Abstract

Objective:

to describe sociodemographic aspects and time evolution of mortality due to suicide among elderly individuals in Bahia State, Brazil, from 1996 to 2013.

Methods:

time series descriptive and ecological study, with data from the Mortality Information System (SIM); Prais-Winsten regression was used for trend analysis and to calculate annual percent change (APC).

Results:

858 deaths due to suicide were identified in elderly in Bahia; 85.4% were men, and 53.8% were in the 60-69 age group; 64.3% of deaths resulted from hanging/strangulation, followed by self-poisoning by pesticides and chemical products (13.1%); there was an increasing trend in suicide mortality rate in the general elderly population (APC 11.0; 95%CI 6.9;15.3) and in the male sex (APC 12.1; 95%CI 7.1;17.3), whilst in the female population it remained stable.

Conclusion:

in Bahia, mortality due to suicide among elderly individuals presented an increasing trend in the period studied and was higher among males.

Keywords:
Suicide; Mortality; Aged; Epidemiology, Descriptive; Time Series Studies

Introduction

Suicide consists in a complex phenomenon, related to multiple variable factors in time and space, which results in death from intentional self-harm.¹1. World Health Organization. World report on violence and health [Internet]. Geneve: World Health Organization; 2002 [cited 2016 Oct 5]. 360 p. Available from: Available from: http://www.who.int/violence_injury_prevention/violence/world_report/en/
http://www.who.int/violence_injury_preve... ^,22. World Health Organization. Preventing suicide: a global imperative [internet]. Geneve: World Health Organization ; 2014 [cited 2016 Oct 5]. 92 p. Available from: Available from: http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/
http://www.who.int/mental_health/suicide... It is a serious Public Health issue, pointed as one of the ten main causes of death worldwide.¹1. World Health Organization. World report on violence and health [Internet]. Geneve: World Health Organization; 2002 [cited 2016 Oct 5]. 360 p. Available from: Available from: http://www.who.int/violence_injury_prevention/violence/world_report/en/
http://www.who.int/violence_injury_preve...

Every year, around 800 thousand people die due to suicide in the world, which corresponds to an adjusted global rate of 11.4 per 100 thousand inhabitants (15.0 among men and 8.0 among women).²2. World Health Organization. Preventing suicide: a global imperative [internet]. Geneve: World Health Organization ; 2014 [cited 2016 Oct 5]. 92 p. Available from: Available from: http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/
http://www.who.int/mental_health/suicide... In Brazil, from 2000 to 2012, 112,103 deaths due to suicide were registered among individuals older than 10 years old, a growth of 26.5% in the mortality rate, which increased from 4.9 in 2000 to 6.2 per 100 thousand inhabitants in 2012.³3. Machado DB, Santos DN. Suicídio no Brasil, de 2000 a 2012. J Bras Psiquiatr. 2015 jan-mar;64(1):45-54.

According to the World Health Organization (WHO), age is an important factor in the occurrence of suicide. Higher mortality rates among people aged 70 or more, in comparison with younger individuals, are observed in almost all regions worldwide.²2. World Health Organization. Preventing suicide: a global imperative [internet]. Geneve: World Health Organization ; 2014 [cited 2016 Oct 5]. 92 p. Available from: Available from: http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/
http://www.who.int/mental_health/suicide...

Globally, the mortality rate from suicide among men aged ≥65 years, in the 1990s was around 41 deaths per 100 thousand inhabitants, reaching higher values when considering only those aged ≥75 years (50 deaths/100 thousand inhabitants).²2. World Health Organization. Preventing suicide: a global imperative [internet]. Geneve: World Health Organization ; 2014 [cited 2016 Oct 5]. 92 p. Available from: Available from: http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/
http://www.who.int/mental_health/suicide... In Brazil, from 2000 to 2014, around 10 thousand people died from suicide,⁴4. Ministério da Saúde (BR). Departamento de Informação do SUS (DATASUS). Informações de saúde. Óbitos por causas externas [Internet]. 2016 [citado 2016 nov 6]. Disponível em: Disponível em: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/ext10uf.def
http://tabnet.datasus.gov.br/cgi/tabcgi.... and although the mortality rate is relatively low in the country - in comparison to others -, the risk of suicide in the elderly population represents the double of the estimated to the general population.⁵5. Minayo MCS, Cavalcante FG, Souza ER. Methodological proposal for studying suicide as a complex phenomenon. Cad Saúde Pública. 2006 ago;22(8):1587-96.

The higher vulnerability to suicide among individuals aged 60 years or more, due to health problems and changes in their social roles, highlights the importance of understanding the magnitude of the problem. Moreover, those people get little attention from Public Health authorities, researchers and the media, who, in theirs reflections and actions, usually prioritize younger population groups.⁶6. O’Connell H, Chin AV, Cunningham C, Lawlor BA. Recent developments: suicide in older people. BMJ. 2004 Oct;329(7471):895-9.

Besides that, another justification for this study, is the lack of scientific works on this subject in Brazil, especially in places where it is evident the growth in occurences of this event, such as the Northeast region, especially Ceará and Bahia states, which represent, together, more than 40% of the deaths from suicide in the region in the period from 2010 to 2013.⁴4. Ministério da Saúde (BR). Departamento de Informação do SUS (DATASUS). Informações de saúde. Óbitos por causas externas [Internet]. 2016 [citado 2016 nov 6]. Disponível em: Disponível em: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/ext10uf.def
http://tabnet.datasus.gov.br/cgi/tabcgi....

Aiming to subsidize the increase of knowledge about the topic and help the Health sector in its preventive actions through the identification of vulnerable groups, this study had as objective to describe the sociodemographic aspects and the time evolution of the mortality due to suicide in elderly individuals in Bahia State, from 1996 to 2013.

Methods

This is a descriptive and time series ecological study.

In 2010, Bahia State had a population of 14,016,906 inhabitants, of which 1,450,008 (10.3%) were 60 years old or more.⁷7. Instituto Brasileiro de Geografia e Estatística. Estados - Bahia [Internet]. 2017 [citado 2017 jun 8]. Disponível em: Disponível em: http://www.ibge.gov.br/estadosat/perfil.php?sigla=ba
http://www.ibge.gov.br/estadosat/perfil.... In that same year, 4,760,071 (34%) of the state inhabitants had from complete primary education to higher education degree, and the average monthly household income per capita of those aged 10 years or more was of BRL 947.25.⁷7. Instituto Brasileiro de Geografia e Estatística. Estados - Bahia [Internet]. 2017 [citado 2017 jun 8]. Disponível em: Disponível em: http://www.ibge.gov.br/estadosat/perfil.php?sigla=ba
http://www.ibge.gov.br/estadosat/perfil....

The data on deaths from suicide were obtained in the Mortality Information System (SIM), available in the website of the Brazilian National Health System IT Department (Datasus), of the Ministry of Health. The period of the study (1996 to 2013) was determined for corresponding to the years of coverage of the current International Statistical Classification of Diseases and Health Related Problems, 10^th edition (ICD-10).

All the deaths of individuals aged 60 years or more, who lived in Bahia State and had suicide as its underlying cause, classified in ICD-10 as ‘external causes of morbidity and mortality’, under the codes X60 to X84, were included. The ICD-10 categories corresponding to suicide were:

To characterize the deaths, the following variables were considered:

To analyze time evolution, we calculated the total mortality rates from suicide in elderly individuals (per 100 thousand inhabitants), and also according to sex. The rates were adjusted by age, through direct method, using the elderly Brazilian population of 2010 as reference. The population data were obtained from the Brazilian Institute of Geography and Statistics (IBGE), available in Datasus website, and referred to the population count (1996), demographic censuses (2000; 2010), intercensal projections (1997 to 1999; 2001 to 2012) and population estimates (2013).

In the time trend analysis, we used the proceedings of Prais-Winsten general linear regression, which considers the serial autocorrelation. For this, we estimated the annual percent change (APC) and its respective 95% confidence intervals (95%CI).⁸8. Antunes JLF, Cardoso MRA. Uso da análise de séries temporais em estudos epidemiológicos. Epidemiol Serv Saude. 2015 jul-set;24(3):565-76. The p values were obtained using Wald test. A 5% statistical significance level was adopted. The program Microsoft Office Excel 2010 was used for tabulation, descriptive analysis and rates calculation, and the program Statistical Package for the Social Sciences (SPSS) version 21.0 was used for trend analysis.

This study met the ethical principles of the Resolution of the National Health Council No. 510, dated April 7th, 2016.⁹9. Brasil. Ministério da Saúde. Resolução nº 510, de 07 de abril de 2016. Que trata das especificidades éticas das pesquisas nas ciências humanas e sociais e de outras que utilizam metodologias próprias dessas áreas. Diário Oficial da República Federativa do Brasil, Brasília (DF), 2016 maio 24; seção 1:44-6. Since it used only data publicly available and without identification of the subjects, submission to the Ethics Research Committee was exempted.

Results

From 1996 to 2013, 858 deaths from suicide among individuals aged 60 years or more were identified in Bahia State. When these deaths were distributed according to sociodemographic characteristics (Table 1), it was observed that 85.4% of them were males, 53.8% were in the age group from 60 to 69 years, 54.0% were from the ethnicity/skin color brown and 43.9% were married. With regard to education level, 33.5% had from 1 to 7 years of schooling. It is important to highlight the proportion of non-informed data for the variables ethnicity/skin color (17.7%), marital status (15.3%) and education level (36.6%) (Table 1).

As to the means used, 64.3% of the deaths were due to intentional self-harm by hanging and strangulation, followed by intentional self-poisoning by pesticides and chemical products, with 13.1%. Similar results were found in the distribution by sex (66.9% and 12.7% in the male sex; 49.6% and 15.2% in the female sex) and by age group (64.5% and 12.8% in the 60 to 69 years group; 63.8% and 13.5% in the 70 to 79 years; and 64.9% and 13.2% in 80 years or more) (Table 2).

The time evolution of the mortality rates from suicide in elderly individuals is presented in Table 3. There was an increase of 206.3% in the mortality rate due to suicide in elderly individuals in Bahia, which grew from 2.2/100 thousand inhabitants in 1996 to 6.8/100 thousand inhabitants in 2013, with annual increase of 11.0% (95%CI 6.9;15.3) and a significant and increasing trend. In the male sex, there were higher rates (3.9 in 1996 and 12.7 in 2013), with significant and increasing trend (APC 12.1%; 95%CI 7.1;17.3), whereas in the female sex there were smaller rates (0.8 in 1996 and 2.0 in 2013), with stability throughout the period (Table 3).

Discussion

In Bahia, mortality by suicide in elderly individuals is prevalent in the male sex, in the age group from 60 to 69 years. It was observed an increasing trend in the mortality rate by suicide among elderly individuals as a whole; especially in men, whose rate was, approximately, 4 to 10-fold higher than in women, in the years studied.

The growth observed in this study was more marked when compared to Brazil as a whole (16.2%) and to the Northeast region (57.2%), from 2000 to 2012;³3. Machado DB, Santos DN. Suicídio no Brasil, de 2000 a 2012. J Bras Psiquiatr. 2015 jan-mar;64(1):45-54. and to other Brazilian states, such as Minas Gerais (42.9%)¹⁰10. Gomes LMX, Barbosa TLA, Caldeira AP. Mortalidade por causas externas em idosos em Minas Gerais, Brasil. Esc Anna Nery. 2010 out-dez;14(4):779-86. from 1999 to 2008, and Ceará (145.8%) from 1980 to 2009.¹¹11. Pinto LW, Pires TO, Silva CMFP, Assis SG. Evolução temporal da mortalidade por suicídio em pessoas com 60 anos ou mais nos estados brasileiros, 1980 a 2009. Cienc Saúde Colet. 2012;17(8):1973-81.

It is important to highlight that the growth observed not only can be a consequence of the rise in the number of cases, but also of the possible advances in the coverage of SIM and filling of death certificates (DC), due to a better identification and classification of suicide as cause of death.

In Brazil, the difficulty to estimate suicides steams from the incompleteness of records¹²12. Rios MA, Anjos KF, Meira SS, Nery AA, Casotti CA. Completude do sistema de informação sobre mortalidade por suicídio em idosos no estado da Bahia. J Bras Psiquiatr. 2013 abr-jun;62(2):131-8. and from cultural reasons. Other problems in quality are identified, many of them due to the lack of information accuracy in its record source - such as the Police and the Forensic Medicine Institutes -, and on the other hand, from the social turmoil caused by suicide, not only in the elderly, but also in the general population, due to the stigma and social prejudice related to this event.¹²12. Rios MA, Anjos KF, Meira SS, Nery AA, Casotti CA. Completude do sistema de informação sobre mortalidade por suicídio em idosos no estado da Bahia. J Bras Psiquiatr. 2013 abr-jun;62(2):131-8.

There are many factors related to suicide in elderly individuals. Among them, we can highlight mental disorders, especially depression, physical illness or the presence of terminal diseases, along with the fear of an extended life without dignity, social-related problems, such as isolation, lack of a support network and loneliness, besides the ideation, past attempts and easy access to the means used to commit the act.⁶6. O’Connell H, Chin AV, Cunningham C, Lawlor BA. Recent developments: suicide in older people. BMJ. 2004 Oct;329(7471):895-9.^,1313. Di Mauro S, Leotta C, Giuffrida F, Distefano A, Grasso MG. Suicides and the third age. Arch Gerontol Geriatr. 2003 Jan-Feb;36(1):1-6. Moreover, stressful moments, such as the loss of relatives, psychosocial factors, like alcoholism and use of other drugs, which interfere in the psychological, psychiatric and biological factors of the elderly, can lead them to self-destruction.¹³13. Di Mauro S, Leotta C, Giuffrida F, Distefano A, Grasso MG. Suicides and the third age. Arch Gerontol Geriatr. 2003 Jan-Feb;36(1):1-6.

14. Meneghel SN, Victora CA, Faria NMX, Carvalho LA, Falk JW. Características epidemiológicas do suicídio no Rio Grande do Sul. Rev Saúde Pública. 2004 dez;38(6):804-10.^-1515. Rahimi R, Ali N, Noor SMD, Mahmood MS, Zainun KA. Suicide in the elderly in Malaysia. Malaysian J Pathol. 2015 Dec;37(3):259-63.

In this study, the deaths due to intentional self-harm involving elderly individuals were prevalent in the male sex, with an increasing trend of the mortality rate. This result supports what was verified for Brazil (2000 to 2012)³3. Machado DB, Santos DN. Suicídio no Brasil, de 2000 a 2012. J Bras Psiquiatr. 2015 jan-mar;64(1):45-54. and other states, such as Minas Gerais (1999 to 2008)10 and Espírito Santo (1980 to 2006).¹⁵15. Rahimi R, Ali N, Noor SMD, Mahmood MS, Zainun KA. Suicide in the elderly in Malaysia. Malaysian J Pathol. 2015 Dec;37(3):259-63.

Among the possible justification for this finding, we can mention sex-related fragilities, which constitute important factors in the explanation of suicide occurrence.¹⁷17. Minayo MCS, Meneghel SN, Cavalcante FG. Suicídio de homens idosos no Brasil. Cienc Saúde Coletiva. 2012 out;17(10):2665-74. In the old age, the masculinity which values stoicism, control of emotions, macho attitudes and competitiveness tends to intensify; and the fact of other adults assume the functions as head of the family and in society, previously occupied by the elderly individual, leads him to feel useless, incapable, powerless and humiliated.18 Besides, the removal from work due to retirement or chronic disease, financial difficulties and problems regarding relationships or sexual performance are potential motives for suicidal behavior in elderly individuals.¹⁸18. Farber SS. Envelhecimento e elaboração de perdas. A terceira idade. 2012 mar;23(53):7-17.

The smaller frequency of suicide found in female elderly individuals confirms findings of national¹⁰10. Gomes LMX, Barbosa TLA, Caldeira AP. Mortalidade por causas externas em idosos em Minas Gerais, Brasil. Esc Anna Nery. 2010 out-dez;14(4):779-86.^,1111. Pinto LW, Pires TO, Silva CMFP, Assis SG. Evolução temporal da mortalidade por suicídio em pessoas com 60 anos ou mais nos estados brasileiros, 1980 a 2009. Cienc Saúde Colet. 2012;17(8):1973-81.^,1414. Meneghel SN, Victora CA, Faria NMX, Carvalho LA, Falk JW. Características epidemiológicas do suicídio no Rio Grande do Sul. Rev Saúde Pública. 2004 dez;38(6):804-10. and international¹⁹19. Corona-Miranda B, Hernández-Sánchez M, Lomba-Acevedo P. Epidemiology of suicide in Cuba, 1987-2014. MEDICC Rev. 2016 Jul;18(3): 15-20. studies, possibly justified by the fact that women take more care of their health and sociability. Even during old age, they keep their roles as caretakers, doing household activities and keep a close and communicative relation to relatives and their community, besides being culturally more resistant to pain and suffering.¹⁷17. Minayo MCS, Meneghel SN, Cavalcante FG. Suicídio de homens idosos no Brasil. Cienc Saúde Coletiva. 2012 out;17(10):2665-74.

Most elderly individuals in Bahia State who committed suicide were between 60 and 69 years old, which is similar to results found in Espírito Santo State (1980 to 2006)16 and Santa Catarina State (2009),²⁰20. Sehnem SB, Palosqui V. Características epidemiológicas do suicídio no estado de Santa Catarina. Fractal Rev Psicol. 2014 maio-ago;26(2):365-78. and different from what was found in studies conducted in Rio Grande do Sul State (1980 to 1999)¹⁴14. Meneghel SN, Victora CA, Faria NMX, Carvalho LA, Falk JW. Características epidemiológicas do suicídio no Rio Grande do Sul. Rev Saúde Pública. 2004 dez;38(6):804-10. and in countries such as China (2013 to 2014),²¹21. Zhong BL, Chiu HFK, Conwell Y. Rates and characteristics of elderly suicide in China, 2013-14. J Affect Disord. 2016 Dec;206:273-9. which show the eldest group of elderly individuals (80 years or more) as the one most involved with thoughts, attempts and execution of suicide.

The condition of being single, widowed or divorced, for contributing for the social isolation, is referred as a risk factor for suicide,¹¹11. Pinto LW, Pires TO, Silva CMFP, Assis SG. Evolução temporal da mortalidade por suicídio em pessoas com 60 anos ou mais nos estados brasileiros, 1980 a 2009. Cienc Saúde Colet. 2012;17(8):1973-81.^,1414. Meneghel SN, Victora CA, Faria NMX, Carvalho LA, Falk JW. Características epidemiológicas do suicídio no Rio Grande do Sul. Rev Saúde Pública. 2004 dez;38(6):804-10. as evidenced in this study, since almost half of the elderly individuals who committed suicide belonged to these groups. Regarding the ethnicity/skin color, there was a larger proportion of cases among brown-skinned elderly, similar to what was found in a study conducted in the municipality of Recife, Pernambuco State (2009),²²22. Mendonça Neto FA, Melo AAG, Queiroz AFB, Paiva SOC, Lima FM. Suicídio em idosos no Recife (PE): um estudo sobre mortalidade por causas externas. Rev Kairós Gerontol. 2013 set;16(5):255-67. possibly because most of the population of these places self-declared as brown-skinned.

Still on social aspects, studies performed in Brazil (2000 to 2012)³3. Machado DB, Santos DN. Suicídio no Brasil, de 2000 a 2012. J Bras Psiquiatr. 2015 jan-mar;64(1):45-54. and in countries such as Malaysia (2009)¹⁵15. Rahimi R, Ali N, Noor SMD, Mahmood MS, Zainun KA. Suicide in the elderly in Malaysia. Malaysian J Pathol. 2015 Dec;37(3):259-63. point a higher number of attempts and occurrence of suicide in population groups with smaller education level (up to 7 years of schooling), which was also verified in this present study. However, there is a large proportion of cases in which this variable has not been filled, a problem also identified in Ceará State, in the 1997-2007 period.²³23. Oliveira MIV, Bezerra Filho JG, Feitosa RFG. Estudo epidemiológico da mortalidade por suicídio no Estado do Ceará, no período 1997-2007. Rev Baiana de Saúde Pública. 2012 jan;36(1):159-73.

In Bahia, the analysis of completeness of data about elderly individuals' suicide from 1996 to 2010, using SIM, showed that, despite an improvement in the register of the education level field, its completeness still had a bad score (incompleteness from 20% to 50%).¹²12. Rios MA, Anjos KF, Meira SS, Nery AA, Casotti CA. Completude do sistema de informação sobre mortalidade por suicídio em idosos no estado da Bahia. J Bras Psiquiatr. 2013 abr-jun;62(2):131-8. These data reveal a fragility in the filling quality of the DC, pointing to the need of improving the quality of the registers, in order to obtain the information in the information related to the circumstances of deaths, and also about the population groups under greater risk.

With regard to the means employed, in both sexes and different age groups, the hanging and strangulation stood out, followed by self-poisoning by pesticides and chemical products. This is similar to the results pointed in studies conducted in the municipality of Recife, Pernambuco State (2003)²³23. Oliveira MIV, Bezerra Filho JG, Feitosa RFG. Estudo epidemiológico da mortalidade por suicídio no Estado do Ceará, no período 1997-2007. Rev Baiana de Saúde Pública. 2012 jan;36(1):159-73. and in countries like Cuba (1987-2014)¹⁹19. Corona-Miranda B, Hernández-Sánchez M, Lomba-Acevedo P. Epidemiology of suicide in Cuba, 1987-2014. MEDICC Rev. 2016 Jul;18(3): 15-20. and Malaysia (2009).¹⁵15. Rahimi R, Ali N, Noor SMD, Mahmood MS, Zainun KA. Suicide in the elderly in Malaysia. Malaysian J Pathol. 2015 Dec;37(3):259-63.

The wide availability and easy access to powerful toxic agents, such as industrial chemical products, home care products, cosmetics, rodenticides, as well as the diversity of medicines used during the aging process, can favor the occurrence of suicide in elderly individuals.²⁴24. Seleghim MR, Bellasalma ACM, Mathias TAF, Oliveira MLF. Caracterização das tentativas de suicídio entre idosos. Cogitare Enferm. 2012 abr-jun;17(2):277-83. For cases which are difficult to control, such as hanging/strangulation, the monitoring by the healthcare professionals and specialized services is crucial, as well as the guidance of relatives and other acquaintances of the elderly when emergency moments are identified, aiming at preventing suicide attempts.³3. Machado DB, Santos DN. Suicídio no Brasil, de 2000 a 2012. J Bras Psiquiatr. 2015 jan-mar;64(1):45-54.

In Brazil, we can notice that little or nothing regarding suicide involving elderly individuals is discussed in national health policies, having as examples the National Policy for Reduction of Morbidity and Mortality from Accidents and Violence²⁵25. Brasil. Ministério da Saúde. Portaria nº 737, de 16 de maio de 2001. Aprova a Política Nacional de Redução da Morbimortalidade por Acidentes e Violências. Diário Oficial da República Federativa do Brasil, Brasília (DF), 2001 maio 18; Seção 1:64. and the National Policy for Mental Health,²⁶26. Brasil. Ministério da Saúde. Lei nº 10.216, de 6 de abril de 2001. Dispõe sobre a proteção e os direitos das pessoas portadoras de transtornos mentais e redireciona o modelo assistencial em saúde mental. Diário Oficial da República Federativa do Brasil, Brasília (DF), 2001 abr 6; Seção 1. which emphasize the occurrence of the event in the young population, to whom they direct actions of prevention and control. Similar observation can be directed to the National Policy of Elderly Person Health,²⁷27. Brasil. Ministério da Saúde. Portaria nº 2.528, de 19 de outubro de 2006. Aprova a Política Nacional de Saúde da Pessoa Idosa. Diário Oficial da República Federativa do Brasil, Brasília (DF), 2006 out 19; Seção 1. which does not cover in its guidelines the phenomenon, when mentioning in the area of violence only actions to tackle domestic and institutional violence against the elderly individual. This demonstrates the importance of the resumption of the discussions about the policies and actions to promote the health of elderly individuals in the country, especially the prevention of suicide.

This study presented some limitations such as the use of SIM data, with the possible undernotification of cases due to failures in the fulfillment of death certificates.²⁸28. Soares Filho AM, Cortez-Escalante JJ, França E. Revisão dos métodos de correção de óbitos e dimensões de qualidade da causa básica por acidentes e violências no Brasil. Ciênc Saúde Coletiva. 2016;21(12):3803-18. The high number of cases whose underlying cause of death is classified as ill-defined or external cause with undetermined intent, reinforces the possibility of undernotification of deaths from suicide.¹²12. Rios MA, Anjos KF, Meira SS, Nery AA, Casotti CA. Completude do sistema de informação sobre mortalidade por suicídio em idosos no estado da Bahia. J Bras Psiquiatr. 2013 abr-jun;62(2):131-8.^,2828. Soares Filho AM, Cortez-Escalante JJ, França E. Revisão dos métodos de correção de óbitos e dimensões de qualidade da causa básica por acidentes e violências no Brasil. Ciênc Saúde Coletiva. 2016;21(12):3803-18. Also, the incomplete nature of the data, especially in variables such as education level, ethnicity/skin color and marital status, may have hampered a better characterization of cases, and with it, the identification of vulnerable groups.

Despite these limitations, the results found point to the importance of integration between the Health sector and other social devices, aiming to ensure the support and protection of elderly individuals. Thus, the need to develop actions that promote the welfare, autonomy and sociability of this population group is clear, in order to contribute to life quality and, consequently, to reduce deaths from intentional self-harm.

References

Publication Dates

History