3. EPIDEMIO­LOGICAL ANALYSES

Information on suicide deaths is collected and published as national vital statistics in most of the Nordic countries. National statistical offices report these data to the WHO Mortality Database. Monitoring trends of suicide deaths is essential for evaluating whether preventive efforts have the desired impact. Furthermore, such data allows governments and other stakeholders to determine whether countries meet jointly formulated targets, such as the United Nations Sustainable Development Goals. Data are generally reported by sex, age group and calendar years and may also be available by suicide methods.

In this section, the recent trends in suicide deaths across the Nordic countries are presented. Data was obtained for 2000-2022 from stakeholders in the individual countries and the Statistical Offices and Public Health Agencies, which are listed in Appendix 2 – 8. The data quality of the cause of death registration in Denmark, Finland, Iceland, Norway and Sweden have all been evaluated as being of high quality by the WHO Global Health Estimates (World Health Organization, 2020a). The reliability of the registration of suicides was confirmed by expert statements from each of the countries (Table 6.1). The registration of suicide deaths is described in Section 6. Rates were age-standardized according to the WHO World Standard Population 2000-2025 using direct standardization (World Health Organization, 2020a, Preston, et al., 2000).

A total of 3,574 suicides occurred in the Nordic countries in 2022/2021. The highest number of suicides were recorded in Sweden where 1,566 individuals died by suicide in 2022 (Table 3.1). Faroe Islands and Aaland Islands record the smallest absolute numbers of suicides, followed by Iceland and Greenland with 34 and 40 incidents in 2022, respectively.

The highest age-standardized suicide rate was found in Greenland where 71.3 suicides were recorded per 100,000 population. Followed by Finland and Sweden with age-standardized rates of 11.9 and 12.4 per 100,000 population, respectively. Faroe Islands have previously been shown to have a very low suicide rate, which for 2021 was evaluated to be 4.3 per 100,000 population (Wang & Stórá, 2009). This level was comparable with the suicide rate for Aaland Islands.

When assessed over time, a decline in the age-standardized suicide rate for both sexes was observed in Finland, Iceland, Aaland Islands as well as modest decreases in the Danish and Greenlandic suicide rates, while Faroe Islands, Norway and Sweden seemed to have remained at the same level (Figure 3.1).

With respect to sex, the highest suicide rates were found for both Greenlandic males and females (Appendix 9, Figure A1 and Figure A2). Over calendar time, a decrease in the suicide rate was observed for males in Denmark, Finland, Greenland, Iceland, and Aaland Islands, while decreases were found for females in Finland, Greenland, and Aaland Islands. The decrease observed in small nations, however, can be a result of random variation.

^* Newest year for which data were available for Faroe Island and Aaland Islands were from 2021. In all countries except Sweden, suicide deaths were identified as ICD-10: X60-X84, Y87.0, while following codes were considered as suicide deaths in Sweden ICD-10: X60-X84, Y87.0, Y10-Y34, Y87.2 (see section 6.1).

Table 3.1 Number of suicides and suicide rates for 2022.

The United Nations’ World Goals for Sustainable Development were introduced in 2015 and contains an aim of reducing the number of suicides in the world with 33% before 2030. Using the available data, the percentual change between 2015 and 2022/2021 was calculated as an indicator of the progress secured so far (Appendix 9, Table A1). Based on the age-standardized rates, a decline in the Icelandic suicide rate from 11.7 in 2015 to 8.6 (27.0%) in 2022 was observed. The age-standardized rate in Greenland increased with 8.1% from 73.7 to 79.6 per 100,000. It is, however, important to note that these changes are based on relatively few incidences of suicide, thus, some random variation over time cannot be excluded. In Sweden, the overall suicide rate was found to have decreased with 3.9% from 13.4 to 12.4 per 100,000. Different trends were seen in the age-standardized rate for males and females. As such, none of the Nordic countries have yet reached the goal of a 33% reduction in the suicide rate. Moreover, only modest improvements have been observed in countries with high and/or stable rates.  

The goal of the Nordic Council Welfare Committee of reducing the number of suicides by 25% in 2025 was not assessed, as this was first introduced in 2020.

Males outnumber female suicides with a sex ratio of approximate 3:1 in the Nordic countries, except for Greenland where a 2:1 ratio is reported (Oskarsson, et al., 2023, Seidler, et al., 2023a).

Suicide rates are highest among middle-aged and older adults in Denmark and Sweden, while a more even distribution across all age groups (except those below age 25 years) was seen in Finland and Norway. In Iceland, middle-aged males seemed to have the highest suicide rate of all age groups. In Greenland, suicide rates of males and females are found to peak among adolescents and young adults aged 15-29 years (Oskarsson, et al., 2023, Seidler, et al., 2023a).

In recent decades, hanging has become the most used method in Greenland, followed by shooting (Seidler, et al., 2023a). According to the latest study on suicide methods in the other Nordic countries, hanging is the most frequently used method for males. The largest share of female suicides were due to poisoning, expect for Norwegian women who had a higher prevalence of suicide by hanging (Titelman, et al., 2013). In Finland and Norway, as many as 22% of suicides were by firearms, while around 13-14% of Danish, Icelandic and Swedish males used this method. Suicide by jumping from a high place or in front of moving object, for instance railway, account for a proportionally small share of all suicides. According to expert information, the most frequent method of suicide in Faroe Island is now hanging, while it earlier was shooting (Wang & Stórá, 2009).

When examining the distribution of suicide methods in the Nordic countries for recent years, hanging was found to be the most frequently used method (Table 3.2). In many countries, this was followed by poisoning. In Finland, Greenland, Iceland, and Norway, 15.8%, 17.1%, 9.8%, and 11.0% of all suicides occurred by shooting, respectively.

Figure 3.1 Suicide rates for both sexes by calendar year.

Data for Faroe Island for the years 2000–2006 were based on 5-year periods (i.e. 2000–2004 and 2005–2009). Suicide rates for Greenland were presented on a different scale than the other plots. For this reason, the Greenlandic suicide rate was omitted from the other plots. Further, moving averages were used to smooth the suicide rates of Faroe Islands (5-year moving averages), Greenland (3-year moving averages), Iceland (3-year moving averages), and Aaland Islands (5-year moving averages).

Table 3.2 Distribution of suicide methods (in percent).*

*Due to few suicide incidents on a yearly basis, data were not available for Faroe Islands and Aaland Islands. The proportion of suicide methods was not reported for all categories. Missing data and other suicide methods were classified as ‘Other methods’.

Data sources: Denmark during 2015–2021, Cause of Death Register; Finland during 2013–2022, 11b2: Accidental and violent deaths by underlying cause of death (short list of external causes), age and sex, intoxicated separately, 1998–2022, Statistics Finland; Greenland during 2010–2018, Seidler, Tolstrup, Bjerregaard, Crawford, and Larsen (2023) Time trends and geographical patterns in suicide among Greenland Inuit, BMC Psychiatry, 23, 187; Iceland during 2013–2022,  Number of deceased with legal domicile in Iceland by cause of death (ICD-10), Statistical database, Statistics Iceland; Norway during 2018–2022, D10a: Selvmord etter alder og dødsmåte, Norwegian Institute of Public Health; Sweden during 2012–2022, National Centre for Suicide Research and Prevention of Mental lll-Health (https://ki.se/en/nasp/suicides-in-sweden).

Statistics on suicide attempt are seemingly not published on a regular basis in the majority of Nordic countries. Nevertheless, studies have used hospital records or surveys to examine prevalence and trends of suicide attempt in most of the Nordic countries. Due to different measures of suicide attempt and other self-harming behaviours and different samples, prevalence rates may not be comparable across studies.

In a Finnish survey of 13–18-year-olds, life-time prevalence of self-cutting and other self-injurious methods was reported to be 11.5% and 10.2%, respectively. Self-cutting was more frequent among girls than boys but no difference between boys and girls was seen with respect to other self-injurious methods (Laukkanen, et al., 2009). Swedish 17-year-old students who completed a school survey were found to have a 17.1% lifetime history of deliberate self-harm. Here, girls (23.3%) had a higher prevalence than boys (10.5%) (Landstedt & Gillander, 2011). When comparing results from two waves of school surveys conducted in 8^th to 10^th grade in Norway, the one-year prevalence of self-harm increased from 4.1% in 2002 to 16.2% in 2017/18. Self-harm was reported double as frequent by girls than boys (Tørmoen, et al., 2020).

Using hospital records to identify suicide attempts, Danish and Norwegian studies have demonstrated that young females between 15-24 years have the highest rates of all groups (Morthorst, et al., 2016, Qin & Mehlum, 2020). In Norway, the overall rate of suicide attempt was 108.6 and 133.4 per 100,000 population for males and females, respectively, during 2008-2013. The corresponding rates for Danish males and females were 86.9 and 130.7 per 100,000 population during 1994-2011. A preponderance of female versus male suicide attempts was, thus, observed for both countries.

A continuous monitoring of suicide attempts could facilitate a fast response to emerging trends. By using the same measure to identify suicide attempts over time, under-recording is likely to remain constant over time and observed trends might reflect true changes.