Suicide mortality in Brazil: Post-pandemic excess mortality and spatial inequalities

Suicide remains a major cause of preventable premature mortality worldwide, yet long-term evidence from middle-income countries remains limited, particularly regarding post-pandemic trajectories, geographic inequalities, seasonal variation, and future burden. This study analyzed suicide mortality in Brazil from 2005 to 2024, examining temporal trends, demographic patterns, excess mortality, spatial clustering, seasonality, and projections through 2030.

We conducted a nationwide ecological time-series study using mortality data from the Brazilian Mortality Information System. Suicide deaths were identified using ICD-10 codes X60-X84. Crude and age-standardized mortality rates were calculated per 100,000 inhabitants. Temporal trends were assessed using regression models, interrupted time-series analysis evaluated pandemic-related changes, and ARIMA models estimated excess mortality and future projections. Sex-specific mortality, spatial autocorrelation, and seasonal patterns were also examined.

Brazil recorded 236,474 suicide deaths between 2005 and 2024, increasing from 8550 deaths in 2005 to 16,751 in 2024. Age-standardized mortality increased from 6.24 to 8.67 deaths per 100,000 inhabitants (annual percent change: 2.36%; 95% CI: 1.52-3.20). Men accounted for 78.6% of deaths and had nearly fourfold higher mortality than women (RR = 3.82; 95% CI: 3.71-3.94). Adults aged 20-49 years represented 60.9% of deaths. Mortality accelerated after 2020, exceeded expected levels from 2021 onward, showed clustering in Southern Brazil, peaked in late-year months, and is projected to continue increasing through 2030.

Suicide mortality in Brazil increased substantially between 2005 and 2024 and remained above expected levels from 2021 onward. Although mortality showed a steeper trajectory after 2020, interrupted time-series analyses suggest that these findings should be interpreted as temporal deviations from pre-pandemic trends rather than definitive evidence of a direct pandemic effect.