INTRODUCTION Recent decades have seen an uptick in suicide attempts and completed suicides among adolescents and young adults worldwide. In the Americas, including Cuba, suicide is the third leading cause of death in adolescents (ages 10–19 years).

OBJECTIVE Characterize the epidemiology of attempted and completed suicide in Cuban adolescents from 2011 through 2014.

METHODS A descriptive epidemiological study was carried out. The information was gathered from morbidity records for suicide attempts and mortality records for suicide deaths in adolescents, taken from the Cuban Ministry of Public Health’s Medical Records and Health Statistics Division database for January 1, 2011 through December 31, 2014. Variables were sex, age, occupation or employment status, and suicide method. Suicide attempt incidence rates and suicide mortality rates by age group per 100,000 population (crude, adjusted and age/sex specific), mortality sex ratio and attempt/suicide ratio were calculated. Relative change was calculated as a percentage, as were frequencies by variable for attempted suicide and suicide, and by age and sex for method used.

RESULTS A total of 19,541 suicide attempts and 149 suicides were reported. Average annual numbers were 4,885.2 suicide attempts and 37.2 suicides (131:1 ratio). There were 3,966 suicide attempts among boys, for a sex ratio of 0.25:1. Age-adjusted suicide attempt rates decreased from 391.8 per 100,000 population to 304.5 (22.3% reduction over the study period). Boys accounted for 107 of 149 suicide deaths, for a sex ratio of 2.5:1. Age-adjusted suicide mortality rates decreased from 2.8 to 2.3 per 100,000 population (17.9% reduction). The group aged 15–19 years had the highest age-adjusted suicide rate (3.9 per 100,000 population) and contributed the most deaths (114/149, 76.5%), although it did experience a 31.8% reduction over the study period. The group aged 10–14 years recorded a relative increase of 60% over the study period. Hanging was the most common suicide method (116/149, 77.9%). The suicide rate in Cuban adolescents (2.6 per 100,000 population, 3.7 in boys and 1.5 in girls) is less than that reported by the Region of the Americas between 2005 and 2009, 3.7 per 100,000 population (5/100,000 in boys and 2.3/100,000 in girls).

CONCLUSIONS Suicide rates in Cuban adolescents are lower than reported elsewhere in the Americas. Suicide attempts and suicide rates decreased modestly between 2011 and 2014. Hanging is the most commonly used method. The highest rates occur in the group aged 15–19 years, but those aged 10–14 years showed a relative increase over the study period. These results update the epidemiology of suicide in Cuban adolescents and demonstrate the extent of the problem. Suicides and suicide attempts show opposite patterns in boys and girls; suicides are more frequent among boys while suicide attempts are more frequent among girls.

KEYWORDS Suicide, suicide, attempted, mortality rate, adolescents, Cuba

CONTRIBUTION OF THIS RESEARCH These results update the epidemiology of suicide in Cuban adolescents and reveal the extent of the problem for one of the main preventable causes of death in this age group.

INTRODUCCIÓN El suicidio es un problema de salud influenciado por factores biológicos, genéticos, psicológicos, sociales y económicos. Es responsable del 50% de las muertes violentas en la población masculina en todo el mundo, y del 71% en la población femenina. En el continente americano, cada año ocurren 65 000 muertes por
suicidio. Es la novena causa más frecuente de muertes en Cuba, y la tercera en el rango de edades de 10 a 19 años.
OBJETIVO Caracterizar la epidemiología del suicidio en Cuba desde 1987 hasta 2014.
MÉTODOS Se realizó un estudio retrospectivo descriptivo. La información comprendió todos los registros de muerte por suicidio desde el primero de enero de 1987 hasta el 31 de diciembre del 2014 en la base de datos de la División Nacional de Estadística del Ministerio de Salud Pública de Cuba. Las variables consideradas fueron sexo, edad, color de la piel, estado laboral y ocupación, estado civil y método de suicidio. Las tasas crudas y estandarizadas por edad y las tasas específi cas de mortalidad por edad se calcularon, todas por cada 100 000 habitantes, así como la proporción por sexo. El cambio relativo entre series se calculó como porcentaje. Se calculó la
distribución de los suicidios según las variables y las proporciones se expresaron como porcentajes.
RESULTADOS Se reportó un total de 51 113 muertes por suicidio (para un promedio anual de 1 825), de las cuales 34 671 (67.8%) fueron en hombres. La proporción entre sexos fue 2.1:1 para todo el período estudiado, y 3.9:1 para el período 2011-2014. En el curso del período estudiado, las tasas de suicidio estandarizadas por edad disminuyeron desde 23.9 hasta 10.8 por 100 000 habitantes (54.8% de reducción). El grupo correspondiente a edades ≥60 años tuvo el mayor promedio de tasas estandarizadas por edad, 44.6 por 100 000 habitantes. La mayor carga de suicidios por edad correspondió al grupo de 20 a 59 años (60.5%). Con respecto al color de la piel, la mayor carga se encontró en los registrados como blancos, 68.9%. Con respecto al estado civil, la mayor carga se encontró en personas con una pareja estable (46.7%) y con respecto al estado laboral y la ocupación, en personas jubiladas (25.9%). El método más utilizado fue la asfi xia por ahorcamiento (59.4%).
CONCLUSIONES En el curso de aproximadamente tres décadas, las tasas de mortalidad por suicidio han disminuido en casi la mitad de su valor y todavía son ligeramente superiores que las tasas promedio en el continente americano. El método más utilizado es la asfixia por ahorcamiento. La relación entre sexos es mayor que 2 y ha aumentado en el tiempo. Las mayores tasas ocurren en el grupo de edad ≥60 años, pero se necesita una estratificación más refi nada para identificar las tendencias de riesgo relacionadas con la edad. Dado el envejecimiento de la población cubana, estos resultados son de interés para la salud pública y la epidemiología.
PALABRAS CLAVE suicidio, intento de suicidio, muerte, salud mental, Cuba

INTRODUCTION Suicide is a health problem influenced by biological, genetic, psychological, social and economic factors. It is responsible for 50% of violent deaths in the male population, worldwide, and 71% in the female. In the Americas, 65,000 deaths by suicide occur every year. It is the ninth most frequent cause of death in Cuba, and third among people aged 10–19.

OBJECTIVE Characterize the epidemiology of suicide in Cuba from 1987 to 2014.

METHODS A retrospective descriptive study was conducted. The information comprised all records of death by suicide from January 1, 1987 to December 31, 2014, in the Cuban Ministry of Public Health’s National Statistics Division database. The variables were sex, age, skin color, employment status/occupation, marital status, and method of suicide. Crude and age-standardized mortality rates and age–sex specific mortality rates were calculated, all per 100,000 population, as well as the sex ratio. Relative change over the series was calculated as a percentage. Distribution of suicides by variable was calculated and proportions expressed as percentages.

RESULTS A total of 51,113 deaths by suicide were reported (annual average 1825), of which 34,671 (67.8%) were among men. The sex ratio was 2.1:1 for the entire study period, and 3.9:1 for 2011–2014. Over the course of the period studied, age-standardized suicide rates decreased from 23.9 to 10.8 per 100,000 population (54.8% reduction). The group aged ≥60 years had the highest average age-standardized rate, 44.6 per 100,000 population. The highest suicide burden by age was in the group aged 20–59 years (60.5%). By skin color, the highest burden was in those recorded as white, 68.9%. By marital status, the highest burden was in persons with a stable partner (46.7%), and by employment status/occupation, in retired (25.9%). The most commonly used method was hanging (59.4%).

CONCLUSIONS Over the course of about three decades, suicide mortality rates have declined by almost half and they are still slightly higher than overall rates in the Americas. The most commonly used method is hanging. The sex ratio is greater than two and has increased over time. The highest rates occur in the group aged ≥60 years, but finer stratification is needed to identify an age-related risk trend. In view of Cuba’s aging population, these results are of interest for epidemiology and public health.

KEYWORDS Suicide, suicide attempt, death, mental health, Cuba