Suicidal behaviour

1. Key messages

2. Suicidal behaviour from 2020 onwards

Suicidal thoughts stay high among young women (18-29 years old)

10% of people in November 2023 said they had seriously considered suicide in the last 12 months. The number of young women (aged 18-29) who have had suicidal thoughts has increased by 30% since February 2023 to 23%.

0.6% of people in November 2023 said they had attempted suicide in the last 12 months.

3. Suicidal thoughts

Middle-aged women are more likely to report suicidal thoughts

In 2018, in Belgium, 14% of the population aged 15 years and over had at least once in their life seriously considered suicide; within this group, one in three (or 4.3% of the total population) had thought about committing suicide in the last 12 months. More women (16%) than men (12%) reported suicidal thoughts in their life, while there were no gender differences in suicidal thoughts in the past year (4.4% in women vs 4.2% in men). People aged 65 years and over were less likely to report suicidal thoughts in their life or in the past year than people younger than 64 years. Women in the age group 45-54 years had a particularly high prevalence.

No clear trends in suicidal thoughts are observed

The proportion of people who considered suicide in the last 12 months (as well as in their lifetime) is lower in 2018 than in 2013, but the proportion is still higher than the values observed in 2008 (differences are not significant).

Suicidal thoughts are more frequent in the Walloon Region and the Brussels Capital Region

Lifetime suicidal thoughts were more frequent in the Walloon Region (16%) than in the Flemish Region (13%); suicidal thoughts in the last year were more prevalent in the Walloon Region (5.9%) and in the Brussels Capital Region (5.1%) than in the Flemish Region (3.3%). The prevalence of suicidal thoughts decreased in the Flemish Region between 2013 and 2018 while it remained relatively stable in the Brussels Capital Region and in the Walloon Region.

Suicidal thoughts are more frequent in the lowest educational group

Suicidal thoughts (lifetime and in the past year) are linked with the educational level. People from the lowest educational group were 1.5 more likely to have considered suicide in their life and 2.5 more likely to have considered it in the last year compared to people from the highest educational group.

4. Suicide attempts

More women have a failed suicide attempts

In 2018, in Belgium, 4.3% of the population aged 15 years and over reported to have attempted to commit suicide in their lifetime and 0.2% in the last year. More women (5.4%) than men (3.1%) tried to commit suicide in their lifetime and in the last year (0.3% in women and 0.2% in men). The prevalence of lifetime suicide attempts was higher in people aged between 35 and 54 years. Younger people (15-24 years) and 45-54 years were more likely to report a suicide attempt in the last year.

Trends in suicide attempts are stable

Trends in the prevalence of lifetime suicide attempts are relatively stable in Belgium and its regions. Suicide attempts decreased between 2013 and 2018 in men and women in the Brussels Capital Region but this was not significant.

Suicide attempts are more frequent in the Walloon Region

People from the Walloon Region were more likely to have attempted to commit suicide (6%) than people from the Brussels Capital Region (4.2%) and the Flemish Region (3.3%).

Suicidal attempts are more frequent in the lowest educational group

Suicide attempts (lifetime and in the past year) were linked with educational levels. People from the highest educational group were less likely to attempt suicide than people from the lower educational group.

5. Completed suicide

The number of deaths by suicide decreased to 1641 in 2021

In 2021, the number of deaths by suicide in Belgium fell to 1,641 (compared with 1,736 in 2020). There were more deaths by suicide among men (1174) than among women (467). The highest number of deaths by suicide occurred in the 45-64 age group. These figures are probably underestimated due to the limitations mentioned in the "context" section.

The mortality rate due to suicide is higher in men

The age-adjusted mortality rate due to suicide was 14.3 (per 100,000 people) in 2021 in Belgium. It was 2.6 times higher in men (21.3) than in women (8.0).

Suicide rates by age group are presented pooled over 3 years to avoid jumps due to small numbers. Suicide rates are higher for men than for women at any age, showing a gender difference in suicide. Suicide rates are the highest for men aged over 85 and for women between 45 et 64 years old.

Suicide represents a high share of deaths among young people

The share of deaths due to suicide by age group represents the relative importance of this cause in all deaths occurring in that age group. This has a different age distribution from that of the suicide mortality rates because the denominator of the share (all deaths in a given age group) is much larger at older ages, whereas the denominator of the rates (number of people in a given age group) is smaller at older ages.

Suicide accounts for a large proportion of deaths among young people: 27% of deaths among men and women aged 15 to 24 are due to suicide. Suicide accounts for 24% of deaths among men aged 25 to 44 and 13% among women aged 25 to 44.

Due to the increase in the number of deaths from concomitant causes at higher ages, the share of suicide deaths decreases with age.

Trends in suicide deaths are better understood together with deaths of undetermined intent

Between 2011 and 2021, suicide mortality rates decreased by 26% for both men and women. However, if we group suicides with deaths linked to events of undetermined intent, we see a smaller decrease of 8% for both men and women.

Deaths from suicide tend to decrease in all regions

Between 2011 and 2021, suicide rates among men decreased by 27% in the Flemish Region and by 22% in the Walloon Region. For women, suicide rates are, over the whole period, at a much lower level than for men in all regions. Between 2011 and 2021, rates decreased by 22% in the Flemish Region and by 32% in the Walloon Region.

When pooling suicide with the deaths from events of undetermined intent, the rates are decreasing slower or even increasing in the Flemish Region.

Between 2020 and 2021, age-adjusted mortality rates decreased in the Brussels-Capital Region, stagnated in the Walloon Region, and decreased among men and stagnated among women in the Flemish Region.

The high suicide rate in Belgium must be interpreted with caution

Belgium has the highest apparent suicide rate among women and the second highest among men. The rates are 1.4 times higher for men and 1.7 times higher for women than the average rate for the EU-14 countries. However, international comparisons of suicide mortality rates should be interpreted with caution as differences in socio-cultural context and data quality hamper the comparability between countries. Nevertheless, this warning should not serve to minimize the problematic suicide rates in Belgium.

6. Read more

View the metadata for this indicator

Statbel — Causes of death
SPMA: Standardized Procedures for Mortality Analysis (SPMA)
HISIA: Health Interview Survey Interactive Analysis (HISIA)

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Background

Suicide and suicide attempts are important societal and public health issues. They have ripple effects on families, friends, colleagues, communities, and society on the whole. Suicide occurs throughout the lifespan and was the second leading cause of death among 15-29-year-olds in the world in 2016. Suicide is preventable and its prevention has been prioritized by the World Health Organization (WHO) as a global target and included as an indicator in the United Nations Sustainable Development Goals (SDGs) [8]. To effectively develop suicide prevention strategies, efficient monitoring of suicide as well as identification of specific groups at risk is needed.

Suicidal thoughts never have just one cause but arise due to an interaction of risk and protective factors. These risk factors are always a combination of biological, psychological, social, and psychiatric risk factors. Suicidal thoughts also do not evolve linearly but with ups and downs. An entire process always precedes suicide [9]. The strongest risk factor for suicide is a previous suicide attempt [10]. The current COVID-19 crisis is particularly affecting the population's mental health and has a negative impact on some of the risk factors linked to suicide.

To apprehend this complex phenomenon, we use several indicators:

• Suicidal thoughts are an important risk factor for future suicide and important for prevention.
• Suicide attempts are a strong risk factor for completed suicide and a key moment to provide help to the person [11,16].
• Suicide deaths: we report the number of deaths, the mortality rate, and the share of total deaths that are due to suicide by age group. As suicides are often poorly recorded, these numbers are probably underestimated [12-15]. Misclassifications can occur when the exact cause of death is unknown (suicide may thus be classified as ‘unknown cause’); when the intention is not clear (suicide may thus be classified as 'deaths of undetermined intent'); or when the intention is wrongly evaluated (suicide may thus be classified as ‘accidents’ or ‘homicides’). It may also be possible that the doctor avoids mentioning suicide to protect the family from different problems (insurance, administration, religion, …). Additionally, administrative procedures can lead to misclassifications. For example, in Brussels, for certain years, the prosecution office failed to classify violent deaths (suicides, homicides), leading to a consequent under-reporting of suicides which were then classified as deaths of undetermined intent [11]. Moreover, the reasons for misclassification strongly vary across countries, which limits the interpretation of international comparisons. To partly reduce these biases in the interpretation of trends, we present, in addition to the suicide mortality rates, mortality rates grouping suicides (codes X60-X84; Y87.0) and events of undetermined intent (codes Y10-Y34; Y87.2).

First, we give an overview of suicidal thoughts and attempts during the COVID-19 crisis based on the data collected through online COVID-19 health surveys. Then, we go more in-depth into the suicidal thoughts and attempts based on the previous health interview surveys. Finally, we look at mortality due to suicide.

Definitions

Age-standardized rates (prevalence, incidence, or mortality)

Since most health indicators are strongly influenced by age, comparisons (among regions, educational levels, and over time) need to be standardized by age. The age-standardization removes the impact of differences in the age structure between populations or over time. The age-standardized rate is a weighted average of age-specific rates. The weights are derived from the same reference (standard) population.

EU-14

The EU-14 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, and Sweden. We compare the Belgian health status to that of the EU-14 because these countries have similar socioeconomic conditions. Note: The United Kingdom is not included since 2020.

References

1. Sixième enquête de santé COVID-19 : résultats préliminaires. Deposit number D/2021/14.440/30. Brussels: Sciensano; 2021. doi: 10.25608/j877-kf56
2. Septième enquête de santé COVID-19 : résultats préliminaires. Deposit number D/2021/14.440/50. Brussels: Sciensano; 2021. doi: 10.25608/ht7a-8923
3. Belgian Health and Well-being Cohort (BELHEALTH) - Bulletin 2, Brussels: Sciensano; 2023. https://www.sciensano.be/fr/biblio/bulletin-ndeg-2-belhealth-en 
4. Belgian Health and Well-being Cohort (BELHEALTH) - Bulletin 4, Brussels: Sciensano; 2024. https://www.sciensano.be/en/biblio/bulletin-ndeg4-belhealth 
5. Health Interview Survey, Sciensano, 1997-2018. https://www.sciensano.be/fr/projets/enquete-de-sante 
6. Causes of death, Statbel. https://statbel.fgov.be/en/themes/population/mortality-life-expectancy-and-causes-death/causes-death
7. Eurostat. https://ec.europa.eu/eurostat/databrowser/view/TPS00122/default/table?lang=en
8. WHO. Suicide in the world. https://www.who.int/publications-detail/suicide-in-the-world
9. 1813 zelfmoord. Oorzaken en suïcidaal proces. https://www.zelfmoord1813.be/feiten-en-cijfers/oorzaken-en-su%C3%AFcidaal-proces
10. WHO. Suicide. https://www.who.int/westernpacific/health-topics/suicide
11. Centre de prévention du suicide. LE SUICIDE UN PROBLEME MAJEUR DE SANTE PUBLIQUE Introduction à la problématique du suicide en Belgique Chiffres de 2014. Bruxelles, Belgique: Centre de prévention du suicide; 2017 Sep.
12. De Spiegelaere M, Wauters I, Haelterman E. Le suicide en Région de Bruxelles-Capitale: Situation 1998-2000. Brussels: Observatoire de la santé et du social de Bruxelles- Capitale; 2003.
13. Ohberg A, Lonnqvist J. Suicides hidden among undetermined deaths. Acta Psychiatr Scand. 1998.
14. Jougla E, Pequignot F, Chappert J, Rossollin F, Le TA, Pavillon G. Quality of suicide mortality data. RevEpidemiolSante Publique. 2002.
15. Moens GFG. The reliability of reported suicide mortality statistics: An experience from Belgium. Int J Epidemiol. 1985.
16. Gisle L, Drieskens S, Demarest S, Van der Heyden J. Enquête de santé 2018 : Santé mentale [Internet]. Bruxelles, Belgique: Sciensano; 2020 Jan. Report No.: D/2020/14.440/3. https://www.sciensano.be/fr/biblio/enquete-de-sante-2018-sante-mentale 

Please cite this page as: Sciensano. Mental Health: Suicidal behaviour, Health Status Report, 24 Apr 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mental-health/suicidal-behaviour