Trends of non-lethal intentional self-harm and suicide in Spain 2018-2023: a nationwide registry-based study

Abstract

Background: Monitoring suicide and non-lethal intentional self-harm (NLISH) is critical for prevention efforts. We analysed trends in NLISH and suicide in Spain (2018-2023), including related demographic and clinical factors. Methods: Nationwide population-based study including all NLISH hospitalisations (from health registries) and suicides (from national mortality data) in Spain between 2018 and 2023. We first examined the sociodemographic characteristics and method used for both outcomes, and the clinical characteristics of NLISH hospitalisations. Then, we evaluated annual and monthly trends in NLISH and suicide rates overall and by sex and age group using Joinpoint regression. Findings: Between 2018 and 2023, we identified 73,692 NLISH hospitalisations and 23,496 suicides in Spain, averaging 12,282 and 3916 annually, respectively. NLISH hospitalisations were more common among women (n = 44,304; 60·1%), and suicides among men (n = 17,471; 74·4%). Youth aged 10-24 accounted for 17,915 (24·3%) NLISH hospitalisations but only 1125 (4·8%) suicides; conversely, individuals aged ≥65 represented 7327 (31·2%) suicides but only 9410 (12·8%) NLISH hospitalisations. The leading methods were drug poisoning for NLISH (n = 50,643; 68·7%) and hanging for suicide (n = 10,810; 46·0%). From 2018 to 2023, NLISH rates rose annually by 8·0% (95% CI: 1·5, 15·9), especially among young women shortly after the 2020 initial pandemic outbreak. Suicide rates rose 2·6% annually (95% CI: 0·6, 4·8), especially among young women and middle-aged men. Interpretation: Non-lethal self-harm is rising in Spain, especially among young women. Suicide shows smaller but significant increases. Urgent, age- and gender-sensitive strategies are needed to address all suicidal behaviour and ensure timely mental health care. Funding: ISCIII (PI23CIII/00056; CP21/00078; AC22/00006; PI22/00107; PI17/00521), EU (NextGenerationEU/MRR), ERA PerMed, FMTV3 (202220-30), AFSP (ECR-1-101-23), BBRF (NARSAD-31312), NIMH (1R25MH129256-01A1).