Open Access Highly Accessed Research article

Drug suicide: a sex-equal cause of death in 16 European countries

Airi Värnik12*, Merike Sisask1, Peeter Värnik13, Jing Wu12, Kairi Kõlves1, Ella Arensman4, Margareth Maxwell5, Thomas Reisch6, Ricardo Gusmão7, Chantal van Audenhove8, Gert Scheerder8, Christina M van der Feltz-Cornelis9, Claire Coffey4, Maria Kopp10, Andras Szekely10, Saska Roskar11 and Ulrich Hegerl12

  • * Corresponding author: Airi Värnik

  • † Equal contributors

Author Affiliations

1 Estonian-Swedish Mental Health and Suicidology Institute; Estonian Centre of Behavioural and Health Sciences, Õie 39, Tallinn, 11615, Estonia

2 Institute of Social Work, Tallinn University, Narva mnt 25, Tallinn, 10120, Estonia

3 The Estonian Institute for Population Studies, Tallinn University, Narva mnt 25, Tallinn, 10120, Estonia

4 National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork, Ireland

5 Department of Nursing and Midwifery, University of Stirling, FK9 4LA, Stirling, Great Britain

6 Department of Psychiatry, University Hospital of Psychiatry, Bolligenstr.111, 3000 Bern 60, Switzerland

7 De partamento de Saúde Mental, Faculdade de Ciências Médicas, FCM, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal

8 Katholieke Universiteit Leuven, LUCAS, Kapucijnenvoer 39 - bus 5310, 3000 Leuven, Belgium

9 Trimbos-instituut/Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands

10 Institute of Behavioural Sciences, Semmelweis University, Nagyvárad tér 4, 1089 Budapest, Hungary

11 Inštitut za varovanje zdravja RS Insititute of Public Health of the Republic of Slovenia, Trubarjeva, 1000 Ljubljana, Slovenia

12 Department of Psychiatry, University of Leipzig, Semmelweisstr.10, 04103 Leipzig, Germany

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BMC Public Health 2011, 11:61  doi:10.1186/1471-2458-11-61

Published: 29 January 2011



There is a lack of international research on suicide by drug overdose as a preventable suicide method. Sex- and age-specific rates of suicide by drug self-poisoning (ICD-10, X60-64) and the distribution of drug types used in 16 European countries were studied, and compared with other self-poisoning methods (X65-69) and intentional self-injury (X70-84).


Data for 2000-04/05 were collected from national statistical offices. Age-adjusted suicide rates, and age and sex distributions, were calculated.


No pronounced sex differences in drug self-poisoning rates were found, either in the aggregate data (males 1.6 and females 1.5 per 100,000) or within individual countries. Among the 16 countries, the range (from some 0.3 in Portugal to 5.0 in Finland) was wide. 'Other and unspecified drugs' (X64) were recorded most frequently, with a range of 0.2-1.9, and accounted for more than 70% of deaths by drug overdose in France, Luxembourg, Portugal and Spain. Psychotropic drugs (X61) ranked second. The X63 category ('other drugs acting on the autonomic nervous system') was least frequently used. Finland showed low X64 and high X61 figures, Scotland had high levels of X62 ('narcotics and hallucinogens, not elsewhere classified') for both sexes, while England exceeded other countries in category X60. Risk was highest among the middle-aged everywhere except in Switzerland, where the elderly were most at risk.


Suicide by drug overdose is preventable. Intentional self-poisoning with drugs kills as many males as females. The considerable differences in patterns of self-poisoning found in the various European countries are relevant to national efforts to improve diagnostics of suicide and appropriate specific prevention. The fact that vast majority of drug-overdose suicides came under the category X64 refers to the need of more detailed ICD coding system for overdose suicides is needed to permit better design of suicide-prevention strategies at national level.