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Background: The COVID-19 pandemic has already claimed more than six million direct deaths. Low-and middle-income countries, such Brazil, were severely hit, not only due to direct effects on mortality, but also for its indirect effects on other causes of deaths. Aims: The objective of this study was to estimate the excess suicides in Brazil and evaluate patterns within and between its regions during the COVID-19 pandemic in 2020. Method: The observed suicides are gathered from the mortality information system of the Brazilian Ministry of Health. The estimates of expected suicides, according to sex, age group, bimonthly period and region, were reached through quasi-Poisson generalized additive models, with adjustment for overdispersion. The analyses were performed in R software, version 3.6.1 and RStudio, version 1.2.1335. Results: From March 2020 to December 2020, 10,409 suicides were observed in Brazil, resulting in an overall decrease of 13%, in comparison to the expected rate for the period. There were excess suicides of 26% in men from the Northern region in the 60 years and more age group, as well as in women from the Northern region in the 30 to 59 years age group in two consecutive bimonthly periods. Excess suicides of 40% was also observed in women in the 60 years and more age group from the Northeastern region. Conclusions: Despite the overall decrease in suicides in Brazil over the period assessed, substantial excess suicides were observed in different age groups and sexes from the Northern and Northeastern regions of the country, which are regions that are historically more prone to health and socioeconomic inequalities.

Objetivo: descrever as características e taxas de mortalidade por suicídio no estado do Ceará e suas macrorregiões. Método: estudo descritivo, compreendendo o período de 2012-2016. Resultados e conclusão: a maioria dos casos ocorreu no sexo masculino, entre não casados, em domicílio, por enforcamento, na macrorregião de Fortaleza. A taxa no Ceará foi de 5,1/100.000. As macrorregiões do Sertão Central, Sobral e Cariri apresentam maiores taxas. Taxas mais elevadas ocorreram no interior do estado, onde, habitualmente, há menor acesso a serviços especializados, sendo a participação da atenção primária de grande importância no enfrentamento desse agravo.

This study aimed to describe the characteristics, distribution, and mortality rates from suicide in indigenous children in Brazil compared to non-indigenous children. This descriptive study covered the years from 2010 to 2014, using national databases. The study collected deaths in individuals 10 to 14 years of age whose underlying cause was "inentional self-inflicted injury". Hanging was the most frequently used means in both indigenous and non-indigenous children, although it was more frequent in the former. Among indigenous children, suicides in hospitals or other healthcare establishments were less common than in non-indigenous. Approximately three-fourths of suicides in indigenous children occurred in just 17 municipalities. The mortality rate from suicide among indigenous children was 11.0/100,000 (8.4-14.3), or 18.5 times higher (10.9-31.6) than in non-indigenous, which was 0.6/100,000 (0.5-0.6), with no differences between boys and girls. This study showed for the first time on a national scale the specific characteristics of suicide in indigenous children, with high rates, and also identified priority areas for interventions.O objetivo deste trabalho foi descrever as características, a distribuição e as taxas de mortalidade por suicídio entre crianças indígenas no Brasil, comparativamente as não indígenas. Realizou-se um estudo descritivo, compreendendo os anos de 2010 a 2014, utilizando dados dos sistemas nacionais de informação. Foram selecionados os óbitos de pessoas com idades de 10 a 14 anos, cuja causa básica foi classificada como “lesões autoprovocadas voluntariamente”. O enforcamento foi o meio utilizado com mais frequência, tanto entre indígenas como entre não indígenas, embora tenha sido mais frequente no primeiro grupo. Entre indígenas, a ocorrência de suicídio em hospital ou outros estabelecimentos de saúde foi menor do que o observado entre os não indígenas. Aproximadamente, 3/4 dos suicídios entre crianças indígenas ocorreram em 17 municípios. A taxa de mortalidade por suicídio entre crianças indígenas foi de 11,0/100 mil (8,4-14,3), 18,5 (10,9-31,6) vezes maior do que a observada entre as não indígenas, 0,6/100 mil (0,5-0,6), sem diferenças entre meninos e meninas. Este trabalho evidenciou, pela primeira vez, em escala nacional, especificidades das características do suicídio indígena, suas elevadas taxas, bem como identificou ainda áreas prioritárias para intervenções.El objetivo de este trabajo fue describir las características, distribución y tasas de mortalidad por suicidio entre niños indígenas en Brasil, en comparación con los no indígenas. Se realizó un estudio descriptivo, desde el año 2010 hasta el 2014, utilizando datos de los sistemas nacionales de información. Se seleccionaron los fallecimientos de personas con edades comprendidas de 10 a 14 años, cuya causa básica de fallecimiento se clasificó como “lesiones auto provocadas voluntariamente”. El ahorcamiento fue el medio utilizado con más frecuencia, tanto entre indígenas como entre no indígenas, aunque haya sido más frecuente en el primer grupo. Entre indígenas, la ocurrencia de suicidios en hospitales u otros establecimientos de salud fue menor de lo que se observó entre los no indígenas. Aproximadamente, 3/4 de los suicidios entre niños indígenas se produjeron en 17 municipios. La tasa de mortalidad por suicidio entre niños indígenas fue de 11,0/100 mil (8,4-14,3), 18,5 (10,9-31,6) veces mayor que la observada entre los no indígenas, 0,6/100 mil (0,5-0,6), sin diferencias entre niños y niñas. Este trabajo evidenció, por primera vez, en escala nacional, especificidades de las características del suicidio indígena, sus elevadas tasas, así como, incluso, se identificaron áreas prioritarias para intervenciones.

Resumo: O objetivo deste trabalho foi descrever as características, a distribuição e as taxas de mortalidade por suicídio entre crianças indígenas no Brasil, comparativamente as não indígenas. Realizou-se um estudo descritivo, compreendendo os anos de 2010 a 2014, utilizando dados dos sistemas nacionais de informação. Foram selecionados os óbitos de pessoas com idades de 10 a 14 anos, cuja causa básica foi classificada como “lesões autoprovocadas voluntariamente”. O enforcamento foi o meio utilizado com mais frequência, tanto entre indígenas como entre não indígenas, embora tenha sido mais frequente no primeiro grupo. Entre indígenas, a ocorrência de suicídio em hospital ou outros estabelecimentos de saúde foi menor do que o observado entre os não indígenas. Aproximadamente, 3/4 dos suicídios entre crianças indígenas ocorreram em 17 municípios. A taxa de mortalidade por suicídio entre crianças indígenas foi de 11,0/100 mil (8,4-14,3), 18,5 (10,9-31,6) vezes maior do que a observada entre as não indígenas, 0,6/100 mil (0,5-0,6), sem diferenças entre meninos e meninas. Este trabalho evidenciou, pela primeira vez, em escala nacional, especificidades das características do suicídio indígena, suas elevadas taxas, bem como identificou ainda áreas prioritárias para intervenções. Abstract: This study aimed to describe the characteristics, distribution, and mortality rates from suicide in indigenous children in Brazil compared to non-indigenous children. This descriptive study covered the years from 2010 to 2014, using national databases. The study collected deaths in individuals 10 to 14 years of age whose underlying cause was “inentional self-inflicted injury”. Hanging was the most frequently used means in both indigenous and non-indigenous children, although it was more frequent in the former. Among indigenous children, suicides in hospitals or other healthcare establishments were less common than in non-indigenous. Approximately three-fourths of suicides in indigenous children occurred in just 17 municipalities. The mortality rate from suicide among indigenous children was 11.0/100,000 (8.4-14.3), or 18.5 times higher (10.9-31.6) than in non-indigenous, which was 0.6/100,000 (0.5-0.6), with no differences between boys and girls. This study showed for the first time on a national scale the specific characteristics of suicide in indigenous children, with high rates, and also identified priority areas for interventions. Resumen: El objetivo de este trabajo fue describir las características, distribución y tasas de mortalidad por suicidio entre niños indígenas en Brasil, en comparación con los no indígenas. Se realizó un estudio descriptivo, desde el año 2010 hasta el 2014, utilizando datos de los sistemas nacionales de información. Se seleccionaron los fallecimientos de personas con edades comprendidas de 10 a 14 años, cuya causa básica de fallecimiento se clasificó como “lesiones auto provocadas voluntariamente”. El ahorcamiento fue el medio utilizado con más frecuencia, tanto entre indígenas como entre no indígenas, aunque haya sido más frecuente en el primer grupo. Entre indígenas, la ocurrencia de suicidios en hospitales u otros establecimientos de salud fue menor de lo que se observó entre los no indígenas. Aproximadamente, 3/4 de los suicidios entre niños indígenas se produjeron en 17 municipios. La tasa de mortalidad por suicidio entre niños indígenas fue de 11,0/100 mil (8,4-14,3), 18,5 (10,9-31,6) veces mayor que la observada entre los no indígenas, 0,6/100 mil (0,5-0,6), sin diferencias entre niños y niñas. Este trabajo evidenció, por primera vez, en escala nacional, especificidades de las características del suicidio indígena, sus elevadas tasas, así como, incluso, se identificaron áreas prioritarias para intervenciones.

Objective: To evaluate the coverage, characteristics and the risk of suicide in the indigenous people of Tabatinga in the Brazilian Amazon. Methods: An active surveillance strategy for suicide cases was used: records of the Ministry of Health, the Municipal Health Secretariat, the Special Indigenous Health District of the Upper River Solimões (Distrito Sanitario Especial Indígena Alto Río Solimões), the Military Hospital of Tabatinga, the National Indian Foundation (Fundación Nacional del Indio) and the civil registry offices were examined from 2007 to 2011 for individuals over 9 years of age. Adjusted rates were estimated using the direct method and according to age. A descriptive analysis was performed and the hypothesis tests were considered significant if p-values were

OBJETIVO: Analisar as taxas e algumas características da mortalidade por suicídio entre indígenas e não indígenas no Amazonas. MÉTODO: Estudo de coorte retrospectiva, em que os dados de óbito foram obtidos no Sistema de Informações sobre Mortalidade e os populacionais no Instituto Brasileiro de Geografia e Estatística. Foram utilizados todos os registros de suicídio do período de 2006-2010 e a interpolação geométrica anual para a estimação das subpopulações. RESULTADOS: Ocorreram 688 suicídios no Amazonas, dos quais 19,0% em indígenas. A taxa ajustada de mortalidade por suicídio (TAMS) nos indígenas, de 18,4/100 mil, foi 4,4 vezes superior a dos não indígenas. A TAMS em indígenas aumentou 1,6 vez em 2010 em relação a 2006. Nos municípios de Tabatinga e São Gabriel da Cachoeira, as TAMS foram muito altas, 75,8 e 41,9/100 mil, respectivamente. CONCLUSÕES: Evidenciou-se o comportamento desigual das taxas de mortalidade por suicídio entre indígenas e não indígenas, expondo não só sua importância local, como também sua invisibilidade como problema de saúde pública, principalmente entre jovens 15 e 24 anos. OBJECTIVE: To analyze rates and some characteristics of suicide mortality between indigenous and non-indigenous people in the State of Amazonas. METHOD: Retrospective cohort study, where in data of death were obtained from the Information System on Mortality and data of population from the Brazilian Institute of Geography and Statistics. We used all records of suicide that occurred during the period 2006-2010 and the annual geometric interpolation for the estimation of subpopulations. RESULTS: Six hundred eighty-eight suicide cases were reported in the State of Amazonas, of which 19.0% indigenous people. The standardized mortality rate for suicide (SMRS) in indigenous people, of the 18.4/100.000, was 4.4 times higher than that of non-indigenous people. The SMRS in indigenous people increased 1.6 times in 2010 compared to 2006 year. In the municipalities of Tabatinga and São Gabriel da Cachoeira the SMRS were much high, 75.8 and 41.9/100.000, respectively. CONCLUSIONS: Inequalities in the behavior of the suicide mortality rates between indigenous and non indigenous people were proved, exposing not only their local importance, but also a hidden public health problem issue, especially among youth age 15-24.

Objective: To analyze mortality rates and to describe the demographic and epidemiological characteristics of suicides recorded in the state of Amazonas. Methods: A descriptive and retrospective study has been carried out with emphasis on municipalities, which have shown, simultaneously, a high mortality rates and a high proportion of self-reported indigenous population, based on 2005 - 2009 data as provided by the Informatics Department of the Unified National Health System. Results: Among the general population of the state of Amazonas, the mortality rate, by suicide, of 4.2/100.000 inhabitants has been reported, similar to that of Manaus (4.6/100.000 inhabitants). In contrast, at Tabatinga (25.2/100.000 inhabitants), at São Gabriel da Cachoeira (27.6/100.000 inhabitants) and at Santa Isabel do Rio Negro (36.4/100.000 inhabitants), municipalities, where the proportion of self-reported indigenous population is high, besides the taxes being notably higher, it was observed that most of the suicides has occurred among men; among young men aged between 15 - 24 years; at home; by hanging; during "weekend" and among the indigenous population. Discussion: Our findings have unveiled that suicide comes forth as a serious public health issue in some municipalities in the state of Amazonas, further indicating that the event occurs within very specific contexts, and that the dimension and the magnitude of the problem can be even more serious among populations or in territories exclusively inhabited by indigenous people.

to describe suicide characteristics and mortality rates among indigenous and non-indigenous people in Roraima, Brazil.descriptive study using data from the Mortality Information System (SIM) about the suicides in individuals over 10 years old, recorded in the period from 2009 to 2013; suicide mortality rates were adjusted by sex and age.170 suicide cases were reported, being 17.1% among indigenous people; median ages were 24 years among indigenous and 29 among non-indigenous people; four municipalities concentrated 25/29 of the suicides among indigenous people; the 141 suicides among non-indigenous people were distributed in 13/15 municipalities in the state; suicide mortality rates were 15.0/100,000 among indigenous people and 8.6/100,000 among non-indigenous people.ethnic-racial peculiarities stood out in suicide mortality; among the indigenous people, rates were higher, younger ages prevailed and deaths were concentrated in a smaller number of municipalities, when compared to non-indigenous people.descrever características e taxas da mortalidade por suicídio entre indígenas e não indígenas em Roraima, Brasil.estudo descritivo, com dados do Sistema de Informações sobre Mortalidade (SIM) sobre suicídios ocorridos em maiores de 10 anos de idade, registrados no período 2009-2013; as taxas de mortalidade por suicídio foram ajustadas por sexo e idade.foram registrados 170 suicídios, 17,1% em indígenas; as medianas das idades foram de 24 para indígenas e de 29 anos para não indígenas; quatro municípios concentraram 25/29 dos suicídios entre indígenas; os 141 suicídios entre não indígenas distribuíram-se em 13/15 municípios do estado; as taxas de mortalidade por suicídio foram de 15,0/100 mil indígenas e de 8,6/100 mil não indígenas.evidenciaram-se especificidades étnico-raciais na mortalidade por suicídio; entre os indígenas, as taxas foram mais elevadas, predominaram idades menores e as mortes concentraram-se em menor número de municípios, na comparação com os não indígenas.describir características y tasas de mortalidad por suicidios entre indígenas y no-indígenas en Roraima.se realizó un estudio descriptivo con datos del Sistema de Información de Mortalidad, referente a suicidios en mayores de 10 años, entre 2009-2013; las tasas de mortalidad por suicidio se ajustaron por sexo y edad.se registraron 170 suicidios, 17.1% indígenas; las medias de edad fueron 24 años entre indígenas y 29 entre no-indígenas; cuatro municipios concentran 25/29 suicidios entre los indios; los 141 suicidios entre los no-indígenas se distribuyeron en 13/15 municipios en el estado; las tasas de mortalidad por suicidio fueron 15.0/100.000 entre indígena y 8.6/100.000 entre no-indígena.hubo especificidades étnico-raciales en la mortalidad por suicidio; entre los indígenas, las tasas fueron más altas, predominaron las edades más jóvenes y las muertes se concentran en pocos municipios, comparado con no-indígenas.

OBJECTIVE To analyze the narratives of family members on the suicide of older adults in Manaus, State of Amazonas, Brazil. METHODS This is a qualitative study of the narratives of eight older adults, who committed suicide in the period of 2001-2012. In the analytic-interpretative process, we have tried to perform the hermeneutic double exercise: to interpret the interpretation of narrators. We have used as theoretical references authors who have investigated suicide from the perspective of gender and its correlations with the sociofamiliar context and with mental disorders. RESULTS The family members would conceive the suicide of the older adults as related to losses, which would occur in a strained sociofamiliar scenario, leading to the appearance of psychopathological situations that, if not properly followed, would result in death. There would also be something inexorable in this sequence of events. The older adults, by the very time of their life, would tend to accumulate losses of different aspects in their trajectory. Their rigor and other relational limitations would simultaneously stress family relationships, favoring conflicts, and hinder adherence to treatment. This model of understanding, which has a wide support in the hegemonic medical-psychological discourse, in a sense minimizes possible self- or heteroaccusations directed at family members. CONCLUSIONS Special attention should be given to identify the older adults who present losses, family conflicts, and signs of psychopathology and who do not follow-up psychosocial care services. Strategies to help older adults handle family conflicts and losses, empowering them, should be developed and made available by intersectoral actions. The adequate treatment of psychopathological conditions should be implanted in a context in which active search mechanisms also existed for older adults who abandoned follow-up. The implementation of these actions is a challenge to be faced in Manaus, State of Amazonas, Brazil, where there is a low availability of psychosocial care services, which are not articulated with specialized care services in tertiary medical conditions, and there is still low coverage by the basic care.

Objective: To examine spatial-temporal distribution and risk of suicide, as well as trends in suicide mortality rates, in the indigenous and non-indigenous population of the state of Mato Grosso do Sul, Brazil. Methods: Data were obtained from the Information Department of the Brazilian Unified Health System. Deaths recorded as voluntary self-inflicted injuries (ICD-10 codes X60.0 to X84.9) were considered suicide. Suicide rates were estimated and adjusted by age in the population > 9 years of age. Kernel analysis was used to assess the spatial distribution of suicide cases, while trend analysis was carried out using a non-parametric test (Mann-Kendall). Results: The suicide risk among the indigenous population was 8.1 (95%CI 7.2-9.0) times higher than in the non-indigenous population. For indigenous residents in the 15-24 age group, the risk was 18.5 (95%CI 17.5-19.6) times higher than in the non-indigenous population. The majority of indigenous cases were concentrated in a few villages in reservation areas, mainly occupied by Guarani-Kaiowá and Guarani-Ñandeva groups. Rate patterns remained stable over time in both groups. Conclusion: Suicide is a serious public health problem in Mato Grosso do Sul, and has had an alarming and disproportionate impact on the indigenous population for more than a decade.

No Brasil, há indícios de que alguns povos indígenas apresentam taxas de mortalidade por suicídio significativamente superiores às taxas nacionais e regionais. Por outro lado, evidências apontam para as dificuldades de se transpor categorias biomédicas ao contexto das sociedades indígenas, tendo em vista que estes se valem de referenciais simbólicos particulares para compreender o processo saúde-doença e a morte. O objetivo deste artigo foi refletir sobre as dificuldades para utilização do conceito de suicídio no contexto indígena, ponto crucial para abordagem deste tema através de uma perspectiva menos etnocêntrica. O caminho proposto para tal foi o de se recorrer ao chamado “estranhamento antropológico” do conceito biomédico de suicídio. Para tanto, nós fizemos a análise do mito do Jurupari amplamente difundido entre os povos indígenas da região do Alto Rio Negro, utilizando três perguntas norteadoras: Jurupari queria morrer?; Jurupari morreu?; Quem matou Jurupari? Para responder estas perguntas, recorreu-se a informações etnográficas sobre suicídio entre povos indígenas brasileiros. Através da análise realizada, demonstraram-se as dificuldades de transposição do conceito biomédico de suicídio para o contexto indígena. Isto foi feito na medida em que evidenciamos: 1) a amplificação das dificuldades de se falar de intencionalidade no contexto indígena; 2) as diferentes concepções indígenas sobre morte e morrer; 3) a complexa correlação entre suicídio e homicídio nos sistemas etiológicos nativos. Por fim, apresentaram-se, mesmo que de forma preliminar, algumas eventuais dificuldades como possíveis caminhos para abordagem do suicídio indígena, tanto por meio de estratégias qualitativas como quantitativas. Several evidences shows that in Brazil, suicide mortality rates of some indigenous people are significantly higher than national and regional rates. Furthermore, evidence points to the difficulties to transport biomedical categories to the indigenous societies, because they use specific symbolic references to understand the health-disease process and the death. The aim of this paper was to reflect on the difficulties to use the concept of suicide in the indigenous context, an important principle to explore this theme from a less ethnocentric way. The proposed way for this was to resort to the so-called “anthropological strangeness” of the biomedical concept of suicide. To this end, we did an analysis of an indigenous myth that is widespread in the Upper Rio Negro region, the myth of Jurupari, using three guiding questions: Jurupari wanted to die?; Jurupari died?; Who killed Jurupari? To answer these questions we used the ethnographic information about suicide among Brazilian indigenous. Through the performed analysis, the difficulty to transport the biomedical concept of suicide to the indigenous context was demonstrated. This was down when we presented: i) the amplification of the difficulties to speak of intentionality in this context, ii) the different indigenous conceptions about death and dying, iii) the complex correlation between suicide and homicide in native’s etiological systems. Finally, even in a preliminary way, some potential difficulties and possible ways to approach indigenous suicide by qualitative and quantitative strategies was presented.

OBJECTIVE: To describe the characteristics and the raw suicide mortality rates (RSMR) during the period 2000-2007 in the municipality with the largest proportion of self-reported indigenous people in Brazil, São Gabriel da Cachoeira (SGC), State of Amazonas. METHOD: A retrospective descriptive study was carried out using data from the Information Department of the Brazilian Unified Health System (DATASUS). We considered suicide the cause of death coded in the records as voluntary self-Inflicted injuries according to the International Classification of Diseases and Related Health Problems, 10th revision. RESULTS: Forty-four suicide cases were registered in this period. The average RSMR was 16.8 per 100,000 inhabitants (male, 26.6; female, 6.3). The highest rates were observed in the age groups 15-24 years and 25-34 years, with RSMR of 43.1 and 30.2 per 100,000 inhabitants, respectively. Most suicides occurred among indigenous people (97.7%), males (81.8%), and unmarried people (70.5%). In most cases, deaths occurred at home (86.4%), during weekends (59.1%) and mainly by hanging (97.7%). CONCLUSION: Suicide is a significant health and social problem in SGC. The suicide profile observed in this municipality was, as a whole, more similar to that observed in certain indigenous communities than that found in most urban and non-indigenous environments, demonstrating the sociocultural specificity of these events in Brazil. OBJETIVOS: Descrever as características e as taxas brutas de mortalidade por suicídio (TBMS), no período de 2000-2007, no município brasileiro com a maior proporção de pessoas autodeclaradas indígenas, São Gabriel da Cachoeira (SGC), Estado do Amazonas, Brasil. MÉTODO: Estudo retrospectivo e descritivo, utilizando dados do Departamento de Informática do Sistema Único de Saúde (DATASUS). Foram considerados óbitos por suicídio os registros codificados como lesões autoprovocadas voluntariamente na Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde, 10ª revisão. RESULTADOS: Foram registrados 44 suicídios no período. A TBMS média foi 16,8 por 100.000 habitantes (masc., 26,6; fem., 6,3). As taxas mais elevadas foram observadas nas faixas etárias 15-24 e 25-34 anos, com TBMS 43,1 e 30,2 por 100.000 habitantes, respectivamente. A maioria dos suicídios ocorreu entre indígenas (97,7%), do sexo masculino (81,8%) e solteiros (70,5 %). Os óbitos ocorreram em sua maioria em casa (86,4%), no final de semana (59,1%) e principalmente por enforcamento (97,7%). CONCLUSÃO: O suicídio é um importante problema social e de saúde pública em SGC. O perfil dos suicídios observados neste município como um todo foi mais próximo daquele encontrado em certos contextos indígenas do que o encontrado em ambientes urbanos e não indígenas, demonstrando as especificidades socioculturais desses eventos no Brasil.