Suicide

1. Key messages

  • Suicidal behaviors (thoughts, attempts, and actual suicides) represent an important problem for public health and society in Belgium.
  • 4.3% of the population seriously considered suicide and 0.2% 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.
  • 1903 suicide deaths were recorded in 2016. The highest numbers were found in the 45-95 age group.
  • While more women consider and attempt to commit suicide, more men succeed: 1360 suicides were recorded in men and 543 in women in 2016. The mortality rate was 24.5 (per 100 000) in men and 9.5 in women.
  • Nearly 1 out of 3 deaths in men between 15 and 29 years was due to suicide; 1 out of 5 deaths in women between 15 and 34 years was due to suicide.
  • A comprehensive multisectoral suicide prevention strategy is needed.

2. Background

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, we need an efficient registration and monitoring of suicide as well as to identify specific groups at risk.

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].

To apprehend this complex and important 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].
  • Suicide deaths: we report the number of deaths, the mortality rate, and the share of total deaths that are due to suicide at a particular age. Since suicides are commonly misclassified, 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, the prosecution office fails to deal with all violent deaths (suicides, homicides), leading to a consequent under-reporting of suicides which are then classified as deaths of undetermined intent. Moreover, the reasons for misclassification strongly vary across countries, which limits the interpretation of international comparisons.

Suicide attempts and suicide deaths show different age and sex patterns. Women are more at risk to attempt to commit suicide than men and men are more at risk of succeeding (suicide deaths). Moreover, the risk of suicide deaths increases with age while the risk of suicide attempts decreases with age. Thus, younger people and women attempt more to commit suicide while men and older people have more success in completing suicide [3,8].

3. 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]

4. 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]

5. Suicide deaths

Number of deaths

In 2016, in Belgium, 1903 deaths from suicide were registered. There were more deaths by suicide in men (1360) than in women (543). The highest numbers of suicide deaths occurred in the 45-59 age group. Suicide deaths may be misclassified for different reasons; in Brussels, there is a problem in the certification of suicide deaths since 2009, meaning that these numbers are an underestimation of the actual number of suicides.

Number of suicide deaths by age and sex, Belgium, 2016
Source: Own calculations based on the death certificates database, Statbel [10]

Share of suicide deaths

Since few deaths occur at younger ages, the share of the total deaths attributed to suicide at younger ages is important. Due to the increase in the number of deaths and the concurrent causes of deaths at older ages, the share of suicide deaths decreases with age.

Suicide deaths represent nearly 30% of deaths in men between 15 and 29 years. In women, suicide deaths represent around 20% of deaths between 15 and 34 years of age.

Share of the total number of suicide deaths by age and sex, Belgium, 2016
Source: Own calculations based on the death certificates database, Statbel [10]

Mortality rate due to suicide

The mortality rate due to suicide was 16.8 (per 100 000 people) in 2016 in Belgium. It was 2.6 times higher in men (24.5) than in women (9.5). The suicide rate by age group shows a different pattern than the number of suicide deaths because the denominator (number of people in a given age group) is smaller at old ages. The highest mortality rate due to suicide was found in men between 80 and 94 years old and in women between 45 and 54 years old.

Suicide mortality rate (per 100 000) by age and sex, Belgium, 2016
Source: Own calculations based on the death certificates database, Statbel [10]

Trends

Belgium

Suicide mortality rates are decreasing in men and, to a smaller extent, in women.

Regional differences

Suicide mortality rates are decreasing among men both in Flanders and Wallonia (starting from 2008). Among women, the suicide mortality rates stayed stable at a much lower level than among men in both the Walloon and the Flemish Regions.

The suicide mortality rate in Brussels cannot be interpreted due to the delay of the Brussels public prosecutor's office in confirming suicide cases.

  • Men
  • Women

Suicide age-adjusted mortality rates among men by region, Belgium, 2000-2016
Note: The rates of suicide in Brussels are underestimated.
Source: Own calculations based on the death certificates database, Statbel [10]

Suicide age-adjusted mortality rates among women by region, Belgium, 2000-2016
Note: The rates of suicide in Brussels are underestimated.
Source: Own calculations based on the death certificates database, Statbel [10]

International comparison

Belgium has the highest apparent suicide rates among the EU-15 countries in men and women. However, international comparison of suicide mortality rates should be interpreted with caution as differences in socio-cultural context and data quality hampers the accurate recording of suicide and the comparability between countries. However, this warning should not serve to minimize the problematic higher rates of Belgium.

  • Men
  • Women

Suicide age-adjusted mortality rates among men by country, EU-15, 2016 or latest year
Source: OECD health data [11]

Suicide age-adjusted mortality rates among women by country, EU-15, 2016 or latest year
Source: OECD health data [11]

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)

Definitions

Age-adjusted prevalence
Most indicators are linked to age. Since the Belgian population is ageing over time and that differences are observed within regions and within educational groups, the prevalences are standardized by age with a standard population to allow for comparability.
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/