Why Has the Continuous Decline in German Suicide Rates Stopped in 2007?

BACKGROUND Whereas German suicide rates had a clear decreasing tendency between 1991 and 2006, they increased from 2007 to 2010. Deeper analyses of suicide data might help to understand better this change. The aim of this study was to analyze 1) whether recent trends can be related to changes in specific suicide methods and diverge by gender and age; 2) whether the decrease of suicide rates before 2007 as well as the increase from 2007 to 2010 are driven by the same suicide method. METHODS Analyses were based on suicide data from the Federal Statistical Office of Germany. For 1998-2010, 136.583 suicide cases of men and women with known age and suicide method could be identified. These data were analyzed by joinpoint regression analysis, allowing identification of the best fitting point in time ("joinpoint") at which the suicide rate significantly changes in magnitude or direction. RESULTS The national downward trend between 1998 and 2007 was mainly due to corresponding changes in self-poisoning by other means than drugs (e.g., pesticides) (annual percentage change (APC) ≤ -4.33), drowning (APC ≤ -2.73), hanging (APC ≤ -2.69) and suicides by firearms (APC ≤ -1.46) in both genders. Regarding the overall increase of age-adjusted suicide rates in Germany 2007-2010, mainly the increase of self-poisoning (e.g., by drugs) and "being overrun" (APC ≥ 1.50) contributed to this trend. LIMITATIONS The true suicide rates might have been underestimated because of errors in the official death certificates. CONCLUSIONS Increase in suicide rates in Germany since 2007 went along with corresponding changes for "being overrun" and "self-poisoning". Copycat suicides following the railway suicide of the goalkeeper Robert Enke partly contributed to the results. Thus, prevention of Werther effects and limitation of the availability of high pack sizes for drugs are of special relevance for the reversal of this trend.