1. EXCECUTIVE SUMMARY

• In 2022, a total of 3,574 individuals died by suicide in the Nordic countries.
• The highest suicide rate was found in Greenland. The lowest rates were found in Faroe Islands and Aaland Islands.
• In 2015, the United Nations, as a part of the World Goals for Sustainable Development, introduced the goal of a 33% reduction in the suicide mortality rate by 2030 (aim 3.4.2). In Nordic countries with stable trends over time, only modest improvements have been observed in the suicide rate since 2015.
• The registration of suicide deaths is evaluated to be reliable across all the Nordic countries. Rates are being monitored on a yearly basis. Yet, suicide figures from Faroe Islands, Greenland and Aaland Islands are seemingly not being reported to the WHO Mortality Database. This is concerning, given that Greenland has the highest suicide rate in the world.
• National register data facilitates setting up monitoring systems for surveying high-risk groups as well as calculation of statistical measures, such as cumulative incidences and population attributable risk, which are useful for identifying target groups for suicide preventive efforts.
• In almost all countries, suicide attempts are seemingly not been monitored. A continuous monitoring of suicide attempts could facilitate a fast response to emerging trends.
• An abundance of scientific evidence exists regarding risk and protective factors for suicide from the Nordic countries.

• Identified high-risk groups include individuals with mental disorders and individuals who have had a previous suicide attempt. The time shortly after discharge from psychiatric hospital has been linked to extremely high suicide rates. Also, numerous stressful and traumatising life-events are associated with elevated risks of suicide.
• Physical disorders, which affect large segments of the population, such as cancer and heart diseases, are linked to elevated risks of suicide. It is plausible that the excess risk is mediated through depressive disorders.
• Approximately 75% of those who die by suicide have been seen by their primary care provider within the last 12 months. However, deficiencies in the provided care have been suggested.
• Physician-assisted suicide remains illegal in all Nordic countries.
• It is important to inform about palliative care options and to ensure sufficient availability.
• Almost all Nordic countries have a national plan for suicide prevention. Long-term funding for achieving identified goals is essential to ensure that measures will be implemented in clinical and daily practice.
• Building on the universal, selective, and indicated model, national plans for suicide prevention should be multi-level and multi-modal; this implies employing a range of different strategies and addressing different groups. Although evidence on effective interventions exists, there is still need of development of specialized interventions and research to document scientific effects of these.
• Means restrictions have consistently been linked to suicide reductions. Although jumping from a high place and suicide by moving object, for instance railway, account for relatively small proportions of all suicides, effective interventions exist and might be further explored.
• A detailed, real-time monitoring of suicide methods and high-risk groups would allow for identification of potential venues for means restriction and target groups for interventions.
• An award for promotion of adherence to the WHO media guidelines exist in several but not all of the Nordic countries and nations.
• Psychosocial therapy, based on cognitive behavioural therapy and dialectic behavioural therapy, provided in out-patient settings for individuals with severe suicide thoughts or after a suicide attempt has been evaluated as effective.
• Clinical staff in the psychiatric sector is reported to be knowledgeable about risk assessment and safety planning. However, follow-up routines for people who present with suicide attempts in somatic emergency departments are seemingly missing in most countries.

• The Nordic countries benefit from a largely free healthcare model. Given that many patients are in regular contact with healthcare providers for the treatment of their disorder, wider attention to and screening for depression might be considered, for instance in the primary care sectors.
• The cultural and societal similarities across the Nordic countries is a strong argument for exchange of effective efforts as well as development of joint interventions.