Temporal Trends and Identification of Suicide Mortality Risk Areas in Brazil (2000-2022): Are We Dealing with an Underestimated Epidemic?

Background and Objectives: Suicide is a pressing public health issue globally, including in Brazil, where it ranks among the leading causes of mortality. This study aimed to analyze the spatial, temporal, and spatiotemporal distribution of suicide mortality in Brazil from 2000 to 2022. Materials and Methods: Using secondary data from the Mortality Information System of Brazil's 5570 municipalities, an ecological study of time series was conducted. Segmented linear regression (Joinpoint 4.6 version) was used to calculate temporal trends, while Moran's indices were employed to analyze spatial autocorrelations. Retrospective scanning was utilized to investigate spatiotemporal clusters, and choropleth maps were developed to visualize high-risk areas. Results: The analysis revealed the occurrence of 240,843 suicides in Brazil, with higher percentages in the southeast, south, and northeast regions. The south, central-west, and southeast regions exhibited the highest mortality rates, predominantly among white, single men, aged 20 to 59, with 1 to 11 years of schooling. Intentional self-harm by hanging, strangulation, and suffocation was the main cause. The general trend of mortality due to suicide in Brazil was increasing (AAPC: 2.9; CI 95%: 2.6 to 3.0), with emphasis on the age groups from 10 to 19 years (AAPC: 3.7; CI 95%: 2.9 to 4.5) and 20-39 years old (AAPC: 2.9; CI 95%: 2.3 to 3.5). The brutal and smoothed rates revealed areas of high mortality in the south, north, and central-west regions. Conclusions: The findings of this study highlight the need to direct resources and efforts to the south and midwest regions of Brazil, where suicide rates are the highest. Additionally, implementing targeted prevention programs for young men, who are the most affected, is essential to reduce suicide mortality in these areas.