Spatiotemporal clustering and epidemiological characterization of suicides in Ecuador, 2015-2023

Suicide is an important public health issue worldwide, especially among the young population. This study aimed to analyze the epidemiological characteristics and the spatial and temporal distribution of suicide at the provincial level in Ecuador between 2015 and 2023, using national mortality registries and spatiotemporal clustering methods. Crude rates were calculated by sex, age group, and province, and cluster analysis was applied using the K-means algorithm. A total of 10,297 suicides were recorded, with a clear predominance of males (78%), especially in the 20-29 age group, while among females the highest concentration occurred in the 10-19 age group in 2023. The most common method of suicide was hanging (73%). The highest rates were concentrated in provinces located in the Highlands (Sierra) and Amazon regions of the country. Five clusters of provinces were identified, with different levels and trends: (C1) provinces with very high but temporarily unstable suicide rates, which showed sharp peaks followed by sharp declines; (C2) provinces with persistently high rates during the study period; (C3) provinces with moderate and relatively stable rates over time; (C4) mainly coastal provinces with consistently low rates and minimal temporal variation; and (C5) the island region, characterized by a low rate with greater temporal dispersion. These findings highlight the need for territorially differentiated public policies, with emphasis on adolescent suicide prevention and improved access to mental health services.