Suicide is an increasing contributing cause of mortality in middle-aged adults; however, knowledge to guide prevention is limited. This first systematic review and meta-analysis of studies on midlife suicide has provided an overview of published research on this issue and synthesized the evidence on socioeconomic and physical and mental health factors associated with this mortality. Using PRISMA guidelines MEDLINE, Embase, PsycINFO, Scopus and Web of Science were searched for English-language publications that involved persons aged 35 to 65, used individual-level data, and reported prevalence of exposure(s) or relative risks. The search identified 62 studies on midlife suicides and associated factors (28 for SES, 22 for psychiatric disorder and 23 for physical illness). All studies were from high income countries, and most (80.6%) used data from population registries. Meta-analyses showed that the pooled prevalence of exposure in suicide decedents was 57.8% for psychiatric disorder, 56.3% for low income, 43.2% for unemployment, and 27.3% for physical illness. The associated pooled risk ratio was 11.68 (95% confidence intervals: 5.82-23.47) for psychiatric illness of any type, 12.59 (8.29-19.12) for mood disorders, 3.91 (2.72-5.59) for unemployment, 3.18 (2.72-3.72) for being separated or divorced, 2.64 (2.26-3.10) for cancer, 2.50 (0.96-6.38) for central nervous system illness, and 2.26 (1.16-4.41) for low income. In conclusion, midlife suicide is strongly associated with socioeconomic difficulties and physical and psychiatric illnesses that are common in this age population. Future investigations should consider the interactions between risk factors, the intersectionality of sex and ethnicity, and include data from low- and middle-income countries.

Objectives Suicide rates in India are among the highest in the world, equating to over 200 000 suicides annually. Reports of suicides are a routine feature in major newspapers in India, and reporters may selectively present ‘newsworthy’ suicide stories. The aim of this paper was to systematically investigate whether mass media reports of suicides reflect the epidemiological data on suicide in a high suicide state in India. Design We undertook a content analysis study to extract sociodemographic data on suicides reported among nine of the most highly read daily newspapers in the high suicide southern state of Tamil Nadu between June and December 2016. A total of 1258 newspaper articles were retrieved containing reports on 1631 suicides. Two-tailed binomial tests on aggregate frequencies assessed whether the sociodemographic characteristics of suicides in the newspaper articles were different to the population suicide statistics for Tamil Nadu. Results We identified some statistically significant discrepancies between suicide characteristics in the population and the media. Suicides involving females (p<0.001), those aged under 30 years (p<0.001), separated or widowed males (p<0.001), unmarried females (p<0.001), those using methods with a higher case fatality rate (ie, hanging (p<0.001), jumping off high structures (p<0.001) and coming under vehicles (p<0.001) and those who were students (p<0.001) or working in the agricultural sector (p<0.001) were significantly over-reported relative to their occurrence in the broader population. Suicides involving men (p<0.001), those aged over 30 years and above (p<0.001), those who were married and suicides by poisoning (p<0.001) were significantly under-reported relative to their occurrence in the broader population. Conclusions The suicide characteristics in the print media were not entirely representative of suicides in the broader Tamil Nadu population, which may lead the general public to develop misunderstandings about suicide in their state. The discrepancies we identified will inform tailored suicide prevention education for media professionals.

Background It has been proposed that the National Crime Records Bureau (NCRB), which reports suicides in India, differentially underenumerates suicides by geographic and demographic factors. We assessed the extent of potential underenumeration by comparing suicides recorded in NCRB data with recent estimates of Indian suicides developed by the Global Burden of Disease (GBD) initiative. Methods Age-standardised suicide rates were calculated for both data sources by sex, age and state, and rate ratios of NCRB to GBD estimates by corresponding strata were compared to ascertain the relative under-reporting in the NCRB report. Results The GBD Study reported an additional 802 684 deaths by suicide (333 558 male and 469 126 female suicide deaths) compared with the NCRB report between 2005 and 2015. Among males, the average under-reporting was 27% (range 21%–31%) per year, and among females, the average under-reporting was 50% (range 47%–54%) per year. Under-reporting was more evident among younger (15–29 years) and older age groups (≥60 years) compared with middle age groups. Indian states belonging to low Socio-Demographic Index (SDI) generally had greater underenumeration compared with middle and high-SDI states. Conclusion NCRB data under-report suicides in India, and differentially by sex, age and geographic area, possibly because of lack of community-level reporting of suicides due to social stigma and legal consequences. While the recent decriminalisation of suicide is expected to improve community-level reporting of suicides, suicide prevention policies should be developed, with a priority to address social stigma attached with suicide and suicidal behaviour, especially among females.

Timely and accurate data are critical for effective suicide prevention. Indonesia—the fourth most populous country in the world—has limited data availability and thus, limited data-driven interventions. Through a national government partnership, we obtained critical non-public data for attempts and suicides that could be analysed for the first time in Indonesia's history. We obtained and analysed data from five sources from 2016 to 2021: police data, death registry data, a provincial survey, a sample registry system, and the WHO's Global Health Observatory (WHO GHO) data. Using these data, we estimated underreporting, identified provinces with the highest suicide and suicide attempt rates, assessed gender ratios, identified methods used, and compared urban and rural suicides. The analysis yielded an underreporting rate of 859.10% for suicides, while verbal autopsies and increased quality control only increased coverage from 12.80% to 51.40%. Provinces with the highest rates of suicide were Bali, Riau Islands, Special Region of Yogyakarta, Central Java, and Central Kalimantan. Gender analysis revealed a ratio of 1: 2.11 for female to male suicides. Suicide methods analysis revealed that hanging and self-poisoning were the most used method, and rural suicides occurred at a rate 4.47 times higher than urban suicides. The analysis revealed the highest underreporting rate in the literature from a national sample and vast heterogeneity among provinces with high suicide rates—including provinces with strong mystic beliefs, suggesting the need for a culturally sensitive sub-national tailored approach. Through our study, we provide critical information which will allow for data-driven suicide prevention. The data collection for this was part of a project funded by the 10.13039/501100000996 Australian Department of Foreign Affairs and Trade , Australian-Indonesian Institute (AII2020322).