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. 2025 Mar 21;16:1529941. doi: 10.3389/fpsyt.2025.1529941

Prevalence, incidence, and Disability-Adjusted Life Years of self-harm and suicide mortality in the Middle East and North Africa: a sex-specific study based on Global Burden of Disease

Moien AB Khan 1, Sohrab Amiri 2,*
PMCID: PMC11969069  PMID: 40191115

Abstract

Objectives

The study examined the prevalence, incidence, and Disability-Adjusted Life Years (DALYs) associated with self-harm across countries in the Middle East and North Africa, while also analyzing suicide mortality. It aims to explore the variations in self-harm and suicide mortality by sex and assess trends in these phenomena from 1990 to 2021.

Methods

Global Burden of Disease 2021 data sources were used in this study. Estimates for all-age counts and age-standardized prevalence rates (per 100,000) were determined for prevalence, incidence, Disability-Adjusted Life Years (DALYs), and suicide mortality. These disease burden indicators were analyzed across the period from 1990 to 2021, and the results were further stratified by sex and location. Additionally, the percentage change observed between 1990 and 2021 was documented. A 95% uncertainty interval was used for each estimate reported.

Results

The age-standardized prevalence of self-harm in the MENA region was 111.82 per 100,000 in 1990, decreasing to 105.84 by 2021. The global age-standardized prevalence rate of self-harm is 182.24 per 100,000 in 2021. Throughout this period, the self-harm rates in the MENA region remained lower than the global average. In 2021, approximately 621,509 individuals in the region were reported to engage in self-harm. In the same year, the age-standardized suicide mortality rate in MENA stood at 3.43 per 100,000, with an estimated total of over 21,000 suicide deaths. The age-standardized DALYs rate of self-harm in MENA was 246.03 per 100,000 in 1990 and decrease to 177.44 per 100,000 in 2021. The gender disparity in 2021 revealed higher self-harm rates among females than males, at 112.57 vs. 99.67 per 100,000, respectively. In contrast, suicide mortality rates were higher in males than females, recorded at 4.83 vs. 1.92 per 100,000.

Conclusions

Although the rates of suicide mortality and self-harm have declined, the overall number of cases has risen alongside population growth. This highlights the necessity for more comprehensive efforts in mental health care, including screening, prevention, treatment, and the accurate identification of risk factors.

Keywords: prevalence, incidence, self-harm, suicide mortality, global burden of disease, Middle East and North Africa

Introduction

Self-harm and suicide are major health and societal issues in the world, and have a great burden on health, especially in low- and middle-income countries (1). Self-harm is defined as “when somebody injures or harms themselves to cope with or express extreme emotional distress and internal turmoil. They do not generally intend to kill themselves, but the results can be fatal” (2). Suicide is defined as “the act of intentionally carrying out an action to kill oneself” (2).

Based on the estimates made during recent decades, age-standardized incidence rates of self-harm are 62.48 per 100,000 and the rate of DALY rates of self-harm were 424.7 per 100,000 (3). The burden of self-harm varies with age and sex (3). The ratio of self-harm in young women to that in men is reported to be 2.6 to 1 (4). In the most recent report published by the Institute for Health Metrics and Evaluation (IHME), the prevalence of self-harm was 8.4 million in females and 7.07 million in males (5). The World Health Organization (WHO) estimates that more than 700,000 people die by suicide every year, of which 77% live in low- and middle-income countries (6). Among the causes of death, 1.3% of deaths are caused by suicide; according to a report published in 2019, suicide was the 17th most common cause of death worldwide (7), and suicide is more prevalent in men than in women (8, 9). One of the super regions of the world that has faced many challenges in recent decades and has affected mental health is MENA (10).

North Africa and the Middle East, including 21 countries, have a range of sociodemographic similarities. However, there are also differences in other dimensions, and these differences exist in health systems (11). Over the past few decades, this super region has witnessed an improvement in morbidity and mortality due to improvements in health care, health education, and socioeconomic development (11). Several factors can affect mental health, especially self-harm and suicide in MENA. First, as mentioned, the highest rates of self-harm and suicide occur in low- and middle-income countries (6). In this regard, a classification of 21 countries in MENA shows that almost two-thirds of these countries are low- and middle-income countries (11). Second, conflict, war, and its consequences, i.e., displacement and migration, are important factors in mental health (12–15). In this respect, MENA has been the center of conflict and war during the last few decades (16). These wars and conflicts have led to injuries, trauma, human crises, destruction of health infrastructure, displacement, and increase in morbidity and mortality (17). Third, demographic changes in MENA are among the most important health issues affecting all aspects of health. In the past, we have seen a trend of population growth in this super region, which led to an increase in the population and, as a result, the demand for healthcare and services; however, in recent years, a population change has been observed with a decrease in the fertility rate (18, 19).

Self-harm and suicide have negative effects on society’s health and impose a significant burden on health and the economic system. The region has faced decades of conflict, war, and displacement, all of which have significantly affected its mental health. Simultaneously, the shared history and cultural similarities among countries in the area provide a valuable context for understanding these mental health challenges. Examining suicidal behaviors is especially crucial, as the region encounters distinct sociopolitical pressures such as ongoing conflict, migration issues, and scarce mental health resources. These factors play a critical role in shaping both the prevalence of self-harm and suicide as well as the patterns of how they are reported. Based on this, this study aimed to investigate the prevalence, incidence, and Disability-Adjusted Life Years (DALYs) caused by self-harm in MENA countries, as well as suicide mortality. Sex differences in self-harm and suicide mortality, as well as investigating the trends of self-harm and suicide from 1990 to 2021, are among the goals of this study.

Methods

Data source

This study was based on the Global Burden of Disease 2021 (20). The analysis of disease burden indicators included prevalence, incidence, Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLDs), Years of Life Lost (YLLs), and mortality data spanning 371 diseases and injuries. It also incorporates estimates of healthy life expectancy (HALE). These metrics are categorized by sex, age groups, and 204 countries and territories, with subnational data provided for 21 of these countries (20). The GBD 2021 analysis utilized 100,983 data sources, including 19,189 newly added specifically for DALYs. Furthermore, 12 new causes were introduced, accompanied by several major methodological improvements (20). The estimates covered the Middle East and North Africa region, with additional details about GBD 2021 available from other sources (20).

Case definitions

Self-harm in the GBD 2021 is “deliberate bodily damage inflicted on oneself, resulting in death or injury. ICD-9: E950-E959; ICD-10: X60-X64.9, X66-X84.9, Y87.0” (20, 21). Contains two subclasses Self-harm by firearm “Death or disability inflicted by the intentional use of a firearm on oneself. ICD-9: E955-E955.9; ICD-10: X72-X74.9” (20, 21). Self-harm by other specified means is defined as “death or occurrence of deliberate bodily damage inflicted on oneself resulting in death using self-poisoning, medication overdose, transport, falling from height, hanging or strangulation, or other mechanisms not including firearms. ICD9: E950-E954, E956-E959; ICD10: X60-X64.9, X66-X67.9, X69-X71.9, X75-X75.9, X77-X84.9, Y87.0” (20, 21). This study incorporated suicide data from various sources, including vital registration (VR) records, survey results, verbal autopsy (VA) data, and surveillance systems, with further details available in other referenced materials (22).

Estimation framework

Years Lived with Disability (YLDs) were calculated “with a microsimulation process that used estimated age-sex-location-year-specific prevalent counts of non-fatal disease sequelae (consequences of a disease or injury) for each cause and disability weights for each sequela as the input estimates at varying levels of severity by an appropriate disability weight” (20). YLLs calculated as “the product of estimated age-sex location-year-specific deaths and the standard life expectancy at the age death occurred for a given cause” (20). DALYs were calculated as the sum of YLDs and YLLs (20).

Statistical analysis

Estimates for all-age counts and age-standardized rates (per 100,000) were computed for prevalence, incidence, Disability-Adjusted Life Years (DALYs), and suicide mortality. The age-standardized rate is “a weighted average of the age-specific rates, where the weights are the proportions of a standard population in the corresponding age groups” (23). Disease burden indicators were analyzed for the period spanning 1990 to 2021, broken down by sex and location. In addition, the percentage change over the years was recorded. A 95% uncertainty interval was used for each estimate. More details about the data, data processing, and modeling are provided elsewhere and are related to GBD 2021 (20).

GBD 2021 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) (24).

Results

Prevalence of self-harm in MENA from 1990 to 2021

The age-standardized prevalence rate of self-harm in MENA was 111.82 [95% UI 96.54 to 131.55] per 100,000 in 1990, and this rate decreased to 105.84 [95% UI 90.98 to 125.05] per 100,000 in 2021 [ Table 1 ]. The percentage change from 1990 to 2021 showed a negative trend of -5% [95% UI −8 to −4]. Global age-standardized prevalence rate of self-harm was 182.24 per 100,000 in 2021. Compared with the global population, self-harm was less prevalent in MENA from 1990 to 2021 ( Figure 1 ). The prevalence of self-harm in MENA countries is lower than that in most other countries ( Figure 2 ).

Table 1.

All-ages counts and age-standardized prevalence rate (per 100,000) of self-harm in MENA, 1990–2021.

Location 1990 2021
Value Lower Upper Value Lower Upper
Age-standardized prevalence Rate (Per 100,000)
North Africa and Middle East 111.82 96.54 131.55 105.84 90.98 125.05
Afghanistan 111.88 97.34 129.75 104.34 91.01 120.48
Algeria 134.81 114.37 160.77 103.58 88.6 123.32
Bahrain 95.35 83.03 111.58 119.22 101.53 143.03
Egypt 81.73 71.01 95.66 88.39 76.52 103.49
Iran 173.92 146.13 208.75 131.2 110.55 156.67
Iraq 109.05 94.87 127.56 118.2 102.07 138.7
Jordan 82.1 71.97 94.97 76.66 66.65 90.16
Kuwait 73.08 63.79 85.76 88.8 76.36 104.62
Lebanon 102.26 87.91 121.35 107.58 91.66 128.63
Libya 102.34 87.52 120.18 114 97.78 134.77
Morocco 144.02 123.75 168.26 134.51 115.37 156.85
Oman 73.49 64.03 85.59 82.61 70.8 98.38
Palestine 70.76 61.81 82.26 83.91 72.69 99.07
Qatar 102.74 90.11 120.04 96.75 83.77 113.44
Saudi Arabia 53.52 47.02 62 95.17 82.38 110.53
Sudan 130.66 111.66 154.11 126.57 107.84 150.33
Syrian Arab Republic 60.21 52.49 69.83 78.94 68.72 92.79
Tunisia 88.23 76.62 103.65 96.41 82.67 114.15
Türkiye 95.55 83.68 110.01 89.94 77.67 106.44
United Arab Emirates 97.25 85.72 112.19 106.14 92.21 123.58
Yemen 100.3 87.38 116.27 111.62 96.54 130.96
All-ages counts estimates
North Africa and Middle East 267,304.61 228,778.94 318,669.66 621,509.77 531,046.77 739,915.39
Afghanistan 7,909.47 6,927.91 9,146.10 18,858.01 16,236.62 22,177.90
Algeria 23,247.34 19,572.84 28,056.27 44,675.15 38,051.79 53,409.93
Bahrain 390.11 332.87 464.21 2,011.37 1,701.57 2,437.11
Egypt 33,490.41 28,736.89 39,470.22 77,620.71 66,617.93 91,756.83
Iran 65,834.87 55,038.75 79,967.61 122,781.76 103,040.92 147,165.99
Iraq 12,522.28 10,752.90 14,795.54 40,557.01 34,775.12 48,026.69
Jordan 1,833.36 1,579.83 2,158.45 8,325.41 7,153.27 9,888.32
Kuwait 1,014.58 867.24 1,216.92 4,673.31 3,991.38 5,593.46
Lebanon 2,595.39 2,234.40 3,091.57 6,536.60 5,556.50 7,852.53
Libya 2,832.41 2,414.23 3,359.13 8,334.35 7,105.74 9,909.74
Morocco 27,072.54 23,075.18 32,003.19 51,204.98 43,881.75 59,844.69
Oman 1,009.97 863.55 1,206.67 3,709.37 3,106.59 4,514.89
Palestine 865.5 746.67 1,018.27 3,281.85 2,807.36 3,917.45
Qatar 390.9 333.87 466.92 3,080.66 2,612.67 3,696.63
Saudi Arabia 5,748.03 4,962.64 6,776.36 37,008.59 31,506.94 43,731.43
Sudan 17,340.03 14,735.78 20,735.97 40,074.99 33,761.26 48,175.35
Syrian Arab Republic 4,692.16 4,039.52 5,512.92 11,257.51 9,819.87 13,190.99
Tunisia 5,681.90 4,890.12 6,704.71 12,970.76 11,110.96 15,340.59
Türkiye 43,702.56 38,003.76 50,617.99 85,080.45 73,573.38 100,502.85
United Arab Emirates 1,431.58 1,225.22 1,713.30 13,057.58 11,130.04 15,351.78
Yemen 7,553.00 6,536.83 8,839.71 25,829.63 22,042.46 30,732.54
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Figure 1.

Figure 1

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Trend in age-standardized prevalence rate of self-harm in MENA, 1990–2021.

Figure 2.

Figure 2

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Age-standardized prevalence rate of self-harm globally, 1990–2021.

The all-age count estimates that the prevalence of self-harm in MENA was 267,304 [95% UI 228,778 to 318,669] in 1990, and this rate increased to 621,509 [95% UI 531,046 to 739,915] in 2021. The percentage change from 1990 to 2021 showed a sharp increase of 133% [95% UI 124 to 140]. This shows that, despite the decrease in the age-standardized prevalence rate, the number of self-harms has increased. An increase in population leads to an increase in self-harm counts.

Incidence of self-harm in MENA from 1990 to2021

The age-standardized incidence rate of self-harm in MENA was 36.08 [95% UI 30.83 to 41.49] per 100,000 in 1990, and there was a very slight increase to 36.52 [95% UI 30.2to 43.85] per 100,000 in 2021 ( Table 2 ). The percentage change from 1990 to 2021 shows a positive trend of 1% [95% UI −4 to 7]. The incidence rate of self-harm from 1990 to 2021 showed an almost constant trend with a slight fluctuation ( Figure 3 ).

Table 2.

All-ages counts and age-standardized incidence rate (Per 100,000) of self-harm in MENA, 1990–2021.

Location 1990 2021
Value Lower Upper Value Lower Upper
Age-standardized incidence Rate (Per 100,000)
North Africa and Middle East 36.08 30.83 41.49 36.52 30.2 43.85
Afghanistan 38.56 33.4 43.87 34.73 29.3 40.84
Algeria 43.21 37.13 49.87 36.11 30.1 43.04
Bahrain 31.28 26.99 35.68 41.91 35.64 48.53
Egypt 25.93 22.23 29.62 30.44 25.05 36.7
Iran (Islamic Republic of) 57.34 46.67 69.95 46.01 36.07 57.53
Iraq 35.53 30.73 40.4 41.49 34.91 48.4
Jordan 27.4 23.96 30.72 27.31 22.05 33.67
Kuwait 25.27 21.8 29.01 32.66 26.79 39.56
Lebanon 34.43 29.42 39.5 38.95 32.14 46.65
Libya 33.45 28.82 38.3 40.08 33.37 47.63
Morocco 46.03 39.4 52.71 46.12 38.7 54.53
Oman 23.4 19.99 26.98 28.77 23.31 35.48
Palestine 22.59 19.24 26.29 28.82 23.56 35.24
Qatar 33.91 29.26 38.32 34.59 28.88 41.06
Saudi Arabia 16.71 13.94 19.88 33.62 27.62 39.87
Sudan 41.41 35.42 47.69 41.57 33.97 49.88
Syrian Arab Republic 18.95 16.06 22.11 28.01 22.67 34.33
Tunisia 28.96 24.87 33.2 34.3 28.03 40.99
Türkiye 29.84 25.99 33.42 31.9 26.78 37.63
United Arab Emirates 31.1 27.07 35.29 35.84 29.61 42.69
Yemen 32.49 27.39 37.68 36.61 30.26 43.86
All-ages counts estimates
North Africa and Middle East 121,495.91 101,913.55 142,793.80 237,245.31 194,870.01 284,896.08
Afghanistan 3,231.66 2,766.92 3,787.31 9,858.07 8,072.91 12,041.47
Algeria 11,179.92 9,396.39 13,094.70 15,903.78 13,345.60 18,851.03
Bahrain 176.54 150.83 202.14 743.94 639.03 857.82
Egypt 14,442.24 12,178.87 16,881.42 32,092.19 26,104.04 38,977.36
Iran (Islamic Republic of) 32,083.13 25,531.07 40,402.50 40,908.57 32,066.60 50,434.56
Iraq 6,166.07 5,206.52 7,172.78 18,066.91 15,010.30 21,384.77
Jordan 983.67 831 1,147.47 3,675.06 2,920.58 4,634.96
Kuwait 484.51 416.87 557.62 1,733.69 1,429.18 2,055.29
Lebanon 1,029.36 873.84 1,192.05 2,263.30 1,886.79 2,695.80
Libya 1,419.21 1,196.89 1,666.28 3,143.65 2,618.02 3,707.74
Morocco 11,786.05 10,042.92 13,600.20 17,882.33 15,008.41 21,147.80
Oman 440.74 369.51 516.9 1,438.23 1,153.75 1,739.23
Palestine 426.69 350.18 522.6 1,557.17 1,241.16 1,948.97
Qatar 175.24 150.94 200.31 1,249.27 1,048.16 1,462.15
Saudi Arabia 2,668.21 2,175.08 3,282.49 15,355.59 12,601.82 17,906.54
Sudan 8,027.19 6,750.56 9,409.15 19,021.30 15,326.63 23,351.60
Syrian Arab Republic 2,282.00 1,868.61 2,789.69 4,134.98 3,272.06 5,191.67
Tunisia 2,498.67 2,109.54 2,917.34 4,087.78 3,382.42 4,809.16
Türkiye 17,679.13 15,106.48 20,140.35 27,647.74 23,354.29 32,341.81
United Arab Emirates 619.08 536.3 707.66 4,077.51 3,357.01 4,774.41
Yemen 3,630.16 2,988.69 4,326.80 12,182.95 9,804.32 14,951.23
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Figure 3.

Figure 3

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Trend in age-standardized incidence rate of self-harm in MENA, 1990–2021.

The all-age count estimates that the incidence of self-harm in MENA was 121,495 [95% UI 101,913 to 142,793] in 1990, and this rate increased to 237,245 [95% UI 194,870 to 284,896] in 2021. The percentage change from 1990 to 2021 showed a sharp increase of 95% [95% UI 83 to 111] ( Figure 4 ).

Figure 4.

Figure 4

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Trend in all-age counts incidence of self-harm in MENA, 1990–2021.

Disability-Adjusted Life Years of self-harm in MENA from 1990 to 2021

The age-standardized DALYs rate of self-harm in MENA was 246.03 [95% UI 199.36 to 274.9] per 100,000 in 1990, and there was a decrease to 177.44 [95% UI 147.61 to 203.87] per 100,000 in 2021 ( Table 3 ). The percentage change from 1990 to 2021 showed a negative trend of −0.28% [95% UI −0.37 to −0.06] ( Figure 5 ).

Table 3.

All-ages counts and age-standardized DALYs rate (Per 100,000) of self-harm in MENA, 1990–2021.

Location 1990 2021
Value Lower Upper Value Lower Upper
Age-standardized DALYs Rate (Per 100,000)
North Africa and Middle East 246.03 199.36 274.9 177.44 147.61 203.87
Afghanistan 309.85 224.4 456.28 249.15 186.92 372.64
Algeria 248.98 166.33 307.51 150.52 104.85 190.44
Bahrain 342.52 303.18 389.51 195 161.2 235.07
Egypt 81.01 63.12 92.04 60.42 49.36 72.75
Iran 350.18 287.04 382.31 226.63 202.91 250.46
Iraq 366.26 290.54 445.84 233.37 178.5 311.05
Jordan 153.29 120.02 180.74 58.31 47.22 72.12
Kuwait 82.61 76.18 90.22 89.93 75.98 108.05
Lebanon 92.32 50.16 120.15 47.79 39.72 57.6
Libya 236.3 162.95 300.54 259.25 171.36 341.21
Morocco 282.22 187.5 356.13 183.29 119.06 265.59
Oman 97.92 73.35 130.57 52.81 42.16 65.24
Palestine 57.36 42.43 75.65 48.17 39 56.51
Qatar 355.05 290.54 436.17 168.25 129.04 218.31
Saudi Arabia 433.87 316.2 558.66 321.88 242.38 418.83
Sudan 359.56 209.94 480.47 252.62 149.03 368.66
Syrian Arab Republic 92.33 70.01 114.63 46.39 35.73 61.23
Tunisia 188.83 131.66 255.84 148.67 101.52 209.82
Türkiye 221.23 154.28 303.57 185.79 137.11 224.5
United Arab Emirates 255.85 190.76 353.16 141.91 113.97 186.64
Yemen 275.99 131.98 397.4 221.61 106.35 333.59
All-ages counts estimates
North Africa and Middle East 777,963.86 620,531.05 873,035.65 1,147,638.50 957,243.58 1,320,562.77
Afghanistan 24,885.81 17,826.90 37,555.51 62,940.69 45,463.07 102,634.93
Algeria 60,094.12 39,395.68 75,236.23 66,709.64 46,799.23 84,751.44
Bahrain 1,788.43 1,567.75 2,032.10 3,577.95 2,967.78 4,286.76
Egypt 41,470.39 32,207.95 48,087.82 61,595.03 49,813.55 74,578.75
Iran 188,787.36 148,375.22 206,949.05 203,257.54 183,865.89 225,136.26
Iraq 56,487.32 45,093.27 69,488.98 95,630.26 73,065.88 128,089.38
Jordan 5,209.86 3,964.08 6,227.24 7,590.38 6,131.49 9,386.95
Kuwait 1,501.65 1,379.65 1,644.49 4,903.51 4,133.08 5,859.56
Lebanon 2,649.40 1,446.08 3,452.94 2,860.92 2,378.27 3,431.60
Libya 9,243.76 6,305.07 11,773.53 20,542.27 13,643.68 27,012.70
Morocco 70,041.54 45,198.32 89,536.89 71,107.29 46,188.12 103,354.72
Oman 1,745.07 1,306.50 2,329.22 2,812.31 2,193.16 3,563.12
Palestine 976.85 732.32 1,277.67 2,424.22 1,942.15 2,859.39
Qatar 1,630.32 1,336.33 2,018.19 6,273.00 4,723.79 8,185.41
Saudi Arabia 61,138.35 44,805.17 79,658.40 155,463.77 113,368.89 206,734.33
Sudan 65,540.44 37,725.06 88,439.14 110,479.44 64,446.19 163,555.63
Syrian Arab Republic 10,151.66 7,680.66 12,613.15 6,874.12 5,306.08 9,126.81
Tunisia 15,403.48 10,643.53 20,796.99 18,264.59 12,327.58 25,762.43
Türkiye 126,836.34 87,336.86 176,140.41 163,725.32 121,424.92 198,256.36
United Arab Emirates 4,749.07 3,497.32 6,758.30 12,560.36 9,969.94 16,626.25
Yemen 27,207.06 11,557.43 40,190.52 66,975.47 30,251.68 102,680.75
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Figure 5.

Figure 5

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Trend in age-standardized DALYs of self-harm in MENA, 1990–2021.

The number of DALYs due to self-harm in MENA was 777,963 [95% UI 620,531 to 873,035] in 1990, and this rate increased to 1,147,638 [95% UI 957,243 to 1,320,562] by 2021. The percentage change from 1990 to 2021 showed a sharp increase of 48% [95% UI 29 to 92].

Suicide mortality in MENA from 1990 to 2021

The age-standardized rate of suicide mortality in MENA was 4.67 [95% UI 3.74 to 5.24] per 100,000 in 1990, and this rate decreased to 3.43 [95% UI 2.81 to 3.94] per 100,000 in 2021 ( Table 4 ). The percentage change from 1990 to 2021 showed a negative trend of −27% [95% UI −36 to −4]. The global age-standardized rate of suicide mortality is 8.99 per 100,000 individuals in 2021. Compared with the global population, suicide mortality was less prevalent in MENA from 1990 to 2021 ( Figure 6 ). The prevalence of suicide mortality in MENA countries was lower than in other countries ( Figure 7 ).

Table 4.

All-ages counts and age-standardized rate (Per 100,000) of suicide mortality in MENA, 1990–2021.

Location 1990 2021
Value Lower Upper Value Lower Upper
Age-standardized suicide mortality (Per 100,000)
North Africa and Middle East 4.67 3.74 5.24 3.43 2.81 3.94
Afghanistan 6.74 4.94 9.15 5.32 3.98 7.4
Algeria 4.54 3.01 5.57 2.85 1.96 3.63
Bahrain 7.29 6.52 8.24 3.93 3.28 4.8
Egypt 1.51 1.12 1.7 1.14 0.91 1.39
Iran (Islamic Republic of) 6.26 5.26 6.9 4.12 3.72 4.58
Iraq 7.37 5.86 8.86 4.89 3.68 6.46
Jordan 2.96 2.28 3.48 1.1 0.88 1.37
Kuwait 1.59 1.47 1.74 1.78 1.49 2.13
Lebanon 1.68 0.86 2.19 0.86 0.7 1.04
Libya 4.42 3.03 5.59 4.93 3.2 6.78
Morocco 5.17 3.41 6.54 3.59 2.3 5.04
Oman 1.91 1.4 2.58 1.02 0.8 1.28
Palestine 1.08 0.78 1.45 0.89 0.71 1.06
Qatar 7.74 6.3 9.49 3.41 2.6 4.48
Saudi Arabia 9.18 6.62 11.79 6.64 5.04 8.57
Sudan 6.61 3.83 8.79 4.68 2.78 6.77
Syrian Arab Republic 1.73 1.29 2.15 0.87 0.65 1.16
Tunisia 3.63 2.47 5.15 2.88 1.89 4.16
Türkiye 4.27 3 5.78 3.58 2.69 4.33
United Arab Emirates 5.27 3.91 7.17 2.76 2.21 3.61
Yemen 5.62 2.83 7.99 4.45 2.19 6.53
All-ages counts estimates
North Africa and Middle East 13,332.59 10,628.81 14,969.02 21,195.57 17,412.70 24,366.77
Afghanistan 510.82 371.17 703.41 1,124.18 812.67 1,735.13
Algeria 982.55 639.13 1,224.09 1,221.94 845.11 1,565.66
Bahrain 31.77 28.14 36.07 65.46 54.29 79.42
Egypt 690.46 514.42 799.17 1,064.19 844.64 1,297.64
Iran (Islamic Republic of) 3,069.66 2,463.49 3,362.63 3,708.56 3,354.15 4,117.61
Iraq 1,009.43 798.17 1,235.49 1,819.85 1,371.48 2,435.05
Jordan 87.27 66.53 104.06 132.38 105.11 166.67
Kuwait 25.65 23.5 28.08 91.46 76 110.16
Lebanon 45.88 23.32 60.3 51.89 42.28 62.81
Libya 155.85 105.51 199.88 379.13 248.49 515.46
Morocco 1,183.60 769.64 1,511.53 1,367.01 874.92 1,937.08
Oman 30.11 22.12 40.71 49.07 37.69 62.68
Palestine 16.12 11.76 21.64 40.27 31.5 48.05
Qatar 28.91 23.57 35.92 113.51 84.04 148.41
Saudi Arabia 1,117.26 817.64 1,442.92 2,967.63 2,165.27 3,921.08
Sudan 1,096.78 625.39 1,481.35 1,857.14 1,077.14 2,736.46
Syrian Arab Republic 169.18 125.66 211.79 125.23 93.8 169.05
Tunisia 269.87 184.5 372.34 362.45 235.45 525.28
Türkiye 2,230.28 1,536.91 3,068.71 3,209.80 2,426.94 3,882.02
United Arab Emirates 83.29 60.78 118.74 228.59 177.92 307.89
Yemen 490.56 223.19 716.3 1,196.07 549.34 1,832.18
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Figure 6.

Figure 6

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Trend in age-standardized suicide mortality rate in MENA, 1990–2021.

Figure 7.

Figure 7

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Age-standardized suicide mortality rate globally, 1990-2021.

More than 21,000 suicide mortalities were estimated in MENA in 2021, which was estimate for 1990 was 13,332 [95% UI 10,628 to 14,969]. This shows that, despite the decrease the in age-standardized prevalence rate, the number of suicide deaths has increased.

The sex-specific burden of self-harm and suicide mortality in MENA

Sex-specific prevalence of self-harm in MENA showed that the age-standardized prevalence rate (per 100,000) in 2021 was higher in females (112.57 [95% UI 95.65 to 134.77]) than in males (99.67 [95% UI 86.59 to 116.49]) ( Table 5 ).

Table 5.

Sex specific prevalence of self-harm in MENA, 1990–2021.

Location Sex 1990 2021
Value Lower Upper Value Lower Upper
Age-standardized prevalence Rate (Per 100,000)
North Africa and Middle East Males 95.63 83.89 110.96 99.67 86.59 116.49
Afghanistan Males 67.85 59.56 78.74 71.93 62.35 83.33
Algeria Males 100.06 85.69 118.41 88.7 76.54 105.15
Bahrain Males 103.11 89.89 119.14 124.6 106.42 149.36
Egypt Males 55.74 49.15 64.06 80.32 69.82 93.61
Iran (Islamic Republic of) Males 136.66 116.78 162.01 137.62 116.74 162.53
Iraq Males 101.13 89.28 116.73 118.6 103.09 137.12
Jordan Males 78.69 69.42 90.53 67.17 58.8 77.89
Kuwait Males 69.81 60.42 81.27 85.92 74.75 100.53
Lebanon Males 81.96 70.91 96.32 105.49 90.67 124.38
Libya Males 88.97 76.8 104.04 105.37 90.76 122.9
Morocco Males 123.01 107.32 141.98 122.52 106.02 142.08
Oman Males 80.43 70.09 93.78 80.36 68.59 96.17
Palestine Males 80.84 70.31 94 81.13 70.31 95.39
Qatar Males 100.15 87.97 116.18 97.1 84.43 113.41
Saudi Arabia Males 52.94 46.67 60.47 99.41 85.87 114.35
Sudan Males 98.28 85.17 115.22 112.68 97.09 132.65
Syrian Arab Republic Males 62.22 54.73 72.13 70.86 61.68 82.58
Tunisia Males 74.39 65.02 86.35 91.53 79.18 107.21
Türkiye Males 114.15 99.83 130.11 80.74 70.92 93.7
United Arab Emirates Males 96.48 84.78 112.07 105.73 91.48 122.94
Yemen Males 75.89 66.58 86.71 95.11 82.85 110.62
All-ages counts estimates
North Africa and Middle East Males 115,055.41 99,459.44 135,137.30 302,534.19 261,114.27 356,524.46
Afghanistan Males 2,323.95 2,047.90 2,676.30 6,645.52 5,746.66 7,816.53
Algeria Males 8,550.55 7,243.75 10,283.70 19,230.63 16,549.88 22,839.61
Bahrain Males 253.08 217.7 299.93 1,389.07 1,176.82 1,683.94
Egypt Males 11,334.74 9,875.68 13,161.94 36,418.42 31,501.37 42,611.71
Iran (Islamic Republic of) Males 25,980.61 21,921.03 31,313.86 64,913.99 54,867.53 76,963.05
Iraq Males 5,794.81 5,046.07 6,780.73 20,673.39 17,830.47 24,171.28
Jordan Males 909.67 784.62 1,058.58 3,941.25 3,416.27 4,617.59
Kuwait Males 599.1 510.16 713.35 2,438.45 2,099.72 2,888.11
Lebanon Males 997.43 860.25 1,172.77 3,063.87 2,620.00 3,644.77
Libya Males 1,343.33 1,149.48 1,588.39 3,951.76 3,389.26 4,642.88
Morocco Males 11,239.79 9,743.30 13,048.32 23,196.60 20,033.60 26,952.59
Oman Males 706.31 602.63 843.58 2,373.74 1,978.93 2,920.03
Palestine Males 465.34 397.87 550.16 1,586.35 1,355.86 1,881.70
Qatar Males 278.03 237.15 329.97 2,299.57 1,954.46 2,754.60
Saudi Arabia Males 3,369.31 2,914.77 3,913.57 23,196.17 19,808.24 27,251.07
Sudan Males 6,355.42 5,491.06 7,490.40 17,626.49 15,124.83 20,761.13
Syrian Arab Republic Males 2,449.77 2,124.84 2,865.44 4,884.30 4,285.46 5,632.28
Tunisia Males 2,394.33 2,081.45 2,813.13 6,025.98 5,212.24 7,049.40
Türkiye Males 25,831.83 22,509.35 29,768.34 37,601.30 33,002.38 43,689.79
United Arab Emirates Males 1,039.20 885.61 1,247.40 10,088.48 8,571.49 11,892.68
Yemen Males 2,775.87 2,428.80 3,198.96 10,706.70 9,277.27 12,673.68
Age-standardized prevalence Rate (Per 100,000)
North Africa and Middle East Females 128.83 109.52 152.86 112.57 95.65 134.77
Afghanistan Females 151.7 131.25 175.82 133.86 116.17 155.33
Algeria Females 169.7 143.41 202.27 118.89 100.8 142.87
Bahrain Females 85.12 72.31 101.59 109.78 92.36 131.87
Egypt Females 108.88 93.04 128.8 97.37 83.55 114.8
Iran (Islamic Republic of) Females 212.79 176.25 258.02 124.82 104.03 151.66
Iraq Females 117.53 100.72 138.8 118.31 101.18 141.68
Jordan Females 85.92 74.81 99.85 88.03 74.88 104.63
Kuwait Females 78.94 68.01 92.79 92.05 78.35 109.73
Lebanon Females 120.85 103.19 144.65 109.92 92.99 132.87
Libya Females 118.78 100.28 139.25 123.16 104.24 147.67
Morocco Females 164.51 139.66 194.07 146.47 125.2 172.21
Oman Females 63.04 54.85 73.64 86.7 73.97 102.37
Palestine Females 62.09 54.29 72.33 86.78 74.12 103.4
Qatar Females 110.24 95.16 129.56 96.17 82.27 113.05
Saudi Arabia Females 54.39 47.13 63.95 88.44 75.31 104.27
Sudan Females 162.84 137.95 194.53 140.64 118.65 169.01
Syrian Arab Republic Females 58.02 49.95 68.09 85.9 73.48 101.68
Tunisia Females 102.18 87.33 120.96 101.12 85.97 120.86
Türkiye Females 77.53 67.24 90.26 99.13 84.14 119.34
United Arab Emirates Females 99.07 87.57 113.2 105.69 91.58 124.17
Yemen Females 124.11 107.25 145.24 127.85 109.17 151.32
All-ages counts estimates
North Africa and Middle East Females 152,249.20 128,889.25 182,579.38 318,975.58 269,387.72 383,923.59
Afghanistan Females 5,585.52 4,852.08 6,482.66 12,212.50 10,445.08 14,348.00
Algeria Females 14,696.79 12,383.45 17,732.75 25,444.52 21,454.19 30,681.62
Bahrain Females 137.03 114.9 166.13 622.3 519.85 754.7
Egypt Females 22,155.67 18,800.13 26,400.42 41,202.29 34,986.61 49,101.34
Iran (Islamic Republic of) Females 39,854.26 32,912.27 49,170.48 57,867.77 48,020.96 70,468.16
Iraq Females 6,727.47 5,695.31 8,019.78 19,883.63 16,844.31 24,003.92
Jordan Females 923.69 789.27 1,092.72 4,384.17 3,700.27 5,279.68
Kuwait Females 415.48 352.69 499.14 2,234.86 1,867.44 2,707.61
Lebanon Females 1,597.96 1,359.35 1,922.69 3,472.72 2,933.94 4,196.58
Libya Females 1,489.08 1,254.79 1,765.20 4,382.60 3,684.05 5,292.07
Morocco Females 15,832.75 13,405.93 18,851.19 28,008.38 23,919.43 32,988.68
Oman Females 303.66 260.63 362.23 1,335.63 1,123.94 1,597.11
Palestine Females 400.15 344.91 470.26 1,695.51 1,426.04 2,039.79
Qatar Females 112.87 95.28 136.35 781.1 650.5 941.34
Saudi Arabia Females 2,378.73 2,020.80 2,855.31 13,812.42 11,610.60 16,546.25
Sudan Females 10,984.61 9,223.03 13,171.21 22,448.50 18,761.31 27,341.78
Syrian Arab Republic Females 2,242.39 1,913.83 2,679.00 6,373.21 5,456.16 7,563.77
Tunisia Females 3,287.56 2,798.52 3,922.40 6,944.79 5,909.80 8,265.87
Türkiye Females 17,870.73 15,340.99 20,987.87 47,479.15 40,439.47 56,975.47
United Arab Emirates Females 392.38 336.85 463.43 2,969.09 2,534.81 3,520.18
Yemen Females 4,777.13 4,105.67 5,651.56 15,122.93 12,774.45 18,124.23
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The incidence of self-harm in MENA showed that the age-standardized incidence rate (per 100,000) in 2021 was higher in females (43.12 [95% UI 35.33to 52.24]) than in males (30.36 [95% UI 25.33 to 35.93]) ( Table 6 ).

Table 6.

Sex specific incidence of self-harm in MENA, 1990–2021.

Location Sex 1990 2021
Value Lower Upper Value Lower Upper
Age-standardized incidence Rate (Per 100,000)
North Africa and Middle East Males 27.27 23.36 31.05 30.36 25.33 35.93
Afghanistan Males 18.37 15.69 20.98 19.93 16.42 23.81
Algeria Males 27.91 23.48 32.58 26.65 21.87 32.34
Bahrain Males 30.94 27.15 35.1 39.55 34.25 45.42
Egypt Males 15.6 13.15 18.12 24.2 19.69 29.46
Iran (Islamic Republic of) Males 39.72 32.38 48.02 42.9 33.59 53.18
Iraq Males 29.66 25.33 34.31 37.29 31.47 43.11
Jordan Males 23.2 20.28 26.06 20.97 17.8 24.75
Kuwait Males 21.41 18.89 24.07 27.75 24.09 31.72
Lebanon Males 24.05 20.34 27.87 33.41 27.51 40.18
Libya Males 25.53 21.9 29.6 32.43 26.99 38.64
Morocco Males 35.07 30.08 39.85 37.05 30.99 44.37
Oman Males 23.73 20.57 27.05 25.28 21.12 30.25
Palestine Males 23.33 20.31 26.47 24.72 21.08 28.97
Qatar Males 30.37 26.09 34.31 31.48 26.67 36.99
Saudi Arabia Males 15.12 12.99 17.44 31.94 26.73 37.17
Sudan Males 27.37 23.08 31.8 32.65 26.75 39.17
Syrian Arab Republic Males 17.77 15.64 20.04 21.7 18.38 25.54
Tunisia Males 21.54 18.37 24.46 28.57 23.68 33.83
Türkiye Males 32.46 28.62 36.12 25.27 21.82 29.16
United Arab Emirates Males 28.25 24.59 31.72 32.62 27.47 38.28
Yemen Males 21.68 18.35 25.11 27.54 23.04 32.72
All-ages counts estimates
North Africa and Middle East Males 46,055.30 38,935.11 53,408.96 103,006.04 85,574.22 121,722.06
Afghanistan Males 764.33 632.85 898.65 3,050.07 2,432.26 3,756.16
Algeria Males 3,626.37 3,011.40 4,306.53 5,947.20 4,874.85 7,187.17
Bahrain Males 105.86 91.14 121.39 465.88 404.19 528.87
Egypt Males 4,326.66 3,582.59 5,125.11 13,127.93 10,508.07 16,102.08
Iran (Islamic Republic of) Males 10,863.93 8,683.10 13,557.19 19,891.51 15,639.20 24,678.36
Iraq Males 2,586.13 2,169.17 3,036.84 8,333.66 6,927.53 9,795.16
Jordan Males 439.66 374.28 508.12 1,521.23 1,274.99 1,810.19
Kuwait Males 229.22 202.96 259.08 780.38 687.26 883.25
Lebanon Males 349.17 291.16 416.42 990.21 813.57 1,190.97
Libya Males 569.68 476.9 670.32 1,320.58 1,090.06 1,560.88
Morocco Males 4,324.74 3,688.63 4,948.28 7,225.46 6,042.34 8,646.40
Oman Males 279.24 237.75 321.21 780.76 643.36 934.82
Palestine Males 219.67 185.11 259.36 677.44 569.14 817.42
Qatar Males 112.52 96.38 128.96 867.36 734.43 1,005.03
Saudi Arabia Males 1,380.11 1,165.60 1,617.39 8,849.34 7,352.84 10,251.07
Sudan Males 2,525.86 2,108.08 2,963.71 7,368.57 5,924.11 9,058.95
Syrian Arab Republic Males 1,072.28 913.87 1,245.96 1,490.06 1,238.40 1,804.55
Tunisia Males 921.11 774.54 1,070.00 1,700.56 1,420.30 1,994.00
Türkiye Males 9,764.26 8,450.14 11,025.57 11,197.87 9,735.73 12,811.35
United Arab Emirates Males 389.67 339.13 444.67 2,817.86 2,313.93 3,324.45
Yemen Males 1,179.63 966.1 1,414.85 4,506.05 3,673.58 5,482.65
Age-standardized incidence Rate (Per 100,000)
North Africa and Middle East Females 45.3 38.49 52.72 43.12 35.33 52.24
Afghanistan Females 54.82 47.72 62.68 49.37 41.67 57.67
Algeria Females 58.98 51.01 67.94 45.89 38.31 54.69
Bahrain Females 30.47 25.27 35.6 45.06 37.41 53.39
Egypt Females 36.84 31.76 42.07 37.25 30.56 44.76
Iran (Islamic Republic of) Females 75.31 60.81 92.21 49.28 38.52 62
Iraq Females 41.88 36.31 48.1 45.99 38.25 54.44
Jordan Females 32.06 27.85 36.61 34.78 26.53 43.88
Kuwait Females 30.91 25.78 36.77 37.99 29.07 48.33
Lebanon Females 44.06 37.83 50.57 44.94 37.58 53.63
Libya Females 42.72 36.88 48.98 48.12 39.87 57.81
Morocco Females 56.78 48.75 65.6 55.31 46.32 65.43
Oman Females 22.79 18.76 27.39 35.12 27.24 43.92
Palestine Females 21.88 17.85 26.78 33.06 25.82 41.73
Qatar Females 41.54 36.07 47.61 40.57 33.13 49.43
Saudi Arabia Females 18.68 14.93 23.13 35.61 28.27 43.98
Sudan Females 54.77 46.98 63.24 50.6 41.02 61.1
Syrian Arab Republic Females 20.19 16.39 24.99 33.07 25.78 41.36
Tunisia Females 36.45 31.39 42.09 40 32.43 48.21
Türkiye Females 27.06 23 31.86 38.75 31.36 47.41
United Arab Emirates Females 37.42 32.56 42.94 41.65 33.95 50.19
Yemen Females 43.07 36.15 50.09 45.68 37.26 55.33
All-ages counts estimates
North Africa and Middle East Females 75,440.61 63,161.37 89,493.70 134,239.27 109,704.29 163,264.05
Afghanistan Females 2,467.33 2,117.68 2,887.47 6,808.00 5,599.21 8,272.44
Algeria Females 7,553.55 6,351.81 8,849.35 9,956.58 8,335.40 11,798.28
Bahrain Females 70.68 58.55 84.31 278.07 230.24 328.18
Egypt Females 10,115.57 8,543.74 11,774.91 18,964.26 15,303.74 22,977.30
Iran (Islamic Republic of) Females 21,219.21 16,839.31 26,855.28 21,017.07 16,503.98 26,128.95
Iraq Females 3,579.94 3,039.98 4,179.76 9,733.26 8,010.47 11,659.25
Jordan Females 544.02 450.89 651.2 2,153.83 1,608.78 2,771.91
Kuwait Females 255.29 210.94 308.08 953.32 741.58 1,185.27
Lebanon Females 680.18 577.92 791.9 1,273.10 1,073.97 1,503.73
Libya Females 849.53 715.19 1,007.80 1,823.07 1,506.24 2,178.93
Morocco Females 7,461.31 6,304.40 8,714.20 10,656.87 8,920.42 12,582.24
Oman Females 161.5 127.94 202.84 657.46 506.19 829.21
Palestine Females 207.02 160.84 265.09 879.73 662.96 1,137.79
Qatar Females 62.72 54.13 72.6 381.91 303.74 459.97
Saudi Arabia Females 1,288.10 986.02 1,653.58 6,506.26 5,131.79 7,818.94
Sudan Females 5,501.33 4,622.98 6,499.25 11,652.73 9,308.09 14,379.60
Syrian Arab Republic Females 1,209.72 940.27 1,564.50 2,644.92 1,999.37 3,381.75
Tunisia Females 1,577.56 1,330.31 1,846.99 2,387.22 1,955.51 2,837.37
Türkiye Females 7,914.86 6,554.23 9,576.53 16,449.87 13,398.54 20,057.14
United Arab Emirates Females 229.41 195.14 267.54 1,259.65 1,015.77 1,505.50
Yemen Females 2,450.53 2,024.05 2,916.47 7,676.90 6,126.53 9,461.56
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The trend of incidence of self-harm in males and females from 1990 to 2021 showed that the trend in females decreased, but it increased in males ( Figure 8 ). DALYs of self-harm rate per 100,000 in 2021 were higher in males (242.52 [95% UI 200.7 to 278.99]), than in females (106.64 [95% UI 85.25 to 128.14]). The trend of DALYs caused by self-harm in both sexes showed a decreasing trend compared with 1990 ( Table 7 ).

Figure 8.

Figure 8

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Sex specific age-standardized incidence rate of self-harm in MENA, 1990-2021.

Table 7.

Sex specific DALYs of self-harm in MENA, 1990–2021.

Location Sex 1990 2021
Value Lower Upper Value Lower Upper
Age-standardized DALYs Rate (Per 100,000)
North Africa and Middle East Males 302.75 246.29 345.11 242.52 200.7 278.99
Afghanistan Males 376.99 243.72 545.72 293.27 215.31 419.72
Algeria Males 282.97 214.52 348.94 190.73 135.41 245.48
Bahrain Males 434.98 374.36 512.67 263.11 214.52 319.53
Egypt Males 106.13 83.32 126.32 84.85 68 103.16
Iran (Islamic Republic of) Males 394.97 339.53 445.59 325.29 277.26 357.39
Iraq Males 512.3 392.76 631.43 339.32 253.01 458.71
Jordan Males 183.05 145.83 219.12 82.5 66.11 102.3
Kuwait Males 95.54 85.89 106.95 134.91 111.58 164.47
Lebanon Males 98.72 53.37 131.29 57.19 47.47 69.52
Libya Males 280.02 193.03 363.69 350.13 241.08 457.11
Morocco Males 280.02 211.81 360.62 205.41 142.49 313.27
Oman Males 124.81 90.98 172.14 70.5 54.45 88.29
Palestine Males 83.43 61.02 112.53 72.99 55.38 86.49
Qatar Males 440.07 354.76 554.14 221.78 167.47 290.99
Saudi Arabia Males 517.06 378.27 688.77 434.4 323.9 586.06
Sudan Males 385.18 253.01 522.73 321.68 197.64 457.61
Syrian Arab Republic Males 130.68 98.75 167.23 73.6 54.87 98.43
Tunisia Males 220.23 166.39 336.62 211.41 141.28 307.61
Türkiye Males 341.25 235.18 445.16 283.3 212.27 343.89
United Arab Emirates Males 287.44 205.92 420.74 178.65 139.08 248.89
Yemen Males 341.95 187.85 493.24 288.39 151.34 434.33
All-ages counts estimates
North Africa and Middle East Males 478,630.60 389,396.59 546,563.14 817,712.72 677,563.34 941,813.38
Afghanistan Males 13,719.84 9,083.67 19,986.06 37,226.62 26,865.39 54,632.73
Algeria Males 34,001.22 25,211.82 42,555.66 42,849.37 30,381.18 55,206.63
Bahrain Males 1,349.88 1,154.89 1,610.36 3,140.52 2,585.16 3,807.87
Egypt Males 27,614.10 21,728.33 33,419.30 44,919.14 35,755.92 54,522.88
Iran (Islamic Republic of) Males 105,109.67 88,800.06 118,654.48 150,642.85 129,386.56 165,530.23
Iraq Males 39,289.40 30,621.57 49,225.45 71,402.32 52,565.55 97,663.20
Jordan Males 3,209.08 2,512.14 3,911.12 5,880.51 4,673.51 7,359.85
Kuwait Males 1,027.57 920.95 1,151.05 3,903.84 3,197.45 4,742.81
Lebanon Males 1,338.15 730.27 1,810.55 1,727.38 1,427.41 2,106.62
Libya Males 5,803.72 3,955.71 7,708.27 14,339.55 9,931.11 18,681.82
Morocco Males 32,989.46 24,889.81 43,534.61 39,905.46 27,645.22 61,069.07
Oman Males 1,409.20 1,025.29 1,948.61 2,402.35 1,840.78 3,071.48
Palestine Males 691.04 499.78 935.19 1,872.35 1,415.20 2,244.01
Qatar Males 1,395.26 1,119.95 1,775.76 5,863.43 4,401.58 7,717.36
Saudi Arabia Males 42,138.02 30,493.61 56,042.06 125,162.98 88,930.30 172,548.80
Sudan Males 32,579.45 21,514.94 44,818.03 68,362.29 41,007.18 98,811.41
Syrian Arab Republic Males 7,221.81 5,363.71 9,432.67 4,959.15 3,684.60 6,771.38
Tunisia Males 8,886.06 6,632.13 13,595.55 12,828.29 8,552.82 18,754.00
Türkiye Males 98,639.19 68,224.01 129,932.04 126,613.82 94,875.49 153,671.33
United Arab Emirates Males 3,695.62 2,671.69 5,599.87 10,530.57 8,262.72 14,285.00
Yemen Males 16,261.05 8,155.58 23,951.62 42,417.24 20,972.65 64,665.56
Age-standardized DALYs Rate (Per 100,000)
North Africa and Middle East Females 186.34 126.28 212.64 106.64 85.25 128.14
Afghanistan Females 256.35 184.77 425.17 204.75 144.38 354.49
Algeria Females 214.76 102.43 291.02 109.44 64.2 145.98
Bahrain Females 203.43 155.02 240.33 71.64 57.77 102.83
Egypt Females 54.9 35.97 67.31 34.44 26.65 43.49
Iran (Islamic Republic of) Females 303.11 202.92 343.37 124.44 108.73 155.18
Iraq Females 212.3 152.16 265.78 119.43 89.16 170.84
Jordan Females 120.14 75.2 155.9 29.01 22.55 39.19
Kuwait Females 63.89 58.28 72.54 39.93 34.72 46.25
Lebanon Females 86.96 43.47 120.59 38.67 29.64 49.94
Libya Females 182.92 95.51 245.58 162.83 91.95 246.02
Morocco Females 284.61 133.3 380.37 161.29 89.71 250.36
Oman Females 51.71 33.18 69.14 22.94 17.87 29.41
Palestine Females 32.9 23.98 45.57 22.72 18.4 29.42
Qatar Females 174.11 122.8 221.46 46.17 34.7 66.07
Saudi Arabia Females 304.46 195.54 399.87 155 111.84 215.98
Sudan Females 333.76 132.31 501.24 184.99 84.37 306.45
Syrian Arab Republic Females 52.42 34.63 66.92 24.45 18.38 35.4
Tunisia Females 157.33 82.13 218.84 88.39 54.1 125.23
Türkiye Females 99.03 60.7 191.88 86.74 60.01 109.94
United Arab Emirates Females 186.33 135.43 246.55 95.11 72.86 137.02
Yemen Females 210.12 65.15 331.61 155.87 60.35 238.86
All-ages counts estimates
North Africa and Middle East Females 299,333.25 201,107.98 342,548.29 329,925.78 263,651.16 396,673.90
Afghanistan Females 11,165.97 7,820.10 19,123.92 25,714.07 17,573.87 52,174.13
Algeria Females 26,092.90 11,959.03 35,662.48 23,860.27 14,016.64 31,950.35
Bahrain Females 438.54 333.95 521.58 437.43 353.2 626.16
Egypt Females 13,856.28 8,561.90 17,291.89 16,675.89 12,856.00 21,369.37
Iran (Islamic Republic of) Females 83,677.70 53,304.15 95,584.67 52,614.69 45,850.79 66,073.28
Iraq Females 17,197.92 12,211.37 21,938.07 24,227.94 18,021.65 34,927.77
Jordan Females 2,000.77 1,246.68 2,656.76 1,709.87 1,315.35 2,334.15
Kuwait Females 474.08 427.95 560.39 999.68 864.63 1,152.94
Lebanon Females 1,311.25 651.06 1,812.65 1,133.54 875 1,471.12
Libya Females 3,440.04 1,766.83 4,635.21 6,202.71 3,503.93 9,257.47
Morocco Females 37,052.08 16,786.58 49,748.15 31,201.83 17,338.91 48,426.09
Oman Females 335.88 208.89 448.5 409.96 315.04 529.5
Palestine Females 285.82 204.56 396.88 551.86 439.82 724.43
Qatar Females 235.06 165.24 300.43 409.57 300.1 610.62
Saudi Arabia Females 19,000.33 11,740.29 25,207.64 30,300.80 21,675.04 41,521.78
Sudan Females 32,960.98 12,541.19 49,104.75 42,117.16 18,696.05 71,008.30
Syrian Arab Republic Females 2,929.85 1,953.85 3,781.58 1,914.97 1,432.63 2,778.14
Tunisia Females 6,517.42 3,339.71 9,024.59 5,436.30 3,362.17 7,641.40
Türkiye Females 28,197.15 16,880.92 55,953.71 37,111.50 25,959.59 46,687.57
United Arab Emirates Females 1,053.45 754.42 1,425.32 2,029.79 1,554.58 2,890.45
Yemen Females 10,946.01 3,066.25 17,863.75 24,558.23 8,851.05 38,673.30
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Suicide mortality was more common in males than in females; the age-standardized prevalence rate (per 100,000) of suicide mortality in 2021 was 4.83 [95% UI 3.98 to 5.56] in males and 1.92 [95% UI 1.47 to 2.30] in females ( Table 8 , Figure 9 ).

Table 8.

Sex specific suicide mortality in MENA, 1990–2021.

Location Sex 1990 2021
Value Lower Upper Value Lower Upper
Age-standardized prevalence Rate (Per 100,000)
North Africa and Middle East Males 6.02 4.92 6.83 4.83 3.98 5.56
Afghanistan Males 8.36 5.6 11.58 6.39 4.69 8.86
Algeria Males 5.38 4.16 6.57 3.71 2.59 4.78
Bahrain Males 9.85 8.48 11.44 5.53 4.57 6.73
Egypt Males 2.09 1.61 2.44 1.65 1.3 2.01
Iran (Islamic Republic of) Males 7.42 6.35 8.39 6.04 5.14 6.67
Iraq Males 10.82 8.37 13.19 7.46 5.47 9.88
Jordan Males 3.64 2.88 4.32 1.61 1.28 1.97
Kuwait Males 1.87 1.67 2.07 2.71 2.22 3.29
Lebanon Males 1.92 1 2.57 1.09 0.89 1.34
Libya Males 5.39 3.75 6.88 6.79 4.61 9.07
Morocco Males 5.44 4.06 7 4.23 2.88 6.29
Oman Males 2.53 1.83 3.49 1.46 1.12 1.83
Palestine Males 1.67 1.19 2.24 1.45 1.08 1.72
Qatar Males 9.87 7.93 12.28 4.57 3.47 6.05
Saudi Arabia Males 11.41 8.33 15.13 9.08 6.73 11.82
Sudan Males 7.55 4.83 10.22 6.2 3.81 8.89
Syrian Arab Republic Males 2.52 1.88 3.21 1.44 1.05 1.96
Tunisia Males 4.41 3.32 6.89 4.22 2.74 6.32
Türkiye Males 6.73 4.65 8.71 5.63 4.22 6.83
United Arab Emirates Males 5.93 4.28 8.67 3.22 2.53 4.42
Yemen Males 7.3 4.31 10.17 6.06 3.3 8.9
All-ages counts estimates
North Africa and Middle East Males 8,514.15 6,925.22 9,709.15 15,485.87 12,846.80 17,904.47
Afghanistan Males 294.04 199.01 409.46 664.42 479.24 969.98
Algeria Males 573.6 431.28 712.25 808.5 567.56 1,035.65
Bahrain Males 24.51 21.07 28.98 57.93 47.95 70.2
Egypt Males 487.68 381.8 587.18 808.27 636.06 992.25
Iran (Islamic Republic of) Males 1,779.40 1,522.33 2,017.04 2,802.33 2,398.13 3,090.06
Iraq Males 726.93 560.79 896.8 1,399.53 1,038.63 1,890.04
Jordan Males 54.95 42.97 66.6 105.85 84.18 131.83
Kuwait Males 17.95 16.02 20.01 74.95 60.98 91.36
Lebanon Males 24.67 12.79 33.26 32.7 26.67 40.06
Libya Males 100.58 68.77 131.34 269.44 184.23 355.59
Morocco Males 586.32 438.11 764.95 800.47 541.41 1,198.81
Oman Males 24.71 17.77 34.16 43.02 32.75 55.64
Palestine Males 11.74 8.39 16.04 32.42 24.09 39.02
Qatar Males 24.97 19.93 31.94 106.75 79.35 140.56
Saudi Arabia Males 794.34 574.66 1,058.87 2,411.92 1,734.66 3,298.88
Sudan Males 578.42 377.65 789.45 1,193.00 717.81 1,706.73
Syrian Arab Republic Males 123.63 91.19 160.74 96.88 70.46 134.23
Tunisia Males 160.85 120.02 249.55 259.85 168.5 390.25
Türkiye Males 1,749.42 1,202.73 2,295.31 2,523.86 1,892.59 3,076.91
United Arab Emirates Males 65.77 47.55 99.99 193.61 147.9 266.68
Yemen Males 305 163.11 442.51 785.72 400.57 1,191.67
Age-standardized prevalence Rate (Per 100,000)
North Africa and Middle East Females 3.26 2.21 3.75 1.92 1.47 2.3
Afghanistan Females 5.32 3.92 7.52 4.29 3.07 6.44
Algeria Females 3.7 1.67 5.03 1.96 1.1 2.61
Bahrain Females 3.93 3.05 4.64 1.35 1.09 2.03
Egypt Females 0.9 0.56 1.11 0.6 0.45 0.78
Iran (Islamic Republic of) Females 5.04 3.47 5.71 2.14 1.85 2.74
Iraq Females 3.8 2.64 4.73 2.22 1.61 3.16
Jordan Females 2.2 1.31 2.86 0.49 0.36 0.68
Kuwait Females 1.19 1.09 1.32 0.7 0.6 0.81
Lebanon Females 1.46 0.66 2.06 0.64 0.47 0.84
Libya Females 3.24 1.63 4.34 2.96 1.58 4.64
Morocco Females 4.91 2.16 6.59 2.96 1.52 4.54
Oman Females 0.92 0.57 1.29 0.37 0.27 0.49
Palestine Females 0.55 0.39 0.79 0.35 0.28 0.45
Qatar Females 3.53 2.48 4.42 0.91 0.68 1.35
Saudi Arabia Females 5.86 3.68 7.67 3 2.17 4.18
Sudan Females 5.65 2.08 8.41 3.14 1.37 5.29
Syrian Arab Republic Females 0.89 0.56 1.15 0.38 0.27 0.57
Tunisia Females 2.86 1.38 4.22 1.62 0.92 2.4
Türkiye Females 1.84 1.14 3.48 1.56 1.05 1.99
United Arab Emirates Females 3.82 2.76 5.01 2.48 1.87 3.58
Yemen Females 3.98 1.2 6.26 2.88 1.07 4.44
All-ages counts estimates
North Africa and Middle East Females 4,818.45 3,196.71 5,541.97 5,709.70 4,370.65 6,872.70
Afghanistan Females 216.79 156.72 323.66 459.76 314.56 843.8
Algeria Females 408.94 181.7 562.95 413.44 235.83 558.18
Bahrain Females 7.26 5.54 8.68 7.52 5.95 11.21
Egypt Females 202.78 112.77 256.59 255.92 189.26 337
Iran (Islamic Republic of) Females 1,290.26 820.94 1,468.85 906.23 779.55 1,182.62
Iraq Females 282.5 199.42 357.67 420.32 305.22 607.21
Jordan Females 32.32 19.55 42.65 26.53 19.63 37.51
Kuwait Females 7.71 6.95 9.05 16.51 14.28 19.1
Lebanon Females 21.21 9.45 30.08 19.18 14.4 25.37
Libya Females 55.28 27.7 74.97 109.69 59.08 167.81
Morocco Females 597.27 262.47 809.3 566.54 291.33 872.93
Oman Females 5.4 3.29 7.42 6.05 4.4 8.19
Palestine Females 4.38 2.99 6.28 7.86 6.24 10.37
Qatar Females 3.94 2.78 5.07 6.76 4.81 10.35
Saudi Arabia Females 322.91 201.41 426.67 555.71 395.19 765.25
Sudan Females 518.36 189.01 784.06 664.14 276.11 1,136.47
Syrian Arab Republic Females 45.55 29 59.87 28.35 20.1 42.86
Tunisia Females 109.01 53.86 154.95 102.59 58.23 153.52
Türkiye Females 480.86 286.79 951.21 685.94 468.43 878.16
United Arab Emirates Females 17.52 12.44 23.96 34.99 26.03 51.21
Yemen Females 185.56 49.83 301.68 410.34 140.19 649.39
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Figure 9.

Figure 9

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Sex specific age-standardized suicide mortality rate in MENA, stratified by country, 1990-2021.

Discussion

This study deals with self-harm and suicide mortality in MENA from 1990 to 2021 based on sex and country. Based on this, the prevalence, incidence, DALYs, and suicide mortality in 21 countries according to sex were presented and compared with the global population.

This level of prevalence of self-harm compared to 1990 showed a decreasing trend, and it has also been shown that the estimated prevalence of self-harm is higher in females than in males. This decrease in self-harm over the last three decades may involve different mechanisms. The first point that is evident in MENA is that it especially affects mental health. Sociodemographic and religious commonalities are some of the factors that especially affect the tendency to self-harm and suicide mortality. In addition, the study shows that religiosity is protective against suicide (25–27). The dominant religion of the MENA countries is Islam, and most of the population in these countries are Muslims; according to Islamic teachings, self-harm is forbidden, and suicide is considered unforgivable from God’s point of view and prohibited by Islam (28, 29).

Previous studies have also shown a downward trend in suicide rates in this region (30). Similar to previous studies, this study showed that countries with Muslim populations have a lower prevalence of suicide (31, 32). Being religious is a protective factor against self-harm and suicide, even though this region has been involved in conflict, war, displacement, migration, and poverty for decades. In the past decades, this super region has witnessed an improvement in morbidity and mortality due to improvements in health care, health education, socioeconomic developments (11), and mental health infrastructure (33, 34). The stigma surrounding suicide can influence reported estimates, as many families choose to conceal deaths resulting from suicide due to the associated shame. The tendency to hide such cases can distort the accuracy of suicide-related statistics in the region.

However, the results clearly indicate an increase in the number of self-harm incidents and suicide-related deaths. Over the past three decades, the global population, as well as that of this region, has grown substantially (35), which requires an increase in health infrastructure and access to healthcare, especially mental healthcare. However, health systems in this region have faced challenges (34), which have affected the health performance of countries, and conflicts and wars have also increased the burden on the health system. As a result of conflicts and wars, migration also increases and people are displaced from their places of residence. As the literature also shows, there is an increase in mental disorders as a result of migration and displacement (15, 36). Accordingly, the increase in the number of self-harm and suicide deaths does not seem unusual.

Another finding of this study was the sex differences in the rate of self-harm and suicide mortality, which showed that self-harm is more common in females than in males, but the prevalence of suicide mortality is higher in males. The findings obtained from previous studies also confirm the higher prevalence of self-harm in females than in males; this sex difference has been shown in adolescents and adults (37, 38). Suicidal mortality has also been shown to be more common in males than females (39, 40). Mechanisms have been identified for the higher prevalence of self-harm in females (37). Individual, interpersonal, and sociocultural factors are associated with high levels of depression and distress in females (41). The tendency toward rumination also has an important relationship with self-harm (42). Depression is one of the main causes of suicide. Depression is more common in females, but suicide mortality is more common in males, and there is a paradox (39). In explaining these differences, three factors should be considered “methods used by suicide attempters, lethality of the suicidal act, and intent to die” (43). In females, the use of pills for suicide is more common, and in males, the use of firearms or hanging oneself is more common (44–47). The degree of suicide attempt among females is less lethal (46). There is a difference between males and females in the intention to die (48, 49); in men compared to females, this intention to die is more serious (43). In addition, some biological and cultural factors have been proposed to explain gender differences in suicidal behaviors, including glutaminergic activity (50), sleep time (51), spirituality, and coping skills (52). Therefore, the risk factors for suicidal behavior in women and men are different (53), and these should be considered in explanations.

Not all countries in the region had similar rates of self-harm and suicide mortality and there was a disparity. These differences can be influenced by many factors, some of which can be attributed to the performance of the health systems in these countries. In addition, there are cultural differences, as suicide has high stigma in some countries, which may have affected the estimates obtained. At the political level, some countries in this region have been involved in conflicts and long wars, which have affected the performance of the mental health care system. There is also inequality in economic conditions, such that some countries have a high level of welfare, and some other countries have a high level of poverty and economic and social problems. Therefore, any of these factors can affect differences in the rates of self-harm and suicide in these countries.

Limitations

This was a comprehensive effort to examine the burden of self-harm and suicide mortality in MENA, covering more than three decades, assessing sex differences, and reporting decompositions in 21 countries. This research has limitations according to the Global Burden of Disease study, including the quality and collection of primary data and inconsistency of data availability. The challenges of measuring suicidal behaviors in conflict settings and the impact of missing or biased data should be considered. In addition to the methodological limitations that exist in GBD, some cultural limitations can also affect the estimation of the results in this region. For example, the stigmatization effects of self-harm and suicidal behaviors traditionally exist in this area, and, as a result, the estimates obtained may differ from the true extent. Most countries in this region have predominantly Muslim populations, and in Islam, self-harm and suicide are considered sins. These religious teachings can affect the estimates obtained because families may hide suicide. Raw data are not available for some countries or the data are not up-to-date, and these are extracted and estimated from other countries based on specific methodologies. This uncertainty, as noted in a previous study (Yan et al., 2024), may have affected the estimates.

Conclusion

The findings of this study showed a trend of reducing self-harm and suicide mortality in MENA in recent decades. Self-harm was more common in females than males, but suicide mortality was more common in males. Despite the decrease in the rates of suicide mortality and self-harm, the rates of suicide mortality and self-harm have increased. Therefore, in this context, there is a need to provide structures related to mental health care, screening, prevention, and treatment in a more comprehensive manner, as well as to accurately identify risk factors. Another suggestion involves incorporating mental healthcare into the primary healthcare system. Additionally, providing structured education within families and schools can play a crucial role in enhancing mental health literacy, ultimately helping alleviate the impact of mental disorders.

Funding Statement

The author(s) declare that no financial support was received for the research and/or publication of this article.

Data availability statement

The data sources of this study were taken from GBD 2021, which is publicly available here: https://vizhub.healthdata.org/gbd-results/ https://vizhub.healthdata.org/gbd-compare/.

Author contributions

MABK: Methodology, Visualization, Writing – original draft, Writing – review & editing, Conceptualization, Validation. SA: Methodology, Visualization, Writing – original draft, Writing – review & editing, Formal Analysis.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declare that no Generative AI was used in the creation of this manuscript.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data sources of this study were taken from GBD 2021, which is publicly available here: https://vizhub.healthdata.org/gbd-results/ https://vizhub.healthdata.org/gbd-compare/.

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