Trends in suicide mortality rates in the Republic of Cyprus between 2004 and 2020: changes in age, gender and suicide method.

Background: The Republic of Cyprus has recorded the greatest increase in suicide mortality among Eastern Mediterranean countries, with an average annual increase of 5.1% in 2000-2019.

Aims: To investigate trends in suicide mortality rates between 2004 and 2020 in the Republic of Cyprus, with a focus on age, gender and suicide methods.

Method: Suicide deaths (ICD-10 taxonomy, including 'undetermined' code) and population denominators were obtained from the National Mortality Registry and Statistical Office, respectively. Directly standardised (European Standard) mortality rates were calculated for four gender and age groups. Annual change was estimated using Poisson regression models with interaction terms to assess differential trends over different time periods.

Results: There were 560 suicide deaths; these were four times more frequent in men, and approximately 80% were classified as 'violent' for both genders. The male suicide rate doubled from 4-5 to 9-10 per 100 000, mostly before 2012, representing a 9% annual change (rate ratio = 1.09, 95% CI 1.03, 1.15; P = 0.002). From 2013, the trend reversed (effect modification P < 0.001) with a 4% annual decrease (95% CI -9%, 1%). Declines were not uniform across all age groups; rates in males aged 45-64 years continued to rise, surpassing the previously high rate in males aged 25-44 years. Rates in females declined from 4-5 per 100 000 to 2-3 over the study period. Overall, the male-to-female suicide rate ratio was 5.33 (95% CI 3.46, 8.19) in 2017-2020, compared with 2.73 (1.88, 3.95) in 2004-2008.

Conclusion: Although suicide rates remain relatively low, the gender differential has widened in the Republic of Cyprus. Further analysis of trends in relation to unemployment and other socioeconomic indicators is warranted.