Suicide by hanging in Brazil: challenges to mitigating its escalation.

Suicide by hanging is one of the leading methods of self-inflicted death in the world, both in developed countries and in Brazil.1,2 Already common, this method is steadily growing at an alarming rate. According to the Brazilian Ministry of Health Mortality Information System (SIM), between 1996 and 2016, there were 183,384 deaths by suicide in the country. During this period, the most used methods were hanging (58%), firearm (14%), and self-poisoning by pesticides or other chemicals (10%). The variation of suicide methods over time shows an absolute increase in the number of suicides by hanging from 3,027 in 1996 to 7,813 in 2016 (Figure 1). When the relative contribution of each suicide method was compared at these two time points, hanging was found to have increased from 45% of all cases of suicide in Brazil in 1996 to was 68% in 2016, representing a proportional increase of 51.1% over 20 years. Stratified by sex, while 48% of cases among men in 1996 were by hanging, the proportion increased to 72% in 2016; likewise, for women, the proportion increased from 34 to 56% in the same period.

Figure 1

Proportion of methods of suicide in Brazil (1996-2016).

Factors associated with the popularity of this method are the wide availability of the materials used for hanging and the view that it would constitute a rapid, clean, painless and bloodless method of death.3 Ropes, straps and the places from which these objects are hung (beams, rails, hooks, doorknobs, and trees) are easily reachable.3 The probability of death by hanging is associated with male sex, older age, living in rural areas, and low educational level. Most of these cases occur at home; only one in 10 occur in institutions such as hospitals and prisons.4 Furthermore, people who attempted suicide by hanging have higher chances of future completed suicide when compared with those who attempt other methods.4

Knowledge of the methods used for suicide is important for implementing suicide prevention strategies. From a public health standpoint, developing universal prevention strategies for this method is particularly challenging due to the fact it is most commonly carried out in the home, the ready availability of the materials used, and widespread perceptions about the method. Feasible strategies for the prevention of suicide by hanging must involve greater vigilance in institutional settings and adequate management of patients with previous attempts and patients with mental disorders. The scarcity of effective preventive measures to reduce escalation of this form of suicide demands a comprehensive discussion among professionals, families, and health managers who are at the frontline of care of suicidal people. Future research should focus on the details of deeply rooted perceptions about the meaning of death by hanging in different cultures and the origins of this knowledge as used by suicidal individuals, in order to reduce their willingness to plan suicide by this method.

Disclosure

The authors report no conflicts of interest.