• Li Liu, Colin A Capaldi, Heather M Orpana, Mark S Kaplan, and Lil Tonmyr.
• Centre for Surveillance and Applied Research (Liu, Capaldi, Orpana, Tonmyr), Public Health Agency of Canada; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Luskin School of Public Affairs (Kaplan), University of California, Los Angeles, Calif.; Department of Sociology and Anthropology (Tonmyr), Carleton University, Ottawa, Ont.
• CMAJ. 2021 Mar 8; 193 (10): E331-E338.

BackgroundOngoing surveillance of the means of suicide is necessary for effective prevention. We examined how mortality rates owing to different means of suicide changed in Canada from 1981 to 2018.MethodsWe obtained data from 1981 to 2018 on suicide deaths of individuals aged 10 years and older, from the Canadian Vital Statistics Death Database. We used joinpoint regression analysis to examine changes over time in the suicide mortality rate for the 3 most common means of suicide.ResultsThe age-standardized suicide mortality rate declined in earlier decades for both sexes, but did not significantly change in recent decades for either sex. The age-standardized rate of suicide by suffocation increased from 1993 for females (2.1% per year) and from 1996 for males (0.4% per year). The age-standardized rate of suicide by poisoning decreased for females (2.2% per year) and males (2.1% per year) from 1981 to 2018. The age-standardized rate of suicide by firearm decreased from 1981 to 2008 (7.4% per year) but did not significantly change there-after for females; for males, it decreased 2.1% per year from 1981 to 1993 and 5.7% per year from 1993 to 2007, but did not significantly change thereafter.InterpretationFor both sexes, the rate of suicide by poisoning is decreasing, the rate of suicide by suffocation is increasing, and the rate of suicide by firearm has not significantly changed in the last decade. Given the high proportion of suicide deaths by suffocation, its increasing rate and the difficulty of restricting the means of suffocation, other approaches to suicide prevention are needed.© 2021 Joule Inc. or its licensors.

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