Suicidal behaviour

1. Key messages

  • Suicidal behaviors (thoughts, attempts, and actual suicides) represent an important public health and societal problem in Belgium.
  • During the COVID-19 crisis, suicidal thoughts and suicide attempts have increased in the population. One out of 4 young people (18-29 years old) reported having seriously considered suicide during the last 12 months.
  • 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 and middle-aged people were more at risk. Suicidal thoughts and suicide attempts were more common in the lowest educated group compared to the higher educated groups.
  • 1743 suicide deaths were recorded in 2017. The highest numbers were found in the 45-64 age groups.
  • While more women consider and attempt to commit suicide, more men succeed: 1243 suicides were recorded in men and 500 in women in 2017. The age-adjusted mortality rate was 23 (per 100 000) in men and 8.7 in women.
  • Suicide is the leading cause of death among young people. In the 15-24 age group, 30% of male deaths and 19% of female deaths were due to suicide.
  • The mortality rate from suicide increases with age (but represents a smaller proportion of deaths due to increasing competition from other causes) while the frequency of attempted suicide decreases with age.
  • A comprehensive multisectoral suicide prevention strategy is needed.

2. 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) [1]. 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 [2]. The current COVID-19 crisis is particularly affecting the mental health of the population 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, which are an important risk factor for future suicide and important for prevention.
  • Suicide attempts, which are a strong risk factor for completed suicide and a key moment to provide help to the person [3,8].
  • 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 [4–7]. Misclassifications can occur when the exact cause of deaths 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 [4]. 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 will 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 (2020 onwards). Then, we will go more in-depth into the suicidal thoughts and attempts based on the previous health interview surveys (1997-2018). Finally, we look at mortality due to suicide (data are available until 2017). 

3. Suicidal thoughts and attempts during the COVID-19 crisis

12.5% of the respondents to the 6th survey reported to have seriously considered suicide in the last 12 months (April 2020 to March 2021). Among young people (18-29 years), this percentage rises to 25%. In comparison, only 4.3% of respondents to the HIS 2018 reported considering suicide in the last 12 months.

0.6% of the respondents reported having attempted suicide in the last 12 months (April 2020 to March 2021). Among young people (18-29 years), this percentage rises to 2.3% for men and 1.1% for women. In comparison, only 0.2% of respondents to the HIS 2018 reported having attempted suicide in the last 12 months.

  • Men
  • Women

Percentage of men aged 18 and over having had suicidal thoughts or having attempted to commit suicide in the last 12 months, by age group, Belgium, 2021
Source: COVID-19 health surveys, Sciensano [12]

Percentage of women aged 18 and over having had suicidal thoughts or having attempted to commit suicide in the last 12 months, by age group, Belgium, 2021
Source: COVID-19 health surveys, Sciensano [12]

4. Suicidal thoughts

Situation in 2018

Belgium

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 [9]
Regional differences

Lifetime suicidal thoughts were more frequent in Wallonia (16%) than in Flanders (13%); suicidal thoughts in the last year were more prevalent in Wallonia (5.9%) and Brussels (5.1%) than in Flanders (3.3%).

Trends

Belgium

The proportion of people that considered suicide in the last 12 months (as well 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).

Regional differences

The prevalence of suicidal thoughts decreased in Flanders between 2013 and 2018 while it remained relatively stable in Brussels and Wallonia.

  • 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 [9]

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 [9]

Socio-economic disparities

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 [9]

5. Suicide attempts

Situation in 2018

Belgium

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 [9]
Regional differences

People from Wallonia were more likely to have attempted to commit suicide (6%) than people from Brussels (4.2%) and Flanders (3.3%).

Trends

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 Brussels but this was not significant.

  • 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 [9]

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 [9]

Socio-economic disparities

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 [9]

6. Suicide deaths

Number of deaths

In 2017, in Belgium, 1743 deaths from suicide were registered, representing a diminution by 8.4% as compared to 2016 (or 160 fewer suicide deaths). There were more deaths by suicide in men (1243) than in women (500). 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.

Mortality rate due to suicide

The age-adjusted mortality rate due to suicide was 15.5 (per 100 000 people) in 2017 in Belgium. It was 2.6 times higher in men (23.0) than in women (8.7).

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 completion. 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 2015-2017
Source: Own calculations based on the death certificates database, Statbel [10]

Share of suicide deaths

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.

The share of deaths attributed to suicide at younger ages is important. Suicide deaths represent nearly 30% of deaths in men aged 15-24 and 25% of deaths among men aged 25-44. Suicides represent 19% of deaths in women aged 15-24 and 15% 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 the total number of suicide deaths by age group and sex, Belgium, average 2015-2017
Source: Own calculations based on the death certificates database, Statbel [10]

Trends

Belgium

Between 2000 and 2017, suicide mortality 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 and suicide pooled with events of undetermined intent age-adjusted mortality rates by sex, Belgium, 2000-2017
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 [10]
Regional differences

Between 2000 and 2017, suicide mortality rates among men have decreased by 28% in Flanders, by 30% in Wallonia (where the decrease started from 2008), and by 37% in Brussels. Among women, the suicide mortality rates are 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 for men than for women; a small increase is even observed for Flemish women since 2016.

  • Men
  • Women

Suicide and suicide pooled with events of undetermined intent age-adjusted mortality rates among men by region, Belgium, 2000-2017
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 [10]

Suicide  and suicide pooled with events of undetermined intent age-adjusted mortality rates among women by region, Belgium, 2000-2017
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 [10]

International comparison

Belgium has the highest suicide rates among the EU-15 countries, both in men and women. The rates are 1,5 times higher for men and 1,8 times higher for women as compared to those from the EU-15 (average) rate. 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 high rates of Belgium.

  • Men
  • Women

Suicide age-adjusted mortality rates among men by country, EU-15, 2017 or latest year
Source: OECD health data [11]

Suicide age-adjusted mortality rates among women by country, EU-15, 2017 or latest year
Source: OECD health data [11]

7. 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)

If you are in distress or in need of emotional/psychological support, do not hesitate to call 02 648 40 14 for the community help service helpline, or visit the Community Help Service online.

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. WHO. Suicide in the world. https://www.who.int/publications-detail/suicide-in-the-world
  2. WHO. Suicide. https://www.who.int/westernpacific/health-topics/suicide
  3. 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. 
  4. 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. 
  5. Ohberg A, Lonnqvist J. Suicides hidden among undetermined deaths. Acta Psychiatr Scand. 1998;98(3):214–8.
  6. Jougla E, Pequignot F, Chappert J, Rossollin F, Le TA, Pavillon G. [Quality of suicide mortality data]. RevEpidemiolSante Publique. 2002;50(1):49–62.
  7. Moens GFG. The reliability of reported suicide mortality statistics: An experience from Belgium. Int J Epidemiol. 1985;14(2):272–5.
  8. 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 
  9. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/
  10. Causes of death, Statbel. https://statbel.fgov.be/en/themes/population/mortality-life-expectancy-and-causes-death/causes-death
  11. OECD health statistics. https://stats.oecd.org/
  12. Sixième enquête de santé COVID-19 : résultats préliminaires. Deposit number D/2021/14.440/30. Brussels: Sciensano; 2021. doi: 10.25608/j877-kf56