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1. Key messages

  • Suicidal behaviors (thoughts, attempts, and actual suicides) represent an important public health and societal problem in Belgium.
  • In 2018, 4.3% of the population had seriously considered suicide and 0.2% had attempted to commit suicide in the last 12 months. Women, middle-aged people, and the lowest educated group were more at risk. 
  • During the COVID-19 crisis, suicidal thoughts and suicide attempts have increased in the population. In June 2021, one out of 6 young people (18-29 years old) reported having seriously considered suicide during the last 12 months.
  • While more women consider and attempt to commit suicide, more men succeed: 1265 suicides were recorded in men and 463 in women in 2019. 
  • Suicide is the leading cause of death among young people. In the 15-24 age group, 30% of male deaths and 23% of female deaths were due to suicide.

2. Impact of the COVID-19 crisis on suicidal behaviour

Suicidal thoughts and suicide attempts have increased during the COVID-19 crisis

10.5% of the respondents in June 2021 reported having seriously considered suicide in the last 12 months. Among young people (18-29 years), this percentage rises to 17%. In comparison, only 4.3% of respondents to the HIS 2018 reported considering suicide in the last 12 months.

0.7% of the respondents in June 2021 reported having attempted suicide in the last 12 months. Among young people (18-29 years), this percentage rises to 2.0%. In comparison, only 0.2% of respondents to the HIS 2018 reported having attempted suicide in the last 12 months.

For more information concerning mental health during the COVID-19 crisis, please consult the dedicated page

  • Men
  • Women

Percentage of men aged 18 and over having had suicidal thoughts in the last 12 months, by age group, Belgium, 2021 compared to the health interview survey 2018
Source: COVID-19 health surveys, Sciensano [1]

Percentage of women aged 18 and over having had suicidal thoughts in the last 12 months, by age group, Belgium, 2021 compared to the health interview survey 2018
Source: COVID-19 health surveys, Sciensano [1]

3. Suicidal thoughts

Middle-aged women are more likely to report suicidal thoughts 

In 2018, in Belgium, 14% of the population aged 15 years and over had at least once in their life seriously considered suicide; within this group, one in three (or 4.3% of the total population) had thought about committing suicide in the last 12 months. More women (16%) than men (12%) reported suicidal thoughts in their life, while there were no gender differences in suicidal thoughts in the past year (4.4% in women vs 4.2% in men). People aged 65 years and over were less likely to report suicidal thoughts in their life or in the past year than people younger than 64 years. Women in the age group 45-54 years had a particularly high prevalence.

Prevalence of suicidal thoughts in the last 12 months among the population aged 15 years and over, Belgium, 2018
Source: Health Interview Survey, Sciensano [2]

No clear trends in suicidal thoughts are observed

The proportion of people that considered suicide in the last 12 months (as well as in their lifetime) is lower in 2018 than in 2013, but the proportion is still higher than the values observed in 2008 (differences are not significant).

Suicidal thoughts are more frequent in the Walloon Region and the Brussels Capital Region

Lifetime suicidal thoughts were more frequent in the Walloon Region (16%) than in the Flemish Region (13%); suicidal thoughts in the last year were more prevalent in the Walloon Region (5.9%) and in the Brussels Capital Region (5.1%) than in the Flemish Region (3.3%). The prevalence of suicidal thoughts decreased in the Flemish Region between 2013 and 2018 while it remained relatively stable in the Brussels Capital Region and in the Walloon Region.

  • Men
  • Women

Prevalence of suicidal thoughts in the last 12 months among men aged 15 years and over by region, Belgium, 2008-2018
Source: Own calculations based onHealth Interview Survey, Sciensano [2]

Prevalence of suicidal thoughts in the last 12 months among women aged 15 years and over by region, Belgium, 2008-2018
Source: Own calculations based onHealth Interview Survey, Sciensano [2]

Suicidal thoughts are more frequent in the lowest educational group

Suicidal thoughts (lifetime and in the past year) are linked with the educational level. People from the lowest educational group were 1.5 more likely to have considered suicide in their life and 2.5 more likely to have considered it in the last year compared to people from the highest educational group.

Prevalence of suicidal thoughts in the lifetime and in the past year among the population aged 15 years and over by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

4. Suicide attempts

More women have a failed suicide attempts

In 2018, in Belgium, 4.3% of the population aged 15 years and over reported to have attempted to commit suicide in their lifetime and 0.2% in the last year. More women (5.4%) than men (3.1%) tried to commit suicide in their lifetime and in the last year (0.3% in women and 0.2% in men). The prevalence of lifetime suicide attempts was higher in people aged between 35 and 54 years. Younger people (15-24 years) and 45-54 years were more likely to report a suicide attempt in the last year.

Prevalence of lifetime suicide attempts among the population aged 15 years and over, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

Trends in suicide attempts are stable

Trends in the prevalence of lifetime suicide attempts are relatively stable in Belgium and its regions. Suicide attempts decrease between 2013 and 2018 in men and women in the Brussels Capital Region but this was not significant.

Suicide attempts are more frequent in the Walloon Region 

People from the Walloon Region were more likely to have attempted to commit suicide (6%) than people from the Brussels Capital Region (4.2%) and the Flemish Region (3.3%).

  • Men
  • Women

Prevalence of lifetime suicide attempts among men aged 15 years and over by region, Belgium, 2004-2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

Prevalence of lifetime suicide attempts among women aged 15 years and over by region, Belgium, 2004-2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

Suicidal attempts are more frequent in the lowest educational group

Suicide attempts (lifetime and in the past year) were linked with the educational levels. People from the highest educational group were less likely to attempt suicide than people from the lower educational group.

Prevalence of lifetime and past year suicide attempts among the population aged 15 years and over by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

5. Committed suicide 

The number of deaths from suicide decreased to 1728 in 2019

In 2019, in Belgium, 1728 deaths from suicide were registered. There were more deaths by suicide in men (1265) than in women (463). The highest number of suicide deaths occurred in the 45-64 age groups. These numbers are probably underestimated due to the limitations mentioned in the background section.

The mortality rate due to suicide is higher in men

The age-adjusted mortality rate due to suicide was 15.2 (per 100 000 people) in 2019 in Belgium. It was 2.9 times higher in men (23.1) than in women (7.9).

Suicide rates by age group are presented pooled over a 3-year period to avoid jumps due to small numbers. Suicide rates are higher for men than for women at any age, showing a gender difference in suicide. Suicide rates are the highest for men aged over 85 and for women between 45 et 64 years old.

Suicide mortality rate (per 100 000) by age and sex, Belgium, average 2017-2019
Source: Own calculations based on the death certificates database, Statbel [3]

Suicide represents a high share of deaths among young people

The share of deaths due to suicide by age group represents the relative importance of this cause in all deaths occurring in that age group. This has a different age distribution from that of the suicide mortality rates because the denominator of the share (all deaths in a given age group) is much larger at older ages, whereas the denominator of the rates (number of people in a given age group) is smaller at older ages.

Suicides accounted for a significant proportion of deaths among young people, indeed suicide deaths represent 30% of deaths in men aged 15-24 and 25% of deaths among men aged 25-44. Suicides represent 23% of deaths in women aged 15-24 and 14% in women aged 25-44.

Due to the increase in the number of deaths from concomitant causes at higher ages, the share of suicide deaths decreases with age.

Share of suicide among all deaths by age group and sex, Belgium, average 2017-2019
Source: Own calculations based on the death certificates database, Statbel [3]

Trends in suicide deaths are better understood together with deaths of undetermined intent

Between 2000 and 2019, suicide rates are decreasing in men and, to a smaller extent, in women. However, pooling the suicides with the external deaths of undetermined intention reveals a slower decrease in both genders.

Suicide alone and suicide pooled with events of undetermined intent age-adjusted mortality rates by sex, Belgium, 2000-2019
Note: In the past, suicide rates in Brussels were underestimated for some years due to the delay of the justice department in transmitting files.
Source: Own calculations based on the death certificates database, Statbel [3]

Deaths from suicide are more frequent in the Walloon Region

Between 2000 and 2019, suicide rates among men have decreased by 30% in the Flemish Region, by 27% in the Walloon Region (where the decrease started in 2008), and by 38% in the Brussels Capital Region. Among women, the suicide rates are, during the whole period, at a much lower level than among men in all regions and showed a similar decrease.

When pooling suicide with the deaths from events of undetermined intent, the rates are decreasing slower.

  • Men
  • Women

Suicide alone and suicide pooled with events of undetermined intent age-adjusted rates among men by region, Belgium, 2000-2019
Note: In the past, suicide rates in Brussels were underestimated for some years due to the delay of the justice department in transmitting files.
Source: Own calculations based on the death certificates database, Statbel [3]

Suicide alone and suicide pooled with events of undetermined intent, age-adjusted rates among women by region, Belgium, 2000-2019
Note: In the past, suicide rates in Brussels were underestimated for some years due to the delay of the justice department in transmitting files.
Source: Own calculations based on the death certificates database, Statbel [3]

The high suicide rate in Belgium must be interpreted with caution

Belgium has the highest suicide rates among the EU-15 countries, both among men and women. The rates are 1,6 times higher for men and 1,8 times higher for women than the average rate of the EU-15 countries. However, international comparison of suicide mortality rates should be interpreted with caution as differences in socio-cultural context and data quality hampers the comparability between countries. Nevertheless, this warning should not serve to minimize the problematic suicide rates in Belgium.

  • Men
  • Women

Suicide age-adjusted rates among men by country, EU-15, 2019 or latest year
Source: OECD health data [4]

Suicide age-adjusted rates among women by country, EU-15, 2019 or latest year
Source: OECD health data [4]

6. Read more

View the metadata for this indicator

Statbel  Causes of death
SPMA: Standardized Procedures for Mortality Analysis (SPMA)
HISIA: Health Interview Survey Interactive Analysis (HISIA)

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Background

For more information concerning mental health during the COVID-19 crisis, please consult the dedicated page

Suicide and suicide attempts are important societal and public health issues. They have ripple effects on families, friends, colleagues, communities, and society on the whole. Suicide occurs throughout the lifespan and was the second leading cause of death among the 15-29-year-olds in the world in 2016. Suicide is preventable and its prevention has been prioritized by the World Health Organization (WHO) as a global target and included as an indicator in the United Nations Sustainable Development Goals (SDGs) [5]. To effectively develop suicide prevention strategies, efficient monitoring of suicide as well as identification of specific groups at risk is needed.

While the link between suicide and mental disorders is well established, many suicides happen impulsively in moments of crisis. Further risk factors include experience of loss, loneliness, discrimination, a relationship break-up, financial problems, chronic pain and illness, violence, abuse, and conflict. The strongest risk factor for suicide is a previous suicide attempt [6]. The current COVID-19 crisis is particularly affecting the population's mental health and has a negative impact on some of the risk factors linked to suicide.

To apprehend this complex phenomenon, we use several indicators:

  • Suicidal thoughts are an important risk factor for future suicide and important for prevention.
  • Suicide attempts are a strong risk factor for completed suicide and a key moment to provide help to the person [7,12].
  • Suicide deaths: we report the number of deaths, the mortality rate, and the share of total deaths that are due to suicide by age group. As suicides are often poorly recorded, these numbers are probably underestimated [8-11]. Misclassifications can occur when the exact cause of death is unknown (suicide may thus be classified as ‘unknown cause’); when the intention is not clear (suicide may thus be classified as 'deaths of undetermined intent'); or when the intention is wrongly evaluated (suicide may thus be classified as ‘accidents’ or ‘homicides’). It may also be possible that the doctor avoids mentioning suicide to protect the family from different problems (insurance, administration, religion, …). Additionally, administrative procedures can lead to misclassifications. For example, in Brussels, for certain years, the prosecution office failed to classify violent deaths (suicides, homicides), leading to a consequent under-reporting of suicides which were then classified as deaths of undetermined intent [8]. Moreover, the reasons for misclassification strongly vary across countries, which limits the interpretation of international comparisons. To partly reduce these biases in the interpretation of trends, we present, in addition to the suicide mortality rates, mortality rates grouping suicides (codes X60-X84) and events of undetermined intent (codes Y10-Y34).

First, we give an overview of suicidal thoughts and attempts during the COVID-19 crisis based on the data collected through the online COVID-19 health surveys. Then, we go more in-depth into the suicidal thoughts and attempts based on the previous health interview surveys. Finally, we look at mortality due to suicide. 

Definitions

Age-standardized rates (prevalence, incidence, or mortality)
Since most health indicators are strongly influenced by age, comparisons (among regions, educational levels, and over time) need to be standardized by age. The age-standardization removes the impact of differences in the age structure between populations or over time. The age-standardized rate is a weighted average of age-specific rates. The weights are derived from a same reference (standard) population.
EU-15
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have similar socioeconomic conditions.

References

  1. Sixième enquête de santé COVID-19 : résultats préliminaires. Deposit number D/2021/14.440/30. Brussels: Sciensano; 2021. doi: 10.25608/j877-kf56
  2. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/
  3. Causes of death, Statbel. https://statbel.fgov.be/en/themes/population/mortality-life-expectancy-and-causes-death/causes-death
  4. OECD health statistics. https://stats.oecd.org/
  5. WHO. Suicide in the world. https://www.who.int/publications-detail/suicide-in-the-world
  6. WHO. Suicide. https://www.who.int/westernpacific/health-topics/suicide
  7. Centre de prévention du suicide. LE SUICIDE UN PROBLEME MAJEUR DE SANTE PUBLIQUE Introduction à la problématique du suicide en Belgique Chiffres de 2014. Bruxelles, Belgique: Centre de prévention du suicide; 2017 Sep. 
  8. De Spiegelaere M, Wauters I, Haelterman E. Le suicide en Région de Bruxelles-Capitale: Situation 1998-2000. Brussels: Observatoire de la santé et du social de Bruxelles- Capitale; 2003. 
  9. Ohberg A, Lonnqvist J. Suicides hidden among undetermined deaths. Acta Psychiatr Scand. 1998.
  10. Jougla E, Pequignot F, Chappert J, Rossollin F, Le TA, Pavillon G. Quality of suicide mortality data. RevEpidemiolSante Publique. 2002.
  11. Moens GFG. The reliability of reported suicide mortality statistics: An experience from Belgium. Int J Epidemiol. 1985.
  12. Gisle L, Drieskens S, Demarest S, Van der Heyden J. Enquête de santé 2018 : Santé mentale [Internet]. Bruxelles, Belgique: Sciensano; 2020 Jan. Report No.: D/2020/14.440/3. https://his.wiv-isp.be/fr/Documents%20partages/MH_FR_2018.pdf