Every suicide death is one too many and, in the Nordic countries, approximately 3,574 died by suicide in 2022.
The highest suicide rates were observed among Greenlandic males and females. Although a goal of a 33% reduction in suicide rates was introduced by the United Nations in 2015 and later ratified by the Nordic Council of Ministers, the suicide rates in the most populated Nordic countries have only shown modest improvements over recent years.
In terms of risk and protective factors, good coherence exists in the evidence from the Nordic countries. Being a multi-factorial outcome, it is not feasible to arrive at detailed explanations for the differences observed in the suicide rates of the individual Nordic countries. From the perspective that ‘any suicide is one too many’, the main goal remains to prevent all suicides.
Belonging to an indigenous group, male sex, being middle-aged or older adult, not being married, having lower education, being unemployed was linked to elevated risks of suicide. On the other hand, being married and having children, in particular young children, were identified as being protective of suicide.
Individuals with mental disorders have some of the highest rates of suicide. If effective interventions lead to removal of the excess risk, this could reduce the overall suicide rate with up to 40%. Suicide risks are high at times of discharge from psychiatric hospital. Risks are particularly high at the time of a first diagnosis. Also, individuals with previous suicide attempts constitute a risk group with respect to suicide.
Many physical disorders have been linked to an excess risk of suicide. Given that a substantial number of members of the general population have chronic disorders, this group might be accountable for a large number of suicide deaths, despite having slightly lower risks than individuals with mental disorders. People with chronic disorders have higher risks of developing depression, and it constitutes a major concern that these not always identified, and thus, also not treated.
Stressful life-events may increase risks of suicide, especially among vulnerable individuals. Findings from Nordic register data studies have identified a range of stressful life-events, ranging from personal losses, such as bereavement, divorce and job loss, to natural disasters. Marginalised groups may be particularly vulnerable, to suicide, for instance LGBT+, young asylum-seekers, homeless individuals, and victims of criminal acts.
Many of those who die by suicide were seen in primary care in the last months. Although this could be an important target group for interventions, findings suggest that not all may receive optimal care.
The registration of suicide deaths has been evaluated as reliable in the Nordic countries. Although some countries have developed algorithms for estimating the true number of suicide attempts in hospital registers, there does not seem to be a continuous monitoring system in place with respect to suicide attempts.
Physician-assisted suicide remains not legal in all Nordic countries. There seems to be a need for better dissemination regarding palliative care options and sufficient availability.
Several evidence-supported interventions, which address different target groups, exist. However, effective interventions are still missing for some target groups. While means restriction is one of the prevention strategies with most supportive evidence, the level of evidence has mainly been based on study designs comparing pre- and post-measurement. Other promising interventions include psychosocial therapy for people at risk of suicide. This intervention strategy has generally been tested by more rigorous study designs, such as randomised clinical trials.
Preventing access to suicide methods has been demonstrated to reduce the number of suicide deaths. Successful approaches include pack size restrictions on pills, barriers on bridges, and stricter gun laws. It is important to identify the specific drugs that are used for suicides as well as the public sites where suicides occur. A more detailed monitoring of suicide methods seems indicated. Real-time monitoring of risk groups and methods would be recommended.
High-quality evidence documents the harmful effects by fictional or non-fictional stories where suicide incidents were glorified. Examples from the Nordic countries illustrate the potential harmful effects that social media activities may have on vulnerable groups. The WHO have developed concrete guidelines for media professionals and filmmakers. A growing body of evidence suggest that presentation of positive role models who promote help-seeking may reduce suicidal behaviour.
School-based interventions on emotion regulation directed towards young children as well as psycho-educative activities for teenagers have been evaluated as being suicide preventive. Several Nordic countries are implementing or testing this type of interventions.
Individuals at risk of suicide may be seen in emergency departments and other clinical settings - or they may contact telephone helplines. Good support exists for brief interventions after ED-presentations and psychosocial therapy, which have been tested in several Nordic countries. Still, effective interventions for individuals recently discharged from psychiatric admission is lacking. Helpline support remains to be assessed in high-quality studies- Online tools, such as internet-based therapy, have been shown to reduce levels of suicide thoughts.
In sum, additional reductions of suicides are needed. Several effective interventions exist, yet evidence is lacking for certain high-risk groups, such as individuals discharged from psychiatric hospital and follow-up after presentation for suicide attempt. Nordic register data provided a unique recourse for real-time monitoring suicide and suicide attempt.