An Epidemiological Study of Completed Suicides in Malta over the Past 24 years

Authors: Dr. Ethel Felice, Ms. Kelsey Renaud, Dr. Kristina Bettenzana, Dr. Greta Darmanin-Kissaun, Ms. Elena Felice, Prof. Marie-Therese Podesta, Dr. Katherine England & Ms. Dolores Gauci

Introduction : Suicide is the second leading cause of death among 15 to 29 year olds, with approximately 800,000 people dying from suicide each year worldwide (WHO, 2018). Identifying correlates of suicidal behaviour and risk has been identified as a research priority globally (National Action Alliance for Suicide Prevention, 2014). The prevalence, characteristics, and methods of suicidal behaviour vary significantly across populations, demographic factors, and time. Regular monitoring and up-to-date information on suicidal behaviour is essential for suicide prevention. However in various countries,  including Malta, suicide remains stigmatized and under-reported. Accurate data is difficult to collect and remains limited, particularly because the necessary systems are not in place. Suicide prevention requires an understanding of the limitations of the data available in that country, as well as efforts to improve the quality and collection of such data (World Health Organization, 2014). Moreover, various studies have highlighted the importance of cultural translation in suicidology (Colucci, 2006; Goldston et al., 2008; Lester, 2008). Cultural and ethnic factors related to suicide include: cultural protective factors such as the role of religion, spirituality, and the family; cultural manifestations and interpretations of distress; as well as the impact of stigma and culture on help-seeking behaviour. These variations have considerable implications for suicide prevention and treatment (Goldston et al., 2008; Lester, 2008).

Aims: The aim of the study was to determine the demographic information of persons who committed suicide, the mode on which suicide was committed, history of mental difficulties and the identification of possible precipitating factors.

Methodology: The post-mortem register, as well as relevant autopsy reports and psychiatric notes were used to gather the data. This was then compared with the statistics held in the Health Department to make sure that no cases are missed. The data collected included individuals’: gender, marital status, age, date when suicide was completed, method of suicide, any mental health problems, substance use, any previous suicide attempts, and previous contact with mental health services.

Results: The overall number of suicides over this 24 year period amounted to 635 individuals. As found in other studies, males accounted for 80.2% of suicides. The ages ranged from 14  to 98 years and the average age was 40. Of particular note, there was a significant increase in suicides in 2015. The large majority of suicides were committed by hanging, jumping or by overdose. As expected, a history of mental health problems was noted in a large number of cases.

Discussion: Suicide is a multi-faceted issue that affects people in their most productive years. This study revealed that many factors such as psychiatric disorders and psychosocial stressors play a significant role in suicides. It is recommended that the findings of this study are used to inform policy makers to provide evidence-based policies and programs aimed at reducing suicide.