Suicide involves an act of volition on the part of the deceased, making it unlike deaths from physical disorders such as cancer or stroke. The latter occur passively and often despite the efforts of the patient to stay alive. Yet when there is a suicide, clinicians involved may often be blamed and families may often feel guilt. This contrasts with the default response of praise and thanks to clinicians following treatment preceding deaths from physical disorders.

Comparative standardized mortality rate (SMR) data are analyzed to demonstrate the impact of developments in care over the past two decades in the United Kingdom (UK), and similar United States (USA) SMR data are noted. The evidence is reviewed regarding our ability to predict who will die by suicide, when and where to target intervention, and practical and effective prevention methods.

Data from the UK are presented that reflects the relative lack of impact of prevention efforts on suicide mortality rates when compared to the reductions seen in various physical disorders. This narrative review comments on the causes and consequences of this difference.

The challenge for psychiatry is that SMR data suggest that we have been unable to significantly reduce suicide SMR unlike that for physical disorders. This needs to be fully acknowledged and the biased assumption of blame needs to stop. The focus needs to be on evidence-based interventions that do work, such as medications, psychological treatments, psychological interventions, and suicide prevention research.

The Republic of Cyprus has recorded the greatest increase in suicide mortality among Eastern Mediterranean countries, with an average annual increase of 5.1% in 2000–2019.

To investigate trends in suicide mortality rates between 2004 and 2020 in the Republic of Cyprus, with a focus on age, gender and suicide methods.

Suicide deaths (ICD-10 taxonomy, including ‘undetermined’ code) and population denominators were obtained from the National Mortality Registry and Statistical Office, respectively. Directly standardised (European Standard) mortality rates were calculated for four gender and age groups. Annual change was estimated using Poisson regression models with interaction terms to assess differential trends over different time periods.

There were 560 suicide deaths; these were four times more frequent in men, and approximately 80% were classified as ‘violent’ for both genders. The male suicide rate doubled from 4–5 to 9–10 per 100 000, mostly before 2012, representing a 9% annual change (rate ratio = 1.09, 95% CI 1.03, 1.15; P = 0.002). From 2013, the trend reversed (effect modification P < 0.001) with a 4% annual decrease (95% CI −9%, 1%). Declines were not uniform across all age groups; rates in males aged 45–64 years continued to rise, surpassing the previously high rate in males aged 25–44 years. Rates in females declined from 4–5 per 100 000 to 2–3 over the study period. Overall, the male-to-female suicide rate ratio was 5.33 (95% CI 3.46, 8.19) in 2017–2020, compared with 2.73 (1.88, 3.95) in 2004–2008.

Although suicide rates remain relatively low, the gender differential has widened in the Republic of Cyprus. Further analysis of trends in relation to unemployment and other socioeconomic indicators is warranted.