Sex- and age-specific trends in mortality from suicide and undetermined death in Germany 1991-2002

Background: Over the last decade, significant downward linear time trends in suicide mortality were observed in most Western countries. To date, it is not established whether those favourable time trends developed homogeneously for sex and age groups and how they were affected by the number of undetermined deaths. Methods: Data on suicide mortality and undetermined death from 1991 to 2002 in Germany were obtained from the German Federal Statistical Office. For each year, the age-standardised suicide rate (SR), undetermined death rate ( UDR) and total rate (SR+UDR) was calculated by direct standardisation separately for men and women. Time trends were analyzed by Poisson regression estimating the average annual percentage change (AAPC) of the rates for sex and four age groups ( 15 - 24, 25 - 44, 45 - 74, >= 75 years). Results: A significant decline of the SR was observed in all age groups but was less pronounced among the younger ages, particularly among men aged 15 - 24 years ( AAPC - 0.7%, p = 0.041). The SR in the oldest male age group (= 75 years) declined much stronger ( AAPC - 3.5%, p < 0.001). In women, the AAPC of the SR ranged from - 1.7% to - 4.6%. The average annual percentage changes in the age groups 25 - 74 years did not differ substantially for SR and SR+UDR. In contrast, due to an increase of undetermined deaths for subjects = 75 years, time trends in this age group were affected by the number of undetermined deaths, especially in women. Conclusion: Observing downward trends in suicide mortality with lower declines for younger subjects, prevention strategies should focus in particular on younger subjects.