Suicide trends in Panama: Results from the national mortality registry

Background According to the World Health Organization (WHO), suicide is the second leading cause of death among 15–29-year-olds globally. Consequently, it represents a major public health concern. In Central-American countries, population-based studies on the epidemiology of suicide are scarce. The aim of this study is to investigate mortality trends due to suicide in Panama at a national and regional level from 2001 to 2016, and to characterize the suicide rates by sex and age groups. Material and methods Data was derived from the National Mortality Registry (NMR) from the National Institute of Statistics and Census. Death was recorded according to the International Classification of Disease - 10th Revision (X60.0-X84.0). Crude mortality rates (MR) were calculated as the number of deaths per 100,000, using the mortality data and the estimates and projections of the total population of Panama to July 1st for each year, according to sex and age, based on the last census. MR were then standardised for 5-year age groups using the direct method and the world standard population of the WHO as a reference. Joinpoint regression analyses were performed to estimate and evaluate trends over time in women and men, expressed as annual percentage change (APC) with 95% confidence intervals (CI). Age-specific suicide trends were also evaluated and categorised according to the age groups 14–24, 25–44, 45–64 and ≥ 65 years. Results During the study period (2001–2016), a total of 2526 deaths due to suicide were recorded in Panama (2174 men and 352 women), representing 1.01% of all causes of death; 68.9% of the deaths were due to intentional self-harm by hanging, strangulation and suffocation, followed by intentional self-poisoning by exposure to pesticides (17.5%). National MR per 100,000 decreased from 9.7 and 1.6 in 2001 to 5.4 and 0.8 in 2016, in men and women, respectively. Joinpoint analyses revealed that suicide rates changed differently across sex, age groups and provinces. Overall, the national MR trends due to suicide decline in women with an APC of −4.8, 95% CI −7.8, −1.7, whereas the trend began to decline from 2006 in men; APC −6.9, 95% CI −8.9, −4.9. A sustained decrease in the trend of mortality rates due to suicide was observed across all age categories, except for the group of younger men ( Conclusions Mortality rates due to suicide have declined at a national level. However, sex, age and geographical disparities were observed. New studies at the individual level are warranted to investigate main suicidal risk factors, in particular across Provinces such as Los Santos and Darien, which are affected by the highest suicide rates in the country. Moreover, it seems crucial to evaluate future trends in adolescents and young adults, and particularly in men, whose mortality rate was approximately six times higher than women. Our findings highlight the need of elaborating suicide prevention programs tailored at a national context, as claimed by WHO.