title: Global trends in suicide epidemiology.
abstract: OBJECTIVE
  Suicide is a major cause of mortality accounting for nearly 1 million deaths globally per year. Suicide occurs throughout the lifespan; therefore, large epidemiological samples are needed to identify patterns in suicide death. This review examines emerging evidence relating to risk and protective factors as well as preventive measures for suicide.
  
  
  RESULTS
  The global financial crisis, natural disasters, air pollution and second-hand smoke have all been associated with increased suicide rates. At an individual level, past self-harm, parental loss or separation and younger age relative to classmates all confer risk. There is mixed evidence for religious affiliation and lithium levels in drinking water as protective factors. Means restriction strategies including barriers at suicide hotspots, firearms restrictions and limiting access to both pesticides and charcoal have all prevented suicide. Other interventions with recent evidence include improvements in mental health systems, selective serotonin reuptake inhibitor (SSRI) and lithium treatment in youth and mental health awareness in schools.
  
  
  CONCLUSIONS
  The evidence for risk/protective factors for suicide continues to grow and, more importantly, numerous prevention efforts continue to demonstrate positive outcomes. Public policy experts should attend to the environmental and social determinants of health when devising suicide prevention programs, and the evidence-based prevention strategies identified here should be implemented more broadly.
authors.affiliation: aDepartment of Psychiatry, University of Toronto bDepartment of Psychiatry, Sunnybrook Health Sciences Centre cRyerson University, Toronto, Ontario, Canada dCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Sinyor
authors.forename: Robyn
authors.initials: R
authors.lastname: Tse
authors.forename: Jane
authors.initials: J
authors.lastname: Pirkis
mesh_terms: D014943:Global Health; D006801:Humans; D013405:Suicide / Q000706:statistics & numerical data / Q000639:trends; D000092864:Suicide Prevention