Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 145 No. 2526 (2015)

Time-trends in assisted and unassisted suicides completed with different methods: Swiss National Cohort

  • Nicole Steck
  • Marcel Zwahlen
  • Matthias Egger
Cite this as:
Swiss Med Wkly. 2015;145:w14153


OBJECTIVE: The number of suicides assisted by right-to-die associations has increased in recent years in Switzerland. The aim of our study was to compare time trends in rates of assisted and unassisted suicide from 1991–2008.

METHODS: The Swiss National Cohort is a longitudinal study of mortality in the Swiss population; based on linkage of census data with mortality records up to 2008. The Federal Statistical Office coded suspected assisted suicides from 1998 onwards; and from 2003 onwards right-to-die associations reported the suicides they assisted. We used Poisson regression to analyse trends in rates of suicide per 100'000 person-years, by gender and age groups (15–34, 35–64, 65–94 years).

RESULTS: A total of 7'940'297 individuals and 24'842 suicides were included. In women, rates changed little in the younger age groups but increased in 65–94-year-olds, due to an increase in suicide by poisoning (from 5.1 to 17.2 per 100'000; p <0.001). An increase in suicides by poisoning was also observed in older men (from 8.6 to 18.2; p<0.001). Most suicides by poisoning were assisted. In men, suicide rates declined in all age groups, driven by declines in suicide with firearms.

CONCLUSIONS: Research is needed to gain a better understanding of the reasons for the tripling of assisted suicide rates in older women, and the doubling of rates in older men, of attitudes and vulnerabilities of those choosing assisted suicide, and of access to palliative care. Rates of assisted suicide should be monitored; including data on patient characteristics and underlying comorbidities.


  1. Federal Statistical Office. Todesfälle: Anzahl, Entwicklung und Ursachen. Secondary Todesfälle: Anzahl; Entwicklung und Ursachen 2014. Available at:
  2. Levi F, La Vecchia C, Lucchini F, Negri E, Saxena S, Maulik PK, et al. Trends in mortality from suicide; 1965–99. Acta Psychiatr Scand. 2003;108(5):341–9.
  3. WHO. Preventing suicide: A global imperative. Secondary Preventing suicide: A global imperative 2014. Available at: (accessed 28.01.2015).
  4. Bundesamt für Gesundheit. Suizid und Suizidprävention in der Schweiz; 2005:41.
  5. Burkhardt S, La HR. Debates About Assisted Suicide in Switzerland. Am J Forensic Med Pathol. 2012.
  6. Steck N, Junker C, Maessen M, Reisch T, Zwahlen M, Egger M. Suicide assisted by right-to-die associations: a population based cohort study. Int J Epidemiol. 2014;43(2):614–22 doi: 10.1093/ije/dyu010 [published Online First: Epub Date]|.
  7. Bosshard G, Ulrich E, Bar W. 748 cases of suicide assisted by a Swiss right-to-die organisation. Swiss Med Wkly. 2003;133(21-22):310–7.
  8. Hurst SA, Mauron A. Assisted suicide and euthanasia in Switzerland: allowing a role for non-physicians. BMJ. 2003;326(7383):271–3.
  9. exit. Erneut mehr Leidenden geholfen. 2015. Available at:
  10. Hepp U, Ring M, Frei A, Rössler W, Schnyder U, Ajdacic-Gross V.. Suicide trends diverge by method: Swiss suicide rates 1969–2005. Eur Psychiatry. Epub 2009 Aug 19. PMID: 19695842.
  11. Federal Statistical Office. Sterbehilfe in der Schweiz 1998–2009: Knapp 300 assistierte Suizide 2009; 2012.
  12. Bopp M, Spoerri A, Zwahlen M, Gutzwiller F, Paccaud F, Braun-Fahrländer C, et al. Cohort Profile: the Swiss National Cohort – a longitudinal study of 6.8 million people. Int J Epidemiol. 2009;38(2):379–84.
  13. Spoerri A, Zwahlen M, Egger M, Bopp M. The Swiss National Cohort: a unique database for national and international researchers. Int J Public Health. 2010;55(4):239–42.
  14. Steck N, Egger M, Zwahlen M, et al. Assisted and unassisted suicide in men and women: longitudinal study of the Swiss population. Br J Psychiatry. 2015; in press.
  15. Spoerri A, Zwahlen M, Bopp M, Gutzwiller F, Egger M. Religion and assisted and non-assisted suicide in Switzerland: National Cohort Study. Int J Epidemiol. 2010;39(6):1486–94.
  16. Robson A, Scrutton F, Wilkinson L, MacLeod F. The risk of suicide in cancer patients: a review of the literature. Psycho-oncology 2010;19(12):1250–8 doi: 10.1002/pon.1717 [published Online First: Epub Date].
  17. Voaklander DC, Rowe BH, Dryden DM, Pahal J, Saar P, Kelly KD.. Medical illness; medication use and suicide in seniors: a population-based case-control study. J Epidemiol Community Health. 2008;62(2):138–46 doi: 10.1136/jech.2006.055533 [published Online First: Epub Date]|.
  18. Conwell Y, Duberstein PR, Caine ED. Risk factors for suicide in later life. Biol Psychiatry. 2002;52(3):193–204.
  19. Conwell Y, Thompson C. Suicidal behavior in elders. Psychiatr Clin North Am. 2008;31(2):333–56.
  20. Steck N, Egger M, Maessen M, Reisch T, Zwahlen M.. Euthanasia and Assisted Suicide in Selected European Countries and US States: Systematic Literature Review. Med Care. 2013;51(10):938–44 doi: 10.1097/MLR.0b013e3182a0f427 [published Online First: Epub Date]|.
  21. Rihmer Z. Can better recognition and treatment of depression reduce suicide rates? A brief review. EurPsychiatry. 2001;16(7):406–9.
  22. Hawton K; van Heeringen K. Suicide. Lancet. 2009;373:1372–81.
  23. Kreitman N. The coal gas story. United Kingdom suicide rates; 1960–71. Br J Prev Soc Med. 1976;30(2):86–93.
  24. Reisch T, Steffen T, Habenstein A, Tschacher W.. Change in Suicide Rates in Switzerland Before and After Firearm Restriction Resulting From the 2003 “Army XXI” Reform. Am J Psychiatry. 2013 doi: 10.1176/appi.ajp.2013.12091256 [published Online First: Epub Date].
  25. Rhodes AE, Boyle MH, Bridge JA, Sinyor M, Links PS, Tonmyr L, et al. Antecedents and sex/gender differences in youth suicidal behavior. World J Psychiatry. 2014;4(4):120–32 doi: 10.5498/wjp.v4.i4.120 [published Online First: Epub Date]|.
  26. Gauthier S, Mausbach J, Reisch T, Bartsch C. Suicide tourism: a pilot study on the Swiss phenomenon. J Med Ethics. 2014 doi: 10.1136/medethics-2014-102091 [published Online First: Epub Date].
  27. Blakely TA, Collings SC, Atkinson J. Unemployment and suicide. Evidence for a causal association? J Epidemiol Community Health. 2003;57(8):594–600.
  28. Fountoulakis KN, Kawohl W, Theodorakis PN, Kerkhof AJ, Navickas A, Höschl C, et al. Relationship of suicide rates to economic variables in Europe: 2000–2011. Bt J Psychiatry. 2014;205(6):486–96 doi: 10.1192/bjp.bp.114.147454 [published Online First: Epub Date]|.
  29. Sheldon G. Der Schweizer Arbeitsmarkt seit 1920: langfristige Tendenzen. Die Volkswirtschaft 2010;1:5.
  30. Tollefsen IM, Hem E, Ekeberg O. The reliability of suicide statistics: a systematic review. BMC psychiatry 2012;12:9 doi: 10.1186/1471-244x-12-9 [published Online First: Epub Date]|.
  31. Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33(3):395–405.
  32. Hjelmeland H, Dieserud G, Dyregrov K, Knizek BL, Leenaars AA. Psychological autopsy studies as diagnostic tools: are they methodologically flawed? Death Stud. 2012;36(7):605–26.
  33. Frei A, Bucher T, Walter M, Ajdacic-Gross V. Suicides in the Canton of Lucerne over 5 years: subjects with and without psychiatric history and diagnosis. Swiss Med Wkly. 2013;143:w13779.
  34. Vögeli D. Gian Domenico Borasio im Gespräch: Autonomie geht weit über Suizidhilfe hinaus. Neuer Zürcher Zeitung 2014.

Most read articles by the same author(s)

1 2 > >>