Counting the hidden cost of suicide in Spain: a direct and indirect cost analysis for the working-age population

Suicide imposes substantial societal costs in Spain, yet robust quantitative evidence to guide policy remains limited. This study estimates the economic burden of premature mortality due to suicide, with particular attention to working-age adults, to inform prevention priorities.

We conducted an economic burden analysis from a societal perspective. We combined national suicide mortality records with population and labour market statistics to estimate costs based on age and sex. Direct costs included healthcare, emergency response, medicolegal procedures and funerary services. Indirect costs were measured as productivity losses due to premature death, using age-specific employment rates, wages and labour force participation. All amounts are expressed in constant euros and reported with and without discounting at standard rates. Sensitivity analyses varied discount rates and retirement age.

Indirect costs ranged from €600 million to €860 million per year, depending on discounting, and exceeded prior national estimates. Losses were concentrated among working-age adults and dominated the total burden. Direct costs accounted for a smaller share of the overall impact.

Prevention that reduces suicide among working-age adults is likely to generate large social and fiscal gains, including for people without a prior mental health diagnosis. Greater transparency in reporting mental health expenditure and suicide-related costs would support evidence-informed resource allocation, collaboration across sectors and rigorous evaluation. Policymakers should prioritise mental health as a core public welfare objective.