Associations between a Brazilian Suicide Awareness Campaign and Suicide Trends from 2000 to 2019: Joinpoint and Regression Discontinuity Analysis

Background: Suicide is a global health concern whose rates are soaring in many low-and-middle-income countries (LMICs), such as Brazil. Public awareness campaigns have been implemented in Brazil, however, their impact is uncertain. The aim of this study is to compare suicide trends in Brazil before and after 2014, which marks the beginning of a large suicide awareness campaign in the country.Methods: This was a quasi-experimental study using population data from DATA-SUS, a Brazilian official notification system, selecting only deaths that were voluntarily self-inflicted (CID-10 X60-X84). We analyzed all available data from 2000 to 2019, excluding 2020, 2021 and 2022 due to COVID-19 pandemic, to assess trends before and after the national YS campaign started in 2014. Differences in trends were assessed by Joinpoint Regression and Regression Discontinuity Analysis.Findings: Overall, there was a progressive increase in the rate of relative (per 100,000 inhabitants) number of suicides over time between 2000 and 2019 (57% increase). A Joinpoint analysis detected a change in the slope of the curve representing an acceleration in suicides starting in the year 2015, which aligns with the year after the YS campaign started. Regression discontinuity analysis revealed the year that Yellow September started significantly change the slope of the association between time and rates of suicide (pinteraction<0.001), and marginal analysis detected the coefficient increased from 0.49 (95%CI 0.41-0.57) to 1.39 (95%CI 1.08-1.65) suicides/year per 100,000 inhabitants.Interpretation: We found an increase in suicidal trends in Brazil, against the global trend that coincides with the beginning of a large national awareness campaign. Although we cannot attribute causality, our results reinforce the need of further studies to better understand the role of awareness campaigns in suicide reduction interventions, including potential unintended effects. Finally, these results also reinforce the urgency of developing additional preventative measures to address the rise in suicides rates in Brazil over the previous two decades.Funding: RFD received grant from FAPESP (process number #2021/14379-8).Declaration of Interest: Authors declare no conflict of interest.