 |
| Guadeloupe | 1981 | 2 | 1 | 3 | 8\.8 | 4\.6 | 6\.8 |
| Japan | 2000 | 335 | 138 | 473 | 8\.8 | 3\.8 | 6\.4 |
| Uruguay | 1990 | 11 | 5 | 16 | 8\.3 | 3\.9 | 6\.2 |
| Bulgaria | 2002 | 25 | 6 | 31 | 9\.2 | 2\.3 | 5\.8 |
| Czech Republic | 2001 | 33 | 6 | 39 | 9\.5 | 1\.8 | 5\.7 |
| Argentina | 1996 | 122 | 67 | 189 | 7\.1 | 4\.0 | 5\.6 |
| Costa Rica | 1995 | 13 | 7 | 20 | 7\.1 | 4\.0 | 5\.6 |
| Germany | 2001 | 207 | 54 | 261 | 8\.7 | 2\.4 | 5\.6 |
| Thailand | 1994 | 189 | 154 | 343 | 6\.1 | 5\.1 | 5\.6 |
| Colombia | 1994 | 120 | 73 | 193 | 6\.7 | 4\.2 | 5\.5 |
| Venezuela | 1994 | 80 | 41 | 121 | 7\.1 | 3\.8 | 5\.5 |
| Republic of Korea | 2001 | 110 | 85 | 195 | 5\.9 | 4\.9 | 5\.4 |
| Hong Kong | 1999 | 12 | 12 | 24 | 5\.1 | 5\.3 | 5\.2 |
| France | 1999 | 150 | 48 | 198 | 7\.5 | 2\.5 | 5\.0 |
| Denmark | 1999 | 13 | 1 | 14 | 9\.0 | 0\.7 | 4\.9 |
| Israel | 1999 | 24 | 2 | 26 | 8\.7 | 0\.8 | 4\.9 |
| Paraguay (reporting areas) | 1987 | 5 | 7 | 12 | 3\.9 | 5\.6 | 4\.7 |
| Romania | 2002 | 59 | 18 | 77 | 7\.0 | 2\.2 | 4\.7 |
| Netherlands | 2000 | 35 | 8 | 43 | 7\.4 | 1\.8 | 4\.6 |
| Sweden | 2001 | 15 | 7 | 22 | 5\.7 | 2\.8 | 4\.3 |
| Brazil (South, South-East and Central West) | 1995 | 286 | 128 | 414 | 5\.7 | 2\.6 | 4\.2 |
| Puerto Rico | 1992 | 14 | 0 | 14 | 8\.3 | 0\.0 | 4\.2 |
| United Kingdom | 1999 | 122 | 33 | 155 | 6\.5 | 1\.8 | 4\.2 |
| Republic of Moldova | 2002 | 13 | 2 | 15 | 7\.1 | 1\.1 | 4\.1 |
| China (selected rural and urban areas) | 1999 | 179 | 253 | 432 | 3\.2 | 4\.8 | 4\.0 |
| Belize | 1995 | 0 | 1 | 1 | 0\.0 | 7\.9 | 3\.9 |
| Slovakia | 2002 | 13 | 4 | 17 | 5\.8 | 1\.9 | 3\.9 |
| Chile | 1994 | 38 | 8 | 46 | 6\.2 | 1\.3 | 3\.8 |
| Mexico | 1995 | 263 | 117 | 380 | 5\.1 | 2\.3 | 3\.7 |
| Spain | 2000 | 71 | 18 | 89 | 5\.3 | 1\.4 | 3\.4 |
| Panama | 1987 | 6 | 2 | 8 | 4\.6 | 1\.6 | 3\.1 |
| Albania | 2001 | 4 | 5 | 9 | 2\.8 | 3\.3 | 3\.0 |
| Dominican Republic | 1985 | 10 | 12 | 22 | 2\.7 | 3\.2 | 2\.9 |
| Italy | 2000 | 57 | 25 | 82 | 3\.6 | 1\.7 | 2\.7 |
| Macedonia | 2000 | 1 | 3 | 4 | 1\.2 | 3\.7 | 2\.4 |
| Tajikistan | 1999 | 11 | 3 | 14 | 3\.3 | 0\.9 | 2\.1 |
| Portugal | 2000 | 9 | 3 | 12 | 2\.6 | 0\.9 | 1\.8 |
| Greece | 1999 | 10 | 2 | 12 | 2\.7 | 0\.6 | 1\.7 |
| Guyana | 1984 | 2 | 0 | 2 | 3\.4 | 0\.0 | 1\.7 |
| Armenia | 2002 | 2 | 1 | 3 | 1\.3 | 0\.6 | 1\.0 |
| Peru | 1983 | 13 | 7 | 20 | 1\.3 | 0\.7 | 1\.0 |
| Jamaica | 1985 | 2 | 0 | 2 | 1\.4 | 0\.0 | 0\.7 |
| Azerbaijan | 2002 | 5 | 0 | 5 | 1\.1 | 0\.0 | 0\.6 |
| Syrian Arab Republic (part) | 1985 | 5 | 0 | 5 | 1\.0 | 0\.0 | 0\.5 |
| Georgia | 2000 | 1 | 0 | 1 | 0\.6 | 0\.0 | 0\.3 |
| Egypt | 1987 | 0 | 1 | 1 | 0\.0 | 0\.04 | 0\.02 |
| Bahamas | 1995 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Guatemala | 1984 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Kuwait | 2001 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Malta | 2002 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Philippines | 1996 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Saint Lucia | 1988 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Saint Vincent and Grenadines | 1986 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Total | | 8,801 | 3,263 | 12,064 | 10\.5 | 4\.1 | 7\.4 |
[Open in a new tab](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/table/T1/)
A total of 12,064 cases of suicide (8,801 males and 3,263 females) from 90 countries (areas) were analysed. The mean suicide rate for 15-19 year-olds in the 90 countries (areas), based on data in different years for the various countries, was 7.4/100,000 (10.5 for males and 4.1 for females).
There were 13 countries with suicide rates 1.5 times or more above the mean: these included Sri Lanka, with the highest suicide rate, followed by Lithuania, Russia and Kazakhstan. In 24 countries (areas) suicide rates were above, but less than 1.5 times, the mean: this category included Norway, Canada, Latvia, Austria, Finland, Belgium and the USA. The remaining 53 countries (areas) had below-average suicide rates (Table [1](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T1)).
The mean suicide rate for males and females together in the 63 countries (areas) for which data for the year 1995 were available was 8.4/100,000, slightly higher than that (7.4/100,000) in the 90 countries (areas) described above, mainly owing to the higher suicide rate in males (Table [2](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T2)). Among these, 13 countries (including Russia, New Zealand, the Baltic states, Kazakhstan, Norway, Canada and Slovenia) reported suicide rates of 1.5 times the mean or more. Sixteen countries (including Ukraine, Switzerland, the USA, Austria, Ireland, Belgium, Hungary and Portugal) showed suicide rates above, but less than 1.5 times, the mean. Thirty-four countries had below-average suicide rates (Table [2](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T2)). More than two-thirds of the countries listed in Table [2](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T2) are European countries.
### Table 2.
Suicide numbers and rates per 100,000 young persons aged 15-19 in the 63 countries (areas) for which data are available for the year 1995
| Country (area) | Number | Rate | | | | |
|---|---|---|---|---|---|---|
| Males | Females | Total | Males | Females | Total | |
| Russian Federation | 1,988 | 509 | 2,497 | 36\.5 | 9\.6 | 23\.2 |
| New Zealand | 45 | 14 | 59 | 33\.0 | 10\.6 | 22\.0 |
| Lithuania | 42 | 8 | 50 | 32\.7 | 6\.4 | 19\.7 |
| Kazakhstan | 222 | 69 | 291 | 29\.3 | 9\.2 | 19\.3 |
| Latvia | 21 | 5 | 26 | 25\.1 | 6\.1 | 15\.7 |
| Estonia | 12 | 3 | 15 | 23\.6 | 6\.2 | 15\.1 |
| Finland | 42 | 6 | 48 | 25\.1 | 3\.7 | 14\.7 |
| Belarus | 89 | 16 | 105 | 23\.7 | 4\.3 | 14\.0 |
| Kyrgyzstan | 36 | 26 | 62 | 16\.1 | 11\.8 | 14\.0 |
| Norway | 28 | 8 | 36 | 20\.3 | 6\.1 | 13\.4 |
| Canada | 217 | 47 | 264 | 21\.4 | 4\.9 | 13\.3 |
| Cuba | 41 | 58 | 99 | 10\.5 | 15\.5 | 12\.9 |
| Slovenia | 15 | 4 | 19 | 19\.3 | 5\.5 | 12\.6 |
| Mauritius | 8 | 5 | 13 | 14\.7 | 9\.4 | 12\.1 |
| Ukraine | 334 | 93 | 427 | 18\.1 | 5\.2 | 11\.7 |
| Switzerland | 32 | 14 | 46 | 15\.7 | 7\.2 | 11\.6 |
| Czech Republic | 72 | 19 | 91 | 16\.2 | 4\.5 | 10\.5 |
| USA | 1,616 | 274 | 1,89 | 17\.4 | 3\.1 | 10\.5 |
| Austria | 44 | 3 | 47 | 18\.6 | 1\.3 | 10\.2 |
| Ireland | 29 | 5 | 34 | 16\.9 | 3\.1 | 10\.1 |
| Barbados | 1 | 1 | 2 | 9\.6 | 9\.8 | 9\.7 |
| Iceland | 2 | 0 | 2 | 18\.7 | 0\.0 | 9\.5 |
| Bulgaria | 43 | 15 | 58 | 13\.4 | 4\.9 | 9\.3 |
| Australia | 87 | 27 | 114 | 13\.4 | 4\.4 | 9\.0 |
| Luxembourg | 1 | 1 | 2 | 8\.8 | 9\.2 | 9\.0 |
| Belgium | 38 | 17 | 55 | 12\.1 | 5\.6 | 8\.9 |
| Hungary | 65 | 9 | 74 | 15\.3 | 2\.2 | 8\.9 |
| Croatia | 24 | 5 | 29 | 14\.2 | 3\.1 | 8\.8 |
| Poland | 234 | 46 | 280 | 14\.2 | 2\.9 | 8\.7 |
| Republic of Moldova | 21 | 8 | 29 | 11\.4 | 4\.4 | 7\.9 |
| Republic of Korea | 181 | 108 | 289 | 8\.9 | 5\.6 | 7\.3 |
| Sweden | 27 | 9 | 36 | 10\.3 | 3\.6 | 7\.1 |
| Turkmenistan | 27 | 4 | 32 | 12\.1 | 1\.8 | 7\.0 |
| China (selected rural and urban areas) | 227 | 373 | 600 | 4\.9 | 8\.7 | 6\.7 |
| Slovakia | 27 | 5 | 32 | 11\.1 | 2\.1 | 6\.7 |
| Germany | 220 | 66 | 286 | 9\.9 | 3\.1 | 6\.6 |
| Singapore | 8 | 5 | 13 | 7\.7 | 5\.2 | 6\.5 |
| Israel | 22 | 9 | 31 | 8\.5 | 3\.7 | 6\.1 |
| Costa Rica | 13 | 7 | 20 | 7\.1 | 4\.0 | 5\.6 |
| Denmark | 15 | 2 | 17 | 9\.1 | 1\.3 | 5\.3 |
| France | 151 | 51 | 202 | 7\.7 | 2\.7 | 5\.3 |
| Romania | 78 | 26 | 104 | 7\.8 | 2\.7 | 5\.3 |
| Uzbekistan | 89 | 34 | 123 | 7\.6 | 3\.0 | 5\.3 |
| Argentina | 113 | 60 | 173 | 6\.7 | 3\.6 | 5\.2 |
| Japan | 287 | 136 | 423 | 6\.6 | 3\.3 | 5\.0 |
| Hong Kong | 14 | 6 | 20 | 6\.4 | 3\.0 | 4\.7 |
| Brazil (South, South-East and Central West) | 286 | 128 | 414 | 5\.7 | 2\.6 | 4\.2 |
| United Kingdom | 106 | 31 | 137 | 6\.0 | 1\.8 | 4\.0 |
| Belize | 0 | 1 | 1 | 0\.0 | 7\.9 | 3\.9 |
| Spain | 100 | 21 | 121 | 6\.2 | 1\.4 | 3\.9 |
| Mexico | 263 | 117 | 380 | 5\.1 | 2\.3 | 3\.7 |
| Tajikistan | 15 | 6 | 21 | 5\.2 | 2\.1 | 3\.6 |
| Malta | 1 | 0 | 1 | 6\.8 | 0\.0 | 3\.5 |
| Netherlands | 21 | 11 | 32 | 4\.4 | 2\.4 | 3\.5 |
| Albania | 5 | 4 | 9 | 3\.7 | 2\.7 | 3\.2 |
| Italy | 81 | 22 | 103 | 4\.4 | 1\.2 | 2\.9 |
| Portugal | 15 | 8 | 23 | 3\.7 | 2\.0 | 2\.9 |
| Greece | 9 | 6 | 15 | 2\.3 | 1\.6 | 2\.0 |
| Macedonia | 1 | 1 | 2 | 1\.2 | 1\.2 | 1\.2 |
| Armenia | 2 | 1 | 3 | 1\.2 | 0\.6 | 0\.9 |
| Kuwait | 1 | 0 | 1 | 1\.7 | 0\.0 | 0\.9 |
| Azerbaijan | 4 | 0 | 4 | 1\.2 | 0\.0 | 0\.6 |
| Bahamas | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Total | 7,859 | 2,573 | 10,432 | 12\.4 | 4\.2 | 8\.4 |
[Open in a new tab](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/table/T2/)
In 26 countries (areas), data were available for the whole period studied, 1965-1999. Table [3](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T3) presents suicide rates for each country (area), broken down by gender, during three periods (1965-1979, 1980-1989 and 1990-1999). A rising trend of suicide rates in the 15-19 age group was observed in males from both non-European and European countries, while the trend was fairly stable or declined slightly in females. Suicide rates among both young males and females were higher in non-European than in European countries during the whole period 1965-1999 (Table [3](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T3), Figure [1](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#F1)).
### Table 3.
Suicide rates per 100,000 young persons aged 15-19 in 26 countries (areas) with data available for 1965-1999
| | Males | Females | Total | | | | | | |
|---|---|---|---|---|---|---|---|---|---|
| 1965-79 | 1980-89 | 1990-99 | 1965-79 | 1980-89 | 1990-99 | 1965-79 | 1980-89 | 1990-99 | |
| Mauritius | 5\.08 | 6\.16 | 11\.69 | 9\.02 | 11\.06 | 13\.17 | 7\.04 | 8058 | 12\.42 |
| Canada | 13\.75 | 20\.74 | 19\.85 | 3\.38 | 3\.65 | 4\.95 | 8\.66 | 12\.40 | 12\.59 |
| USA | 10\.22 | 15\.30 | 16\.48 | 2\.84 | 3\.66 | 3\.38 | 6\.57 | 9\.59 | 10\.11 |
| Hong Kong | 3\.01 | 3\.38 | 5\.87 | 4\.65 | 3\.63 | 4\.95 | 3\.81 | 3\.50 | 5\.43 |
| Japan | 10\.61 | 7\.46 | 6\.60 | 6\.91 | 3\.99 | 3\.24 | 8\.79 | 5\.77 | 4\.96 |
| Singapore | 4\.99 | 5\.19 | 6\.33 | 7\.48 | 7\.42 | 4\.37 | 6\.20 | 6\.27 | 5\.38 |
| Australia | 9\.12 | 14\.13 | 16\.89 | 3\.50 | 3\.05 | 4\.15 | 6\.37 | 8\.72 | 10\.68 |
| New Zealand | 7\.49 | 17\.51 | 28\.60 | 2\.96 | 4\.24 | 9\.80 | 5\.28 | 11\.01 | 19\.33 |
| *Non-European countries* | *10\.34* | *13\.17* | *13\.83* | *4\.08* | *3\.78* | *3\.59* | *7\.25* | *8\.58* | *8\.84* |
| Austria | 16\.67 | 19\.43 | 16\.70 | 5\.26 | 6\.60 | 3\.68 | 11\.08 | 13\.13 | 10\.36 |
| Bulgaria | 7\.55 | 10\.22 | 12\.20 | 5\.15 | 5\.89 | 4\.25 | 6\.38 | 8\.11 | 8\.32 |
| Denmark | 6\.14 | 9\.18 | 8\.02 | 2\.99 | 3\.31 | 2\.43 | 4\.61 | 6\.32 | 5\.29 |
| Finland | 18\.94 | 24\.54 | 25\.90 | 4\.99 | 5\.25 | 4\.65 | 12\.12 | 15\.09 | 15\.51 |
| France | 6\.54 | 7\.95 | 7\.62 | 3\.25 | 2\.85 | 2\.80 | 4\.92 | 5\.46 | 5\.26 |
| Greece | 1\.51 | 2\.61 | 2\.17 | 1\.72 | 1\.72 | 0\.76 | 1\.61 | 2\.18 | 1\.49 |
| Hungary | 19\.59 | 16\.23 | 13\.81 | 8\.01 | 6\.82 | 3\.94 | 13\.92 | 11\.67 | 9\.00 |
| Iceland | 9\.97 | 20\.91 | 26\.72 | 0\.66 | 0\.00 | 6\.71 | 5\.45 | 10\.67 | 16\.91 |
| Ireland | 2\.57 | 6\.80 | 14\.96 | 0\.68 | 1\.12 | 3\.09 | 1\.65 | 4\.03 | 9\.17 |
| Italy | 2\.52 | 2\.93 | 4\.23 | 1\.87 | 1\.05 | 1\.35 | 2\.20 | 2\.01 | 2\.82 |
| Luxembourg | 9\.24 | 12\.00 | 13\.04 | 3\.20 | 6\.24 | 4\.57 | 6\.28 | 9\.18 | 8\.91 |
| Netherlands | 3\.78 | 4\.09 | 5\.62 | 1\.22 | 1\.76 | 2\.37 | 2\.53 | 2\.95 | 4\.03 |
| Norway | 7\.04 | 15\.71 | 17\.37 | 1\.92 | 3\.45 | 6\.63 | 4\.54 | 9\.74 | 12\.12 |
| Portugal | 4\.83 | 5\.30 | 2\.88 | 3\.77 | 4\.62 | 1\.68 | 4\.30 | 4\.96 | 2\.29 |
| Spain | 1\.89 | 4\.03 | 4\.85 | 0\.79 | 1\.16 | 1\.43 | 1\.35 | 2\.63 | 3\.18 |
| Sweden | 8\.69 | 8\.46 | 8\.27 | 5\.48 | 3\.84 | 4\.23 | 7\.12 | 6\.21 | 6\.30 |
| Switzerland | 14\.87 | 18\.63 | 13\.64 | 5\.35 | 4\.58 | 4\.29 | 10\.16 | 11\.77 | 9\.09 |
| United Kingdom | 3\.49 | 4\.95 | 5\.92 | 1\.84 | 1\.42 | 1\.65 | 2\.68 | 3\.23 | 3\.85 |
| *European countries* | *5\.50* | *6\.61* | *7\.13* | *2\.67* | *2\.35* | *2\.26* | *4\.11* | *4\.53* | *4\.75* |
| **All countries** | **9\.12** | **11\.41** | **12\.14** | **3\.73** | **3\.40** | **3\.26** | **6\.46** | **7\.49** | **7\.82** |
[Open in a new tab](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/table/T3/)
### Figure 1.
[](https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=1414751_wpa040114-1.jpg)
[Open in a new tab](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/figure/F1/)
Suicide rates per 100,000 young persons aged 15-19 in 26 countries (areas) with data available for 1965-1999
Causes of death were examined for 90 countries (areas). The data covered the same years as the data presented in Table [1](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T1). A total of 132,423 deaths from all kinds of causes in the 15-19 age group in the 90 countries (areas) (Table [4](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T4)) were analysed. The most common cause of death for both males and females was "transport accidents", which accounted for approximately one-fifth of deaths. Suicide ranked fourth as a cause of death for males, and third for females. Suicide accounted for 9.1% of all deaths among male and female adolescents together: 9.5% and 8.2% respectively (Table [4](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T4)).
### Table 4.
Causes of death for young persons aged 15-19 in 90 countries (areas), according to the WHO Mortality Database, February 2004 (latest available data for each country or area)
| Causes of death | Male | Female | Total | | | |
|---|---|---|---|---|---|---|
| N | % | N | % | N | % | |
| Transport accidents | 19,643 | 21\.2 | 6,919 | 17\.4 | 26,562 | 20\.1 |
| Other accidents | 19,274 | 20\.8 | 5,084 | 12\.8 | 24,358 | 18\.4 |
| Assault | 13,735 | 14\.8 | 2,108 | 5\.3 | 15,843 | 12\.0 |
| Suicide | 8,801 | 9\.5 | 3,263 | 8\.2 | 12,064 | 9\.1 |
| Neoplasms | 5,017 | 5\.4 | 3,585 | 9\.0 | 8,602 | 6\.5 |
| Diseases of the circulatory system | 4,966 | 5\.4 | 3,484 | 8\.8 | 8,450 | 6\.4 |
| Diseases of the nervous system | 3,765 | 4\.1 | 2,230 | 5\.6 | 5,995 | 4\.5 |
| Diseases of the respiratory system | 2,878 | 3\.1 | 2,061 | 5\.2 | 4,939 | 3\.7 |
| Infective and parasitic diseases | 2,580 | 2\.8 | 2,116 | 5\.3 | 4,696 | 3\.5 |
| Diseases of the digestive system | 1,420 | 1\.5 | 940 | 2\.4 | 2,360 | 1\.8 |
| Congenital malformations, deformations | 1,061 | 1\.1 | 817 | 2\.1 | 1,878 | 1\.4 |
| Endocrine, nutritional and metabolic diseases | 850 | 0\.9 | 859 | 2\.2 | 1,709 | 1\.3 |
| Mental and behavioural disorders | 457 | 0\.5 | 188 | 0\.5 | 645 | 0\.5 |
| Other causes | 8,296 | 8\.9 | 6,026 | 15\.2 | 14,322 | 10\.8 |
| Total | 92,743 | 100\.0 | 39,680 | 100\.0 | 132,423 | 100\.0 |
[Open in a new tab](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/table/T4/)
A similar rank order of different categories of causes of death was also seen from the analysis of mortality data for the 63 countries (areas) from which data were available for the same year, i.e. 1995 (data not shown).
Suicide rates varied substantially among the countries, by a factor of up to 100. However, it must been borne in mind that some countries have small populations and that there can be major random variations in the annual number of suicides.
Although the data presented here are an acceptable basis for evaluating the global impact of suicide on young people, it should be kept in mind that relevant data are still lacking from a number of countries. For a more definitive and correct view of suicide worldwide, data collection from these countries is needed.
## DISCUSSION
Suicide data are still not available in many countries. In the present study, data from only 90 countries (areas) out of the world's 192 nations were available for the 15-19 age group in the WHO Mortality Database, which is the largest database in the world on this topic. The WHO mortality statistics are commonly broken down by gender and age. However, some countries do not report deaths broken down for the 15-19 age group, and there are only 130 member states of WHO.
The reliability of suicide statistics is often questioned ([4](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B4)). Suicides are underreported for cultural and religious reasons, as well as owing to different classification and ascertainment procedures. Suicide can be masked by many other diagnostic categories of causes of death. Unfortunately, in cases of young people, death due to suicide is often misclassified or masked by other mortality diagnoses. This makes the global picture of death by suicide even graver.
International comparability of data is also discussed. The information used in this paper, which reflects the official figures reported to WHO by member states, is based on death certificates signed by legally authorised personnel - usually doctors or police officers in the respective country. Usually these professionals have specific routines. How these routines differ between countries and regions, and how they influence suicide statistics, remains to be demonstrated through comparative studies of mortality statistics.
Moreover, it should be borne in mind that reporting of mortality statistics to WHO is subject to delays that vary from one country to the next. Accordingly, years for which data are available are not always the same. Data from 71% of the 90 countries (areas) included in the analysis covered the period 1995-2002. Around half (44 countries) had data for the year 2000 or later. Among these 44, most were in the European region. The remaining countries' data were from the period 1980-1994. After performing the analyses for the 90 countries (areas), we repeated the same analyses for the 63 countries (areas) in which the suicide data and mortality statistics were available for the year 1995. The results concerning suicide rates and the ranking of suicide as a cause of death were fairly similar in the two analyses (with a slightly higher global suicide rate for young people in the analysis for the year 1995).
During the period studied, different ICD classifications were used. This may have been an additional source of misclassification in the mortality statistics.
The mean suicide rate of 7.4/100,000 (10.5 for males and 4.1 for females) may be perceived as a reasonable estimate for the 15-19 age group and used as a basis for evaluating suicide rates among adolescents in different local communities.
In the calculation of suicide rates, the numbers of suicides in two large countries with more than 1,000 suicides in the 15-19 age group (Russia, with 2,883 cases in 2002 and USA with 1,616 in 2000) accounted for 37.3% of the total, thus heavily influencing the mean rate. Interestingly, these two countries' suicide rates were markedly different. The Russian rate was 23.6/100,000, more than 3 times the mean (7.4), whereas that in the USA was 8.0, fairly close to the mean. Sri Lanka had an extraordinarily high suicide rate in the 15-19 age group: at 46.5/100,000, it was more than six times the mean rate. Unfortunately, data for recent years are not available for Sri Lanka.
Suicide rates for young people in the 15-19 age group are, as for other age groups, higher in males than in females. Young males' overall suicide rate was 2.6 times that of females. Exceptions were found in a number of non-European countries, like Sri Lanka, El Salvador, Cuba, Ecuador and China, where suicide rates for females 15-19 years old exceeded those of males in the same age group. This fact urgently calls for further investigations.
Data from the latest 35-year period (1965-1999) show a marked difference in suicide rates between European and non-European countries. The high rates in non-European countries call for more attention. One reason for the lower suicide rates in European countries (although suicide rates in this region also vary widely from one country to another), beside cultural and psychosocial factors, may possibly be the physicians' awareness of the importance of adequately treating people with psychiatric disorders, psychosocial problems and harmful stress. However, this does not apply to the whole European region, since countries in transition show very high suicide rates, both for adults and for young people.
The fact that suicide rates are higher in males than in females has long been widely recognised. However, this study shows that suicide as a cause of death in the 15-19 age group is very similar in both sexes: 9.5% in males and 8.2% in females.
Suicide is one of the leading causes of death among young persons of both sexes. It is the leading cause of death in this age group after transport and other accidents and assault for males, and after transport and other accidents and neoplasms for females.
Scrutiny of the data for individual countries has revealed differences both in suicide rates and in the ranking of leading causes of death. These differences seem to be due to social, cultural and other factors, which call for further investigation.
In conclusion, suicide among young people is a major health problem in many societies, and preventive measures are strongly recommended ([2](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B2)).
## Acknowledgements
This paper is a product of the World Psychiatric Association's Presidential Programme on Global Child Mental Health and Development, carried out in collaboration with the World Health Organization and the International Association for Child and Adolescent Psychiatry and Allied Professions. The programme is organized and managed by a Steering Committee chaired by A. Okasha and co-chaired by N. Sartorius, whose members are H. Remschmidt (Scientific Director and Chairperson of the Primary Prevention Task Force), S. Tyano (Vice Director and Chairperson of the Awareness Task Force), P. Jensen (Chairman of the Service Development Task Force), T. Okasha (Secretary), B. Nurcombe, M. Belfer and J. Heiligenstein. The members of the task forces include: A. Seif El-Din (Egypt), C. So (China), C. Hoven (USA), D. Wasserman (Sweden), D.Y. Song (China), E. Caffo (Italy), J. Cox (UK), J. Fayyad (Lebanon), J. Bauermeister (Puerto Rico), K. Kelleher (USA), K. Hoagwood (USA), L.A. Rohde (Brazil), M. Flament (Canada), M. Hong (Korea), P.-A. Rydelius (Sweden), R. Harrington (UK), S.F. Hung (China), T. Dmitrieva (Russia) and T.A. Agoussou (Congo). The programme is supported by an unrestricted educational grant from the Eli Lilly and Company Foundation and the generous support of several institutions and individuals.
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\[[DOI](https://doi.org/10.1027/0227-5910.25.4.187)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/15580855/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Crisis&title=Natural%20suicide%20rates%20in%20nations%20of%20the%20world.%20Short%20report&author=B%20Yang&author=D%20Lester&volume=25&publication_year=2004&pages=187-188&pmid=15580855&doi=10.1027/0227-5910.25.4.187&)\]
***
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| Readable Markdown | . 2005 Jun;4(2):114–120.
## Abstract
Global suicide rates among adolescents in the 15-19 age group, according to the latest World Health Organization (WHO) Mortality Database, were examined. Data for this age group were available from 90 countries (in some cases areas) out of the 130 WHO member states. The mean suicide rate for this age group, based on data available for the latest year, was 7.4/100,000. Suicide rates were higher in males (10.5) than in females (4.1). This applies in almost all countries. The exceptions are China, Cuba, Ecuador, El Salvador and Sri Lanka, where the female suicide rate was higher than the male. In the 90 countries (areas) studied, suicide was the fourth leading cause of death among young males and the third for young females. Of the 132,423 deaths of young people in the 90 countries, suicide accounted for 9.1%. The trend of suicide rates from 26 countries (areas) with data available during the period 1965-1999 was also studied. A rising trend of suicide in young males was observed. This was particularly marked in the years before 1980 and in countries outside Europe. The WHO database is the largest of its kind and, indeed, the only information source that can currently be used for analysis of global mortality due to suicide. Methodological limitations are discussed.
**Keywords:** Suicide, young people, causes of death
***
Suicidal behaviour is a major health concern in many countries, developed and developing alike. At least a million people are estimated to die annually from suicide worldwide ([1](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B1)). Many more people, especially the young and middle-aged, attempt suicide ([2](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B2)).
Over the last few decades, while suicide rates have been reported as stable or falling in many developed countries, a rising trend of youth suicide has been observed. In 21 of the 30 countries in the World Health Organization (WHO) European region, suicide rates in males aged 15-19 rose between 1979 and 1996. For females, suicide rates rose less markedly in 18 of the 30 countries studied ([3](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B3)). Various possible explanations for these rising suicide trends - loss of social cohesion, breakdown of traditional family structure, growing economic instability and unemployment and rising prevalence of depressive disorders - have been presented.
Some worldwide analyses of suicide trends and rates in the world have been published ([4](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B4)\-[7](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B7)), but very little is known worldwide about the causes of death and suicide rates among young people aged 15-19.
The purpose of this study was to present an overall picture of suicide among adolescents worldwide using available data from the WHO database, and to evaluate the role of suicide as a cause of death in the 15-19 age group.
## METHODS
Data on causes of death and population for each country (area) were downloaded from the WHO Mortality Database website in February 2004. Statistics on causes of death and population in the 15-19 age group were available for 90 countries (areas) in the year 1980 or later. From 71% of these 90 countries (areas), there were data relating to the year 1995 or later, and roughly half had data for 2000 or later. For 30%, there were figures dating back to before 1995.
The downloaded data files were converted into SPSS files. Data files with different versions of the International Classification of Diseases (ICD) were merged and analysed by gender, age group, cause of death and calendar year.
The following codes for certain suicide in the WHO Mortality Database were used: in ICD-7 classification, codes A148 and B049, including E963, E970-E979; in ICD- 8 classification, codes A147 and B049, including E950- E959; in ICD-9 classification, codes B54 and C102, including E950-E959; in ICD-10 classification, codes X60-X84 (in some countries code 1101, including codes X60-X84).
The mean suicide rate in the 15-19 age group was calculated by collating the numbers of suicides in the latest year with available figures in the population from all the 90 countries (areas). Moreover, to avoid confounding country effects with time effects, only countries that reported data for the same year were selected. Therefore, suicide rates in 63 countries in 1995 were also analysed and compared, since the largest number of countries (areas) reported suicide and population data for that year.
A few countries were excluded from the analyses since the population in the 15-19 age group numbered less than 10,000.
In order to evaluate suicide trends, suicide rates from all countries (areas) with data available throughout the period 1965-1999 were examined. Rates in European and non- European countries were compared.
The total number of deaths for the 90 countries (areas) with the latest available data was divided by the number of deaths in each diagnostic category to arrive at percentages for causes of death in each category. The "other causes of death" category includes many different causes that account for relatively small numbers of deaths, such as dis- eases of the blood and blood-forming organs; diseases of the eye, ear, skin and subcutaneous tissue, musculoskeletal system and connective tissue, and genito-urinary system; certain conditions originating in the perinatal period; and various symptoms, signs and ill-defined conditions.
## RESULTS
For 90 countries (areas), data were available both on causes of death and on the population aged 15-19. The numbers of suicides and rates per 100,000 persons aged 15-19 and the latest year in which data were available for each country (area) are presented in Table [1](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T1).
### Table 1.
Suicide numbers and rates per 100,000 young persons aged 15-19 in 90 countries (areas), according to the WHO Mortality Database, February 2004 (latest available data for each country or area)
| Country (area) | Year | Number | Rate | | | | |
|---|---|---|---|---|---|---|---|
| Males | Females | Total | Males | Females | Total | | |
| Sri Lanka | 1986 | 388 | 424 | 812 | 43\.9 | 49\.3 | 46\.5 |
| Lithuania | 2002 | 54 | 12 | 66 | 38\.4 | 8\.8 | 23\.9 |
| Russian Federation | 2002 | 2,384 | 499 | 2,883 | 38\.5 | 8\.3 | 23\.6 |
| Kazakhstan | 2002 | 240 | 78 | 318 | 31\.2 | 10\.5 | 21\.0 |
| Luxembourg | 2002 | 3 | 1 | 4 | 23\.5 | 8\.2 | 16\.0 |
| New Zealand | 2000 | 31 | 11 | 42 | 22\.3 | 8\.2 | 15\.3 |
| El Salvador | 1993 | 44 | 52 | 96 | 13\.2 | 15\.8 | 14\.5 |
| Belarus | 2001 | 100 | 16 | 116 | 23\.6 | 3\.9 | 14\.0 |
| Estonia | 2002 | 13 | 1 | 14 | 24\.1 | 1\.9 | 13\.2 |
| Turkmenistan | 1998 | 41 | 21 | 62 | 16\.6 | 8\.8 | 12\.8 |
| Ukraine | 2000 | 375 | 92 | 467 | 19\.6 | 4\.9 | 12\.4 |
| Ireland | 2000 | 34 | 7 | 41 | 19\.8 | 4\.3 | 12\.3 |
| Mauritius | 2000 | 5 | 6 | 11 | 10\.1 | 12\.5 | 11\.3 |
| Norway | 2001 | 21 | 8 | 29 | 15\.3 | 6\.2 | 10\.9 |
| Canada | 2000 | 173 | 52 | 225 | 16\.3 | 5\.2 | 10\.8 |
| Latvia | 2002 | 16 | 4 | 20 | 16\.9 | 4\.4 | 10\.8 |
| Kyrgyzstan | 2002 | 42 | 13 | 55 | 15\.2 | 4\.8 | 10\.0 |
| Virgin Islands (USA) | 1980 | 1 | 0 | 1 | 20\.0 | 0\.0 | 9\.8 |
| Barbados | 1995 | 1 | 1 | 2 | 9\.6 | 9\.8 | 9\.7 |
| Austria | 2002 | 37 | 9 | 46 | 15\.1 | 3\.8 | 9\.6 |
| Trinidad and Tobago | 1994 | 6 | 6 | 12 | 8\.9 | 10\.5 | 9\.6 |
| Finland | 2002 | 25 | 6 | 31 | 15\.0 | 3\.8 | 9\.5 |
| Uzbekistan | 2000 | 170 | 86 | 256 | 12\.5 | 6\.4 | 9\.5 |
| Belgium | 1997 | 46 | 12 | 58 | 14\.5 | 3\.9 | 9\.3 |
| Cuba | 1996 | 23 | 45 | 68 | 6\.1 | 12\.5 | 9\.2 |
| Ecuador | 1991 | 40 | 64 | 104 | 6\.9 | 11\.4 | 9\.1 |
| Iceland | 1999 | 1 | 1 | 2 | 9\.0 | 9\.3 | 9\.1 |
| Australia | 2001 | 95 | 25 | 120 | 13\.8 | 3\.8 | 8\.9 |
| Singapore | 2001 | 10 | 8 | 18 | 9\.2 | 7\.8 | 8\.5 |
| Suriname | 1990 | 3 | 1 | 4 | 12\.5 | 4\.3 | 8\.5 |
| Poland | 2001 | 242 | 39 | 281 | 14\.1 | 2\.4 | 8\.4 |
| Switzerland | 2000 | 27 | 8 | 35 | 12\.6 | 4\.0 | 8\.4 |
| Croatia | 2002 | 21 | 3 | 24 | 14\.0 | 2\.1 | 8\.2 |
| USA | 2000 | 1,347 | 269 | 1,616 | 13\.0 | 2\.7 | 8\.0 |
| Grenada | 1988 | 0 | 1 | 1 | 0\.0 | 15\.6 | 7\.8 |
| Slovenia | 1987 | 8 | 2 | 10 | 12\.0 | 3\.1 | 7\.6 |
| Hungary | 2002 | 37 | 12 | 49 | 11\.2 | 3\.8 | 7\.5 |
| Guadeloupe | 1981 | 2 | 1 | 3 | 8\.8 | 4\.6 | 6\.8 |
| Japan | 2000 | 335 | 138 | 473 | 8\.8 | 3\.8 | 6\.4 |
| Uruguay | 1990 | 11 | 5 | 16 | 8\.3 | 3\.9 | 6\.2 |
| Bulgaria | 2002 | 25 | 6 | 31 | 9\.2 | 2\.3 | 5\.8 |
| Czech Republic | 2001 | 33 | 6 | 39 | 9\.5 | 1\.8 | 5\.7 |
| Argentina | 1996 | 122 | 67 | 189 | 7\.1 | 4\.0 | 5\.6 |
| Costa Rica | 1995 | 13 | 7 | 20 | 7\.1 | 4\.0 | 5\.6 |
| Germany | 2001 | 207 | 54 | 261 | 8\.7 | 2\.4 | 5\.6 |
| Thailand | 1994 | 189 | 154 | 343 | 6\.1 | 5\.1 | 5\.6 |
| Colombia | 1994 | 120 | 73 | 193 | 6\.7 | 4\.2 | 5\.5 |
| Venezuela | 1994 | 80 | 41 | 121 | 7\.1 | 3\.8 | 5\.5 |
| Republic of Korea | 2001 | 110 | 85 | 195 | 5\.9 | 4\.9 | 5\.4 |
| Hong Kong | 1999 | 12 | 12 | 24 | 5\.1 | 5\.3 | 5\.2 |
| France | 1999 | 150 | 48 | 198 | 7\.5 | 2\.5 | 5\.0 |
| Denmark | 1999 | 13 | 1 | 14 | 9\.0 | 0\.7 | 4\.9 |
| Israel | 1999 | 24 | 2 | 26 | 8\.7 | 0\.8 | 4\.9 |
| Paraguay (reporting areas) | 1987 | 5 | 7 | 12 | 3\.9 | 5\.6 | 4\.7 |
| Romania | 2002 | 59 | 18 | 77 | 7\.0 | 2\.2 | 4\.7 |
| Netherlands | 2000 | 35 | 8 | 43 | 7\.4 | 1\.8 | 4\.6 |
| Sweden | 2001 | 15 | 7 | 22 | 5\.7 | 2\.8 | 4\.3 |
| Brazil (South, South-East and Central West) | 1995 | 286 | 128 | 414 | 5\.7 | 2\.6 | 4\.2 |
| Puerto Rico | 1992 | 14 | 0 | 14 | 8\.3 | 0\.0 | 4\.2 |
| United Kingdom | 1999 | 122 | 33 | 155 | 6\.5 | 1\.8 | 4\.2 |
| Republic of Moldova | 2002 | 13 | 2 | 15 | 7\.1 | 1\.1 | 4\.1 |
| China (selected rural and urban areas) | 1999 | 179 | 253 | 432 | 3\.2 | 4\.8 | 4\.0 |
| Belize | 1995 | 0 | 1 | 1 | 0\.0 | 7\.9 | 3\.9 |
| Slovakia | 2002 | 13 | 4 | 17 | 5\.8 | 1\.9 | 3\.9 |
| Chile | 1994 | 38 | 8 | 46 | 6\.2 | 1\.3 | 3\.8 |
| Mexico | 1995 | 263 | 117 | 380 | 5\.1 | 2\.3 | 3\.7 |
| Spain | 2000 | 71 | 18 | 89 | 5\.3 | 1\.4 | 3\.4 |
| Panama | 1987 | 6 | 2 | 8 | 4\.6 | 1\.6 | 3\.1 |
| Albania | 2001 | 4 | 5 | 9 | 2\.8 | 3\.3 | 3\.0 |
| Dominican Republic | 1985 | 10 | 12 | 22 | 2\.7 | 3\.2 | 2\.9 |
| Italy | 2000 | 57 | 25 | 82 | 3\.6 | 1\.7 | 2\.7 |
| Macedonia | 2000 | 1 | 3 | 4 | 1\.2 | 3\.7 | 2\.4 |
| Tajikistan | 1999 | 11 | 3 | 14 | 3\.3 | 0\.9 | 2\.1 |
| Portugal | 2000 | 9 | 3 | 12 | 2\.6 | 0\.9 | 1\.8 |
| Greece | 1999 | 10 | 2 | 12 | 2\.7 | 0\.6 | 1\.7 |
| Guyana | 1984 | 2 | 0 | 2 | 3\.4 | 0\.0 | 1\.7 |
| Armenia | 2002 | 2 | 1 | 3 | 1\.3 | 0\.6 | 1\.0 |
| Peru | 1983 | 13 | 7 | 20 | 1\.3 | 0\.7 | 1\.0 |
| Jamaica | 1985 | 2 | 0 | 2 | 1\.4 | 0\.0 | 0\.7 |
| Azerbaijan | 2002 | 5 | 0 | 5 | 1\.1 | 0\.0 | 0\.6 |
| Syrian Arab Republic (part) | 1985 | 5 | 0 | 5 | 1\.0 | 0\.0 | 0\.5 |
| Georgia | 2000 | 1 | 0 | 1 | 0\.6 | 0\.0 | 0\.3 |
| Egypt | 1987 | 0 | 1 | 1 | 0\.0 | 0\.04 | 0\.02 |
| Bahamas | 1995 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Guatemala | 1984 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Kuwait | 2001 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Malta | 2002 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Philippines | 1996 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Saint Lucia | 1988 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Saint Vincent and Grenadines | 1986 | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Total | | 8,801 | 3,263 | 12,064 | 10\.5 | 4\.1 | 7\.4 |
A total of 12,064 cases of suicide (8,801 males and 3,263 females) from 90 countries (areas) were analysed. The mean suicide rate for 15-19 year-olds in the 90 countries (areas), based on data in different years for the various countries, was 7.4/100,000 (10.5 for males and 4.1 for females).
There were 13 countries with suicide rates 1.5 times or more above the mean: these included Sri Lanka, with the highest suicide rate, followed by Lithuania, Russia and Kazakhstan. In 24 countries (areas) suicide rates were above, but less than 1.5 times, the mean: this category included Norway, Canada, Latvia, Austria, Finland, Belgium and the USA. The remaining 53 countries (areas) had below-average suicide rates (Table [1](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T1)).
The mean suicide rate for males and females together in the 63 countries (areas) for which data for the year 1995 were available was 8.4/100,000, slightly higher than that (7.4/100,000) in the 90 countries (areas) described above, mainly owing to the higher suicide rate in males (Table [2](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T2)). Among these, 13 countries (including Russia, New Zealand, the Baltic states, Kazakhstan, Norway, Canada and Slovenia) reported suicide rates of 1.5 times the mean or more. Sixteen countries (including Ukraine, Switzerland, the USA, Austria, Ireland, Belgium, Hungary and Portugal) showed suicide rates above, but less than 1.5 times, the mean. Thirty-four countries had below-average suicide rates (Table [2](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T2)). More than two-thirds of the countries listed in Table [2](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T2) are European countries.
### Table 2.
Suicide numbers and rates per 100,000 young persons aged 15-19 in the 63 countries (areas) for which data are available for the year 1995
| Country (area) | Number | Rate | | | | |
|---|---|---|---|---|---|---|
| Males | Females | Total | Males | Females | Total | |
| Russian Federation | 1,988 | 509 | 2,497 | 36\.5 | 9\.6 | 23\.2 |
| New Zealand | 45 | 14 | 59 | 33\.0 | 10\.6 | 22\.0 |
| Lithuania | 42 | 8 | 50 | 32\.7 | 6\.4 | 19\.7 |
| Kazakhstan | 222 | 69 | 291 | 29\.3 | 9\.2 | 19\.3 |
| Latvia | 21 | 5 | 26 | 25\.1 | 6\.1 | 15\.7 |
| Estonia | 12 | 3 | 15 | 23\.6 | 6\.2 | 15\.1 |
| Finland | 42 | 6 | 48 | 25\.1 | 3\.7 | 14\.7 |
| Belarus | 89 | 16 | 105 | 23\.7 | 4\.3 | 14\.0 |
| Kyrgyzstan | 36 | 26 | 62 | 16\.1 | 11\.8 | 14\.0 |
| Norway | 28 | 8 | 36 | 20\.3 | 6\.1 | 13\.4 |
| Canada | 217 | 47 | 264 | 21\.4 | 4\.9 | 13\.3 |
| Cuba | 41 | 58 | 99 | 10\.5 | 15\.5 | 12\.9 |
| Slovenia | 15 | 4 | 19 | 19\.3 | 5\.5 | 12\.6 |
| Mauritius | 8 | 5 | 13 | 14\.7 | 9\.4 | 12\.1 |
| Ukraine | 334 | 93 | 427 | 18\.1 | 5\.2 | 11\.7 |
| Switzerland | 32 | 14 | 46 | 15\.7 | 7\.2 | 11\.6 |
| Czech Republic | 72 | 19 | 91 | 16\.2 | 4\.5 | 10\.5 |
| USA | 1,616 | 274 | 1,89 | 17\.4 | 3\.1 | 10\.5 |
| Austria | 44 | 3 | 47 | 18\.6 | 1\.3 | 10\.2 |
| Ireland | 29 | 5 | 34 | 16\.9 | 3\.1 | 10\.1 |
| Barbados | 1 | 1 | 2 | 9\.6 | 9\.8 | 9\.7 |
| Iceland | 2 | 0 | 2 | 18\.7 | 0\.0 | 9\.5 |
| Bulgaria | 43 | 15 | 58 | 13\.4 | 4\.9 | 9\.3 |
| Australia | 87 | 27 | 114 | 13\.4 | 4\.4 | 9\.0 |
| Luxembourg | 1 | 1 | 2 | 8\.8 | 9\.2 | 9\.0 |
| Belgium | 38 | 17 | 55 | 12\.1 | 5\.6 | 8\.9 |
| Hungary | 65 | 9 | 74 | 15\.3 | 2\.2 | 8\.9 |
| Croatia | 24 | 5 | 29 | 14\.2 | 3\.1 | 8\.8 |
| Poland | 234 | 46 | 280 | 14\.2 | 2\.9 | 8\.7 |
| Republic of Moldova | 21 | 8 | 29 | 11\.4 | 4\.4 | 7\.9 |
| Republic of Korea | 181 | 108 | 289 | 8\.9 | 5\.6 | 7\.3 |
| Sweden | 27 | 9 | 36 | 10\.3 | 3\.6 | 7\.1 |
| Turkmenistan | 27 | 4 | 32 | 12\.1 | 1\.8 | 7\.0 |
| China (selected rural and urban areas) | 227 | 373 | 600 | 4\.9 | 8\.7 | 6\.7 |
| Slovakia | 27 | 5 | 32 | 11\.1 | 2\.1 | 6\.7 |
| Germany | 220 | 66 | 286 | 9\.9 | 3\.1 | 6\.6 |
| Singapore | 8 | 5 | 13 | 7\.7 | 5\.2 | 6\.5 |
| Israel | 22 | 9 | 31 | 8\.5 | 3\.7 | 6\.1 |
| Costa Rica | 13 | 7 | 20 | 7\.1 | 4\.0 | 5\.6 |
| Denmark | 15 | 2 | 17 | 9\.1 | 1\.3 | 5\.3 |
| France | 151 | 51 | 202 | 7\.7 | 2\.7 | 5\.3 |
| Romania | 78 | 26 | 104 | 7\.8 | 2\.7 | 5\.3 |
| Uzbekistan | 89 | 34 | 123 | 7\.6 | 3\.0 | 5\.3 |
| Argentina | 113 | 60 | 173 | 6\.7 | 3\.6 | 5\.2 |
| Japan | 287 | 136 | 423 | 6\.6 | 3\.3 | 5\.0 |
| Hong Kong | 14 | 6 | 20 | 6\.4 | 3\.0 | 4\.7 |
| Brazil (South, South-East and Central West) | 286 | 128 | 414 | 5\.7 | 2\.6 | 4\.2 |
| United Kingdom | 106 | 31 | 137 | 6\.0 | 1\.8 | 4\.0 |
| Belize | 0 | 1 | 1 | 0\.0 | 7\.9 | 3\.9 |
| Spain | 100 | 21 | 121 | 6\.2 | 1\.4 | 3\.9 |
| Mexico | 263 | 117 | 380 | 5\.1 | 2\.3 | 3\.7 |
| Tajikistan | 15 | 6 | 21 | 5\.2 | 2\.1 | 3\.6 |
| Malta | 1 | 0 | 1 | 6\.8 | 0\.0 | 3\.5 |
| Netherlands | 21 | 11 | 32 | 4\.4 | 2\.4 | 3\.5 |
| Albania | 5 | 4 | 9 | 3\.7 | 2\.7 | 3\.2 |
| Italy | 81 | 22 | 103 | 4\.4 | 1\.2 | 2\.9 |
| Portugal | 15 | 8 | 23 | 3\.7 | 2\.0 | 2\.9 |
| Greece | 9 | 6 | 15 | 2\.3 | 1\.6 | 2\.0 |
| Macedonia | 1 | 1 | 2 | 1\.2 | 1\.2 | 1\.2 |
| Armenia | 2 | 1 | 3 | 1\.2 | 0\.6 | 0\.9 |
| Kuwait | 1 | 0 | 1 | 1\.7 | 0\.0 | 0\.9 |
| Azerbaijan | 4 | 0 | 4 | 1\.2 | 0\.0 | 0\.6 |
| Bahamas | 0 | 0 | 0 | 0\.0 | 0\.0 | 0\.0 |
| Total | 7,859 | 2,573 | 10,432 | 12\.4 | 4\.2 | 8\.4 |
In 26 countries (areas), data were available for the whole period studied, 1965-1999. Table [3](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T3) presents suicide rates for each country (area), broken down by gender, during three periods (1965-1979, 1980-1989 and 1990-1999). A rising trend of suicide rates in the 15-19 age group was observed in males from both non-European and European countries, while the trend was fairly stable or declined slightly in females. Suicide rates among both young males and females were higher in non-European than in European countries during the whole period 1965-1999 (Table [3](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T3), Figure [1](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#F1)).
### Table 3.
Suicide rates per 100,000 young persons aged 15-19 in 26 countries (areas) with data available for 1965-1999
| | Males | Females | Total | | | | | | |
|---|---|---|---|---|---|---|---|---|---|
| 1965-79 | 1980-89 | 1990-99 | 1965-79 | 1980-89 | 1990-99 | 1965-79 | 1980-89 | 1990-99 | |
| Mauritius | 5\.08 | 6\.16 | 11\.69 | 9\.02 | 11\.06 | 13\.17 | 7\.04 | 8058 | 12\.42 |
| Canada | 13\.75 | 20\.74 | 19\.85 | 3\.38 | 3\.65 | 4\.95 | 8\.66 | 12\.40 | 12\.59 |
| USA | 10\.22 | 15\.30 | 16\.48 | 2\.84 | 3\.66 | 3\.38 | 6\.57 | 9\.59 | 10\.11 |
| Hong Kong | 3\.01 | 3\.38 | 5\.87 | 4\.65 | 3\.63 | 4\.95 | 3\.81 | 3\.50 | 5\.43 |
| Japan | 10\.61 | 7\.46 | 6\.60 | 6\.91 | 3\.99 | 3\.24 | 8\.79 | 5\.77 | 4\.96 |
| Singapore | 4\.99 | 5\.19 | 6\.33 | 7\.48 | 7\.42 | 4\.37 | 6\.20 | 6\.27 | 5\.38 |
| Australia | 9\.12 | 14\.13 | 16\.89 | 3\.50 | 3\.05 | 4\.15 | 6\.37 | 8\.72 | 10\.68 |
| New Zealand | 7\.49 | 17\.51 | 28\.60 | 2\.96 | 4\.24 | 9\.80 | 5\.28 | 11\.01 | 19\.33 |
| *Non-European countries* | *10\.34* | *13\.17* | *13\.83* | *4\.08* | *3\.78* | *3\.59* | *7\.25* | *8\.58* | *8\.84* |
| Austria | 16\.67 | 19\.43 | 16\.70 | 5\.26 | 6\.60 | 3\.68 | 11\.08 | 13\.13 | 10\.36 |
| Bulgaria | 7\.55 | 10\.22 | 12\.20 | 5\.15 | 5\.89 | 4\.25 | 6\.38 | 8\.11 | 8\.32 |
| Denmark | 6\.14 | 9\.18 | 8\.02 | 2\.99 | 3\.31 | 2\.43 | 4\.61 | 6\.32 | 5\.29 |
| Finland | 18\.94 | 24\.54 | 25\.90 | 4\.99 | 5\.25 | 4\.65 | 12\.12 | 15\.09 | 15\.51 |
| France | 6\.54 | 7\.95 | 7\.62 | 3\.25 | 2\.85 | 2\.80 | 4\.92 | 5\.46 | 5\.26 |
| Greece | 1\.51 | 2\.61 | 2\.17 | 1\.72 | 1\.72 | 0\.76 | 1\.61 | 2\.18 | 1\.49 |
| Hungary | 19\.59 | 16\.23 | 13\.81 | 8\.01 | 6\.82 | 3\.94 | 13\.92 | 11\.67 | 9\.00 |
| Iceland | 9\.97 | 20\.91 | 26\.72 | 0\.66 | 0\.00 | 6\.71 | 5\.45 | 10\.67 | 16\.91 |
| Ireland | 2\.57 | 6\.80 | 14\.96 | 0\.68 | 1\.12 | 3\.09 | 1\.65 | 4\.03 | 9\.17 |
| Italy | 2\.52 | 2\.93 | 4\.23 | 1\.87 | 1\.05 | 1\.35 | 2\.20 | 2\.01 | 2\.82 |
| Luxembourg | 9\.24 | 12\.00 | 13\.04 | 3\.20 | 6\.24 | 4\.57 | 6\.28 | 9\.18 | 8\.91 |
| Netherlands | 3\.78 | 4\.09 | 5\.62 | 1\.22 | 1\.76 | 2\.37 | 2\.53 | 2\.95 | 4\.03 |
| Norway | 7\.04 | 15\.71 | 17\.37 | 1\.92 | 3\.45 | 6\.63 | 4\.54 | 9\.74 | 12\.12 |
| Portugal | 4\.83 | 5\.30 | 2\.88 | 3\.77 | 4\.62 | 1\.68 | 4\.30 | 4\.96 | 2\.29 |
| Spain | 1\.89 | 4\.03 | 4\.85 | 0\.79 | 1\.16 | 1\.43 | 1\.35 | 2\.63 | 3\.18 |
| Sweden | 8\.69 | 8\.46 | 8\.27 | 5\.48 | 3\.84 | 4\.23 | 7\.12 | 6\.21 | 6\.30 |
| Switzerland | 14\.87 | 18\.63 | 13\.64 | 5\.35 | 4\.58 | 4\.29 | 10\.16 | 11\.77 | 9\.09 |
| United Kingdom | 3\.49 | 4\.95 | 5\.92 | 1\.84 | 1\.42 | 1\.65 | 2\.68 | 3\.23 | 3\.85 |
| *European countries* | *5\.50* | *6\.61* | *7\.13* | *2\.67* | *2\.35* | *2\.26* | *4\.11* | *4\.53* | *4\.75* |
| **All countries** | **9\.12** | **11\.41** | **12\.14** | **3\.73** | **3\.40** | **3\.26** | **6\.46** | **7\.49** | **7\.82** |
### Figure 1.
[](https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=1414751_wpa040114-1.jpg)
Suicide rates per 100,000 young persons aged 15-19 in 26 countries (areas) with data available for 1965-1999
Causes of death were examined for 90 countries (areas). The data covered the same years as the data presented in Table [1](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T1). A total of 132,423 deaths from all kinds of causes in the 15-19 age group in the 90 countries (areas) (Table [4](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T4)) were analysed. The most common cause of death for both males and females was "transport accidents", which accounted for approximately one-fifth of deaths. Suicide ranked fourth as a cause of death for males, and third for females. Suicide accounted for 9.1% of all deaths among male and female adolescents together: 9.5% and 8.2% respectively (Table [4](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#T4)).
### Table 4.
Causes of death for young persons aged 15-19 in 90 countries (areas), according to the WHO Mortality Database, February 2004 (latest available data for each country or area)
| Causes of death | Male | Female | Total | | | |
|---|---|---|---|---|---|---|
| N | % | N | % | N | % | |
| Transport accidents | 19,643 | 21\.2 | 6,919 | 17\.4 | 26,562 | 20\.1 |
| Other accidents | 19,274 | 20\.8 | 5,084 | 12\.8 | 24,358 | 18\.4 |
| Assault | 13,735 | 14\.8 | 2,108 | 5\.3 | 15,843 | 12\.0 |
| Suicide | 8,801 | 9\.5 | 3,263 | 8\.2 | 12,064 | 9\.1 |
| Neoplasms | 5,017 | 5\.4 | 3,585 | 9\.0 | 8,602 | 6\.5 |
| Diseases of the circulatory system | 4,966 | 5\.4 | 3,484 | 8\.8 | 8,450 | 6\.4 |
| Diseases of the nervous system | 3,765 | 4\.1 | 2,230 | 5\.6 | 5,995 | 4\.5 |
| Diseases of the respiratory system | 2,878 | 3\.1 | 2,061 | 5\.2 | 4,939 | 3\.7 |
| Infective and parasitic diseases | 2,580 | 2\.8 | 2,116 | 5\.3 | 4,696 | 3\.5 |
| Diseases of the digestive system | 1,420 | 1\.5 | 940 | 2\.4 | 2,360 | 1\.8 |
| Congenital malformations, deformations | 1,061 | 1\.1 | 817 | 2\.1 | 1,878 | 1\.4 |
| Endocrine, nutritional and metabolic diseases | 850 | 0\.9 | 859 | 2\.2 | 1,709 | 1\.3 |
| Mental and behavioural disorders | 457 | 0\.5 | 188 | 0\.5 | 645 | 0\.5 |
| Other causes | 8,296 | 8\.9 | 6,026 | 15\.2 | 14,322 | 10\.8 |
| Total | 92,743 | 100\.0 | 39,680 | 100\.0 | 132,423 | 100\.0 |
A similar rank order of different categories of causes of death was also seen from the analysis of mortality data for the 63 countries (areas) from which data were available for the same year, i.e. 1995 (data not shown).
Suicide rates varied substantially among the countries, by a factor of up to 100. However, it must been borne in mind that some countries have small populations and that there can be major random variations in the annual number of suicides.
Although the data presented here are an acceptable basis for evaluating the global impact of suicide on young people, it should be kept in mind that relevant data are still lacking from a number of countries. For a more definitive and correct view of suicide worldwide, data collection from these countries is needed.
## DISCUSSION
Suicide data are still not available in many countries. In the present study, data from only 90 countries (areas) out of the world's 192 nations were available for the 15-19 age group in the WHO Mortality Database, which is the largest database in the world on this topic. The WHO mortality statistics are commonly broken down by gender and age. However, some countries do not report deaths broken down for the 15-19 age group, and there are only 130 member states of WHO.
The reliability of suicide statistics is often questioned ([4](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B4)). Suicides are underreported for cultural and religious reasons, as well as owing to different classification and ascertainment procedures. Suicide can be masked by many other diagnostic categories of causes of death. Unfortunately, in cases of young people, death due to suicide is often misclassified or masked by other mortality diagnoses. This makes the global picture of death by suicide even graver.
International comparability of data is also discussed. The information used in this paper, which reflects the official figures reported to WHO by member states, is based on death certificates signed by legally authorised personnel - usually doctors or police officers in the respective country. Usually these professionals have specific routines. How these routines differ between countries and regions, and how they influence suicide statistics, remains to be demonstrated through comparative studies of mortality statistics.
Moreover, it should be borne in mind that reporting of mortality statistics to WHO is subject to delays that vary from one country to the next. Accordingly, years for which data are available are not always the same. Data from 71% of the 90 countries (areas) included in the analysis covered the period 1995-2002. Around half (44 countries) had data for the year 2000 or later. Among these 44, most were in the European region. The remaining countries' data were from the period 1980-1994. After performing the analyses for the 90 countries (areas), we repeated the same analyses for the 63 countries (areas) in which the suicide data and mortality statistics were available for the year 1995. The results concerning suicide rates and the ranking of suicide as a cause of death were fairly similar in the two analyses (with a slightly higher global suicide rate for young people in the analysis for the year 1995).
During the period studied, different ICD classifications were used. This may have been an additional source of misclassification in the mortality statistics.
The mean suicide rate of 7.4/100,000 (10.5 for males and 4.1 for females) may be perceived as a reasonable estimate for the 15-19 age group and used as a basis for evaluating suicide rates among adolescents in different local communities.
In the calculation of suicide rates, the numbers of suicides in two large countries with more than 1,000 suicides in the 15-19 age group (Russia, with 2,883 cases in 2002 and USA with 1,616 in 2000) accounted for 37.3% of the total, thus heavily influencing the mean rate. Interestingly, these two countries' suicide rates were markedly different. The Russian rate was 23.6/100,000, more than 3 times the mean (7.4), whereas that in the USA was 8.0, fairly close to the mean. Sri Lanka had an extraordinarily high suicide rate in the 15-19 age group: at 46.5/100,000, it was more than six times the mean rate. Unfortunately, data for recent years are not available for Sri Lanka.
Suicide rates for young people in the 15-19 age group are, as for other age groups, higher in males than in females. Young males' overall suicide rate was 2.6 times that of females. Exceptions were found in a number of non-European countries, like Sri Lanka, El Salvador, Cuba, Ecuador and China, where suicide rates for females 15-19 years old exceeded those of males in the same age group. This fact urgently calls for further investigations.
Data from the latest 35-year period (1965-1999) show a marked difference in suicide rates between European and non-European countries. The high rates in non-European countries call for more attention. One reason for the lower suicide rates in European countries (although suicide rates in this region also vary widely from one country to another), beside cultural and psychosocial factors, may possibly be the physicians' awareness of the importance of adequately treating people with psychiatric disorders, psychosocial problems and harmful stress. However, this does not apply to the whole European region, since countries in transition show very high suicide rates, both for adults and for young people.
The fact that suicide rates are higher in males than in females has long been widely recognised. However, this study shows that suicide as a cause of death in the 15-19 age group is very similar in both sexes: 9.5% in males and 8.2% in females.
Suicide is one of the leading causes of death among young persons of both sexes. It is the leading cause of death in this age group after transport and other accidents and assault for males, and after transport and other accidents and neoplasms for females.
Scrutiny of the data for individual countries has revealed differences both in suicide rates and in the ranking of leading causes of death. These differences seem to be due to social, cultural and other factors, which call for further investigation.
In conclusion, suicide among young people is a major health problem in many societies, and preventive measures are strongly recommended ([2](https://pmc.ncbi.nlm.nih.gov/articles/PMC1414751/#B2)).
## Acknowledgements
This paper is a product of the World Psychiatric Association's Presidential Programme on Global Child Mental Health and Development, carried out in collaboration with the World Health Organization and the International Association for Child and Adolescent Psychiatry and Allied Professions. The programme is organized and managed by a Steering Committee chaired by A. Okasha and co-chaired by N. Sartorius, whose members are H. Remschmidt (Scientific Director and Chairperson of the Primary Prevention Task Force), S. Tyano (Vice Director and Chairperson of the Awareness Task Force), P. Jensen (Chairman of the Service Development Task Force), T. Okasha (Secretary), B. Nurcombe, M. Belfer and J. Heiligenstein. The members of the task forces include: A. Seif El-Din (Egypt), C. So (China), C. Hoven (USA), D. Wasserman (Sweden), D.Y. Song (China), E. Caffo (Italy), J. Cox (UK), J. Fayyad (Lebanon), J. Bauermeister (Puerto Rico), K. Kelleher (USA), K. Hoagwood (USA), L.A. Rohde (Brazil), M. Flament (Canada), M. Hong (Korea), P.-A. Rydelius (Sweden), R. Harrington (UK), S.F. Hung (China), T. Dmitrieva (Russia) and T.A. Agoussou (Congo). The programme is supported by an unrestricted educational grant from the Eli Lilly and Company Foundation and the generous support of several institutions and individuals.
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