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. 2026 May 4;39:e70019. doi: 10.1002/gps3.70019

Global burden, risk factors and projections of self‐harm mortality in adults aged 65+ years: A 60‐year trend analysis from the Global Burden of Disease Study 2021

Jinjie Xu 1, Yiman Guo 1, Zizhao Feng 1, Meiti Wang 2,✉, Chengwei Guo 1,✉, Yuan Feng 1,✉
PMCID: PMC13137939  PMID: 42089096

ABSTRACT

Background

Epidemiological research on self‐harm in older adults (aged 65+ years) remains scarce despite its growing public health significance amid global ageing.

Aims

This study aimed to analyse the global burden, risk factors and projections of self‐harm mortality in adults aged 65+ years from 1990 to 2050.

Methods

Utilising data from the Global Burden of Disease Study 2021, this research examined the spatiotemporal patterns of self‐harm mortality and years of life lost by age, gender and socio‐demographic index (SDI) in adults aged 65+ across 204 countries and territories (grouped into 21 regions) from 1990 to 2021. It also explored the changes during the coronavirus disease 2019 pandemic, identified key risk factors and projected the future burden of self‐harm mortality through 2050.

Results

Global self‐harm deaths among older adults increased from 116 642 in 1990 to 167 920 in 2021, a rise of 43.96%. However, the age‐standardised mortality rate (ASMR) decreased by 39.56%, from 36.83 to 22.26 per 100 000. In 2021, central sub‐Saharan Africa had the highest ASMR at 61.35 per 100 000, while North Africa and the Middle East recorded the lowest at 4.88 per 100 000. Male ASMR was 2.5 times as high as that of females (33.61 vs. 13.58 per 100 000), and adults aged 85 years and older were at particularly elevated risk. High alcohol use was identified as a major risk factor, especially for males. A U‐shaped relationship between ASMR and the SDI was observed, with the lowest point at an SDI of approximately 0.70. Projections indicate a further 46.05% decline in ASMR to 12.01 per 100 000 by 2050.

Conclusions

These results highlight complex global trends in self‐harm mortality and associated risk factors among older adults, emphasising the urgent need for sex‐, age‐, and region‐specific interventions, enhanced social support and systematic risk monitoring to inform age‐friendly self‐harm prevention policies, and sustainable development support goals.

Keywords: Global Burden of Disease, older adults, projections, risk factors, self‐harm

WHAT IS ALREADY KNOWN ON THIS TOPIC

  • Self‐harm is a leading global cause of mortality, with particularly high rates among older adults. Despite the rapidly ageing global population, the self‐harm burden and trends in older adults remain insufficiently documented.

WHAT THIS STUDY ADDS

  • Over the past three decades, the global number of self‐harm deaths among older adults increased, yet the global age‐standardised mortality rate (ASMR) declined.

  • The decline in the global estimated annual percentage change of the ASMR for self‐harm among older adults slowed after the coronavirus disease 2019 pandemic.

  • The burden of self‐harm in older males was significantly higher than that in females, with the risk notably elevated in individuals aged 85 years and older.

  • There were significant differences in self‐harm mortality among older adults across different countries and socioeconomic status.

  • High alcohol use was a leading risk factor for self‐harm mortality in older males.

  • The ASMR among older adults is projected to continue declining through 2050.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

  • The study highlights the need for sex‐, age‐ and region‐specific interventions.

  • It emphasises enhancing social support and risk monitoring for older adults, informing age‐friendly self‐harm prevention policies.

  • It contributes to the progress towards the United Nations' Sustainable Development Goal of reducing self‐harm rates by one‐third by 2030.

INTRODUCTION

Self‐harm, including both nonfatal intentional self‐injury and suicide, represents a leading cause of global mortality, accounting for over 700 000 deaths annually and imposing substantial public health and socioeconomic burdens. 1 Older adults (aged 65 years and older) are disproportionately affected: Despite constituting only 9% of the global population, 2 older adults exhibit the highest self‐harm mortality rate among all age groups, with rates escalating markedly with age. 3 , 4 Concurrently, the global population aged 65 years and older has increased from 6.6% in 1990 to 9.6% in 2021, a figure projected to reach 16% (1.6 billion individuals) by 2050. 5 , 6 This demographic shift poses a formidable challenge to achieving the United Nations' Sustainable Development Goal (SDG) 3.4, which aims to reduce global self‐harm rates by one‐third by 2030. 7

Despite the growing public health urgency of self‐harm in older adults, four critical research gaps persist. First, existing studies often overlook the elevated lethality in this population. 8 Older adults engaging in self‐harm face a 67‐fold increased suicide risk compared to their age‐matched peers. 9 Second, previous studies have shown that 73% of global self‐harm deaths occur in low‐ and middle‐income countries, with males exhibiting higher mortality than females; however, national and regional variations lack granular characterisation. 10 Third, the impact of the coronavirus disease 2019 (COVID‐19) pandemic on self‐harm among older adults is underexplored, despite emerging evidence associating lockdowns with exacerbated loneliness and suicidal ideation in this population. 11 Finally, risk factors for fatal self‐harm in older adults remain unidentified.

This study aims to analyse age‐standardised mortality rates (ASMR) and years of life lost (YLL) among older adults from 1990 to 2021 across geographic, demographic and socioeconomic strata using Global Burden of Disease (GBD) 2021 data to map spatiotemporal disparities. Secondary objectives include (1) assessing pandemic‐related shifts in self‐harm ASMR and YLL, (2) exploring modifiable risk factors for self‐harm and (3) projecting ASMR and YLL trends to 2050. These findings aim to inform evidence‐based, age‐sensitive self‐harm prevention strategies and support progress towards SDG 3.4. This study hypothesises that the ASMR and age‐standardised YLL attributable to self‐harm among individuals aged 65 years and older decreased from 1990 to 2021 but rose following the COVID‐19 pandemic.

METHODS

Data sources

Data were obtained from the GBD 2021 database (https://vizhub.healthdata.org/gbd‐results/), which employs standardised models to estimate the incidence, prevalence, mortality and risk factors of 371 diseases and injuries across 204 countries and territories from 1990 to 2021. The database integrates diverse data sources, including national censuses, civil registration systems, disease registries, household surveys and verbal autopsy records. 12 Data validation and visualisation were performed using the Global Health Data Exchange (https://www.healthdata.org/). We analysed the self‐harm‐related disease burden in adults aged 65 years and older across 204 countries and territories (grouped into 21 regions). This study adheres to the Guidelines for Accurate and Transparent Health Estimates Reporting. 13 Figure 1 depicts the study flowchart.

FIGURE 1.

FIGURE 1

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Study flowchart. ASMR, age‐standardised mortality rate; COVID‐19, coronavirus disease 2019; SDI, socio‐demographic index; YLL, years of life lost.

Study definitions

Self‐harm

Self‐harm encompasses self‐injurious or self‐poisoning behaviours intentionally undertaken by individuals, irrespective of intent, manifesting in forms such as ingesting harmful substances, medication overdoses, burning, cutting or striking the body. 14 These behaviours are categorised into suicidal and non‐suicidal self‐injury. The 2024 Lancet Commission on self‐harm defined self‐harm behaviours resulting in death as suicidal. 15 This study focuses on fatal self‐harm (i.e., suicide), corresponding to the International Classification of Diseases, Tenth Revision (ICD‐10) X60–X84 coding categories. 16

Age‐standardised mortality rate

Self‐harm mortality is defined as the annual number of self‐harm‐related deaths per 100 000 population. ASMR enables comparisons across regions by accounting for variations in age and sex distribution. This study calculated ASMR for individuals aged 65 years and older using the GBD world population as a standard reference. ASMR was determined by direct standardisation, multiplying the crude mortality rates in each 5‐year age group by the proportion of that age group in the standard population, and summing these products. Sex differences were analysed using the female‐to‐male ASMR ratio.

Years of life lost

YLL serves as a crucial metric in the burden of disease studies, quantifying life lost due to premature mortality and representing disease‐specific mortality impacts. YLL is calculated as YLL = N × L, where N represents the number of deaths from a specific disease in an age group over a defined period (usually 1 year), and L denotes the standardised life expectancy for that age group. Age‐adjusted YLL calculations account for regional variations in population age structures, enabling more precise comparisons of disease burden across populations. 17

Estimated annual percentage change

The estimated annual percentage change (EAPC) quantifies temporal trends of disease indicators, representing the annual rate of increase or decrease over a defined period. 18 It is derived from a linear regression model expressed as follows: Y = α + βΧ + ϵ, where Y is the natural logarithm of the age‐standardised rate (ASR), X is the calendar year, α is the intercept, β is the slope and ϵ is the error term. The EAPC is calculated as EAPC = (e β−1) × 100, which indicates the annual percentage change. A linear regression model was employed to estimate the 95% confidence intervals (CIs) for the EAPC. An upward trend was defined as a 95% CI with a lower bound > 0, while a declining trend was defined as a 95% CI with an upper bound below 0. A 95% CI containing 0 indicates a stable ASR trend. 19

Socio‐demographic index

The socio‐demographic index (SDI) is a composite indicator that reflects the health‐related level of development of a country or a region based on birth rate, education level and economic status. SDI ranges from 0 to 1, with higher scores indicating greater socio‐demographic development. Based on SDI scores, the 204 countries and territories (grouped into 21 regions) included in this study were classified into five groups: high (0.81–1), high–moderate (0.69–0.81), moderate (0.61–0.69), low–moderate (0.45–0.61) and low (0–0.45). 12

Risk factors

Estimates of attributable burden from risk factors in GBD 2021 followed the comparative risk assessment framework established in 2002. 3 This study included all self‐harm risk factors available in the GBD 2021 database, encompassing primary, secondary and tertiary categories. In instances of overlap between factors at different hierarchical levels, data from the lower hierarchical level were retained. The risk factors for self‐harm as stipulated in GBD 2021 are high temperature, low temperature, drug use and high alcohol use. In the GBD 2021, high temperature is defined as a daily average temperature surpassing the theoretical minimum risk exposure level (TMREL). TMREL represents the exposure level of a risk factor that corresponds to the lowest burden of disease or mortality risk for a particular population at a specific time and location. 20 The population‐weighted average high temperature is 25.6°C, with a range from 21.3°C to 26.6°C. Low temperature is defined relative to the local TMREL and lacks a fixed value. Any daily average temperature below the TMREL is considered low‐temperature exposure. 21 , 22 In GBD 2021, the prevalence of opioid, amphetamine and cocaine use disorders served as exposure indicators for self‐harm risk. These disorders were defined according to the Diagnostic and Statistical Manual of Mental Disorders or the ICD diagnostic criteria. The TMREL for drug use was set at zero exposure. 21 High alcohol use is defined as alcohol consumption in excess of the TMREL, the level of alcohol consumption at which all‐cause risk is minimised. 21

Bayesian age‐period‐cohort model

The Bayesian age‐period‐cohort (BAPC) model is a statistical approach used to analyse and forecast demographic and epidemiological data, particularly accounting for age, period and cohort effects. 23 Due to the inherent linear dependency among these three dimensions, individually isolating their effects is challenging. 24 Bayesian modelling techniques incorporate prior information with empirical data, enabling robust uncertainty quantification. Furthermore, the BAPC model effectively manages complex data structures, generates probabilistic prediction intervals, evaluates uncertainty in projections and analyses temporal variations in outcomes. 25 This study applied a hierarchical Bayesian framework to assess age, period and cohort effects on self‐harm mortality variability. 26 Parameters were estimated using Markov chain Monte Carlo simulations with 100 000 iterations, discarding the initial 20% as burn‐in. Model fit was assessed using the Watanabe–Akaike Information Criterion. 27

The BAPC model was structured as follows: 28 , 29 Yapc ∼ Poisson (λapc·Napc), where Yapc represents the number of self‐harm deaths in age group a, period p and cohort c. λapc is the predicted rate, and Napc is the exposed population size stratified by sex.

The linear part of the model can be written as follows: log(μa, p, c) = αa + βp + γc, where αa denotes the age effect, βp the period effect and γc the cohort effect.

Statistical analysis

We evaluated ASMR and age‐standardised YLL due to self‐harm among individuals aged 65 years and older, stratified by geographic region, sex and age group. Temporal trends were analysed using Descriptive Epidemiological Meta‐Regression (DisMod‐MR), with 95% uncertainty intervals (UIs) computed based on the 25th and 975th values of the posterior distribution containing 1000 ordered level estimates. 1 Spatial trends were assessed annually across 204 countries and territories, and we explored the global association between SDI and self‐harm burden among older adults. The roles of risk factors influencing sex‐ and age‐specific self‐harm mortality and YLL were investigated. Future projections of ASMR and YLL rates for the period from 2022 to 2050 were generated using the BAPC model. Statistical analyses were conducted using R software (Version 4.2.2). Custom code was employed to produce the core results of this study. The BAPC model was constructed using the ‘BAPC’ package (0.0.36). Detailed analytical methods have been reported previously. 12

RESULTS

Global trends

From 1990 to 2021, global self‐harm‐related deaths among older adults increased by 43.96%, rising from 116 642 (95% UI 97 598–125 024) to 167 920 (95% UI 147 406–185 284). Despite this rise, the ASMR declined significantly by 39.56%, from 36.83 per 100 000 (95% UI 30.81–39.48) to 22.26 per 100 000 (95% UI 19.50–24.58) (table S1). Concurrently, self‐harm‐related YLL increased from 2 139 965 (95% UI 1 790 923–2 294 742) to 2 957 164 (95% UI 2 615 626–3 255 254), while age‐standardised YLL rates decreased by 40.79%, from 646.80 per 100 000 (95% UI 541.09–693.60) to 382.97 per 100 000 (95% UI 338.17–421.78) (table S2).

Regional trends

In 2021, the ASMR in central sub‐Saharan Africa, eastern sub‐Saharan Africa and western sub‐Saharan Africa ranked among the top three of the 21 GBD regions. In contrast, North Africa and the Middle East exhibited the lowest ASMR, followed by Andean Latin America and Central Latin America (table S1). The regional distribution of age‐standardised YLL rates mirrored ASMR patterns (table S2).

National trends

In 2021, ASMR for self‐harm among older adults varied substantially across 204 countries and territories. The Republic of Mozambique, the Republic of South Sudan and the Central African Republic reported the highest ASMR, while the Lebanese Republic, the Syrian Arab Republic and Palestine recorded the lowest (table S3A). National trends in age‐standardised YLL rates aligned with ASMR findings (table S3B). From 1990 to 2021, ASMR decreased in 156 countries, with Qatar, Sri Lanka and Jordan showing the most pronounced reductions. ASMR remained stable in 20 countries (e.g., Djibouti) and increased in 28 countries, notably the Republic of Korea, Ecuador and Honduras (table S3C). Trends in age‐standardised YLL rates corresponded closely with ASMR patterns (table S3D).

Self‐harm burden changes before and after COVID‐19

Globally, the EAPC in ASMR was −1.92 (−2.09 to −1.76) for 1990–2021 and −0.70 (−0.87 to −0.52) for 2019–2021. During the COVID‐19 pandemic (2019–2021), 10 of 21 GBD regions experienced slower annual declines in ASMR. High‐income Asia Pacific, Central Latin America and central sub‐Saharan Africa shifted from negative to positive EAPC trends (table S1). Similarly, 9 of 21 GBD regions showed reduced declines in age‐standardised YLL rates, with Central Latin America and central sub‐Saharan Africa transitioning to positive EAPC values (table S2).

Sex and age trends

In 2021, the ASMR for self‐harm in older females was 40% of that in males globally (ratio: 0.40), with notable regional variations. Central Latin America demonstrated the largest sex gap (ratio: 0.13), whereas East Asia had the smallest (ratio: 0.59) (table S1). ASMR peaked in the 85–89 age group globally (figure 2A; table S4A). YLL age distributions differed slightly, peaking among males aged 85–89 years and females aged 70–74 years (figure 2B; table S4B).

FIGURE 2.

FIGURE 2

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Age‐specific mortality (A) and YLL rates (B) from self‐harm in older adults, by the region and sex, 2021. YLL, years of life lost.

SDI regional trends

The ASMR for self‐harm in older adults demonstrated a significant negative correlation with the SDI (r = −0.32 and p < 0.001). ASMR reached its minimum at SDI ≈ 0.70 but increased when SDI > 0.70 (figure 3A; table S5A). Age‐standardised YLL rates exhibited a similar SDI relationship (figure 3B; table S5B). Distinct ASMR‐SDI patterns emerged across GBD regions: stable (East Asia and South Asia), consistent decline (eastern sub‐Saharan Africa, Andean Latin America and high‐income Asia Pacific), increase (North Africa and Middle East), fluctuating (Central Latin America), U‐shaped (Eastern Europe) and inverted U‐shaped (southern sub‐Saharan Africa) (figure 4A; table S6A). Age‐standardised YLL rate patterns matched ASMR trends (figure 4B; table S6B).

FIGURE 3.

FIGURE 3

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SDI stratified age‐standardised mortality (A) and YLL rates (B) for self‐harm in older adults, 2021. SDI, socio‐demographic index; YLL, years of life lost.

FIGURE 4.

FIGURE 4

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Age‐standardised mortality (A) and YLL rates (B) for self‐harm in older adults across 21 GBD regions by SDI, 1990–2021. GBD, Global Burden of Disease; SDI, socio‐demographic index; YLL, years of life lost.

Attributable burden by risk factors

In 2021, low temperature acted as a protective factor for ASMR and age‐standardised YLL rates, with no significant sex differences (figure S1A, B; table S7A, B). High alcohol use emerged as the primary risk factor for self‐harm mortality, disproportionately affecting males. High temperature and drug use also contributed to risk but lacked sex‐specific significance (figure S1C, D; table S7C, D).

Prediction of the self‐harm mortality burden

BAPC model projections indicate continued global declines in ASMR and age‐standardised YLL rates from 2022 to 2050. By 2050, the ASMR is projected to reach 12.01 (95% UI 9.82–14.20) per 100 000 population, representing a 46.05% reduction from 2021 levels (figure S2A; table S8A). Similarly, age‐standardised YLL rates are expected to decline to 206.35 (95% UI 162.95–249.74) per 100 000 population, reflecting a 46.12% decrease (figure S2D; table S8D). Comparable trends were observed for males and females (figure S2B, C, E, F; table S8B, C, E, F).

DISCUSSION

Main findings

This study reveals a dual trend in global self‐harm mortality among older adults from 1990 to 2021: a 43.96% increase in absolute deaths alongside a 39.56% decline in ASMR. This divergence reflects the interplay between population ageing and effective public health interventions. According to Kirk's demographic transition theory, global populations have entered Stage IV, characterised by low fertility and mortality. 30 Over this period, the proportion of older adults rose from 6.6% to 9.6%, while the global population grew from 5.30 to 7.92 billion, 31 driving higher absolute self‐harm deaths. Conversely, the reduced ASMR reflects advancements in self‐harm prevention. Between 1990 and 2021, changes have occurred in firearm control, psychotropic drug use and geriatric depression screening. Firearms remain the predominant method of self‐harm among older adults. In 2021, firearms were involved in 78.4% of self‐harm deaths among men and 37.9% among women in this age group in the United States. 32 Firearm control policies, such as Australia's 1996 National Firearms Accord, have been associated with a 50% reduction in firearm‐related self‐harm. 33 In addition, the increase in the utilisation rate of psychotropic drugs reflects improvements in mental health treatment. Between 2008 and 2019, psychotropic drug usage increased across 65 countries and regions, with an average annual growth rate of 4.08%. The usage of antidepressants exhibited the most rapid increase at 3.5%, followed by antipsychotics at 2.49%. 34 Moreover, widespread geriatric depression screening, exemplified by Japan's ‘Healthy Japan 21’ programme, 35 is a key intervention that has significantly mitigated self‐harm risks.

Regional analysis identified marked disparities: Central sub‐Saharan Africa exhibited the highest ASMR in 2021, whereas North Africa and the Middle East showed the lowest rates. Such variations reflect global inequities in mental health resource distribution. In sub‐Saharan Africa, severe resource shortages—approximately one psychiatrist per 500 000 people, far below World Health Organization recommendations—combined with cultural stigma, significantly restrict timely professional intervention. 36 , 37 , 38 Conversely, North Africa and the Middle East benefit from Islamic teachings discouraging self‐harm 39 and strong intergenerational support systems, 40 with Saudi studies showing that religious leader involvement reduces suicidal ideation. 41

The COVID‐19 pandemic led to a slowdown in the decline rate of ASMR among older adults compared with pre‐pandemic levels. Evidence suggests heightened suicidal ideation among patients with COVID‐19 and their close contacts relative to the general population. 42 Older adults face amplified vulnerability due to weakened immunity, multiple chronic conditions and increased social isolation. Additionally, insufficient healthcare resources in rural and remote areas impeded timely mental health interventions, further exacerbating self‐harm risk among older populations. 11 , 43

This study confirmed a significantly higher self‐harm ASMR among older males than females globally, with an overall sex ratio of 2.5:1. However, substantial regional variation exists. In Latin America, self‐harm mortality among males is up to 7.7 times as high as that among females, while East Asia exhibits a more balanced sex ratio. These disparities reflect intricate interactions between sociocultural norms and biological factors. The prevailing ‘machismo’ culture in Latin America discourages males from seeking mental health support, exacerbating self‐harm risk. 44 Additionally, alcohol use disorders are 1.7 times more prevalent among males than females, further amplifying self‐harm risk. 45 Sex differences in self‐harm methods also play a role, with males more likely to select highly lethal methods, such as firearms, while females more commonly use overdose. 46 , 47 Age‐specific analyses revealed that mortality rates peaked among individuals aged 85 years and older, aligning with the cumulative disadvantage theory, which posits the accumulation and intensification of psychosocial and physical adversities in an advanced age. 48 Chronic pain, affecting 27.5% of older adults globally, 49 along with multiple bereavements—where nearly a quarter of widowed older adults experience prolonged grief or chronic depression 50 —and cognitive decline, which is associated with a 1.66–1.73‐fold increase in suicidal ideation among individuals with mild cognitive impairment, collectively form a ‘despair triad’. 51 This triad initiates the ‘loneliness–hopelessness–self‐harm’ behavioural chain. 52 , 53 The German young–old shared housing programme has demonstrated efficacy in reducing self‐harm risk in this demographic. 54 Additionally, a combined psychological pain management programme, utilising non‐opioid analgesics and cognitive behavioural therapies, effectively alleviates the psychophysiological burden among individuals aged 85 years and older. 55

The study identified a U‐shaped relationship between the SDI and ASMR attributable to self‐harm among older adults, with the lowest risk observed at an SDI of approximately 0.70. This non‐linear pattern highlights increased vulnerability during social transitions. Countries with a medium SDI, such as China and Brazil, may experience a ‘golden equilibrium’, where traditional family support coexists with emerging welfare systems. In these contexts, intergenerational family support remains robust, with over 80% of middle‐aged and older adults providing support to at least one generation. 56 , 57 Concurrently, primary healthcare coverage is extensive (e.g., China's health insurance participation rate exceeds 95%), and community mental health services, like Brazil's ‘Family Health Programme’, increasingly complement existing systems. 58 , 59 Conversely, high SDI countries, such as Japan, encounter the combined challenges of hyper‐ageing and individualised societies. These findings underscore that social development is non‐linear, necessitating tailored protection networks for various transitional vulnerabilities. For instance, in low SDI countries, reinforcing traditional support systems and expanding basic mental health services are crucial. Middle SDI countries may benefit from policies aimed at preventing concurrent gaps in family and institutional support systems. In high SDI countries, reducing social isolation and rebuilding social connections should be prioritised, potentially through technology‐enabled interventions.

This study identified alcohol use as a significant risk factor for self‐harm ASMR among older adults, particularly in males, aligning with previous research. 60 Alcohol use is known to interact synergistically with depressive disorders and adverse life events, exacerbating self‐harm risk. 61 These findings underscore the need to address modifiable risk factors, including alcohol use, in self‐harm prevention strategies. 62 The alcohol‐attributable burden was significantly higher in males than females, consistent with prior research indicating that the ASMR of males with high alcohol use disorders was approximately 2.88 times that of females. 63 Interestingly, this analysis also suggested a protective effect associated with low temperature. Although this finding appears contradictory to documented increases in self‐harm rates during winter months in colder regions, such as Northern Europe, it likely reflects the complexity inherent in macroecological relationships influencing self‐harm risk.

Using the BAPC model, this study projects a continued decline in the global ASMR attributable to self‐harm among older adults, reaching 12.01 per 100 000 by 2050, representing a 46.05% reduction relative to 2021. However, emerging factors such as climate change and artificial intelligence (AI)‐based interventions may substantially alter this trajectory. Evidence suggests that global average temperatures could increase by 2°C–4°C over the next two decades. 64 Additionally, each additional heatwave (defined as a daily maximum temperature exceeding 35°C) is associated with a 3.5% increase in self‐harm rates. 65 , 66 Heatwaves can elevate the risk of self‐harm among older adults by triggering delirium. 67 Current forecasting models do not incorporate this climate‐sensitive variable, potentially leading to an underestimation of ASMR under high‐emission scenarios. Simultaneously, the rapid integration of AI‐based interventions has been linked to reductions in impulsive self‐harm, 68 , 69 , 70 although such technologies may also exacerbate health disparities across regions with varying SDI levels. 16 , 71

Limitations

This study has several limitations. Firstly, the GBD study utilised diverse data sources, such as national health surveys, disease surveillance systems and relevant literature, which may be incomplete or inaccurate. Self‐harm, particularly when associated with suicidal intent, is often stigmatised due to religious, cultural and legal factors, leading to under‐reporting, especially in regions where self‐harm is criminalised. Second, despite employing the latest GBD 2021 estimates, inherent limitations in the GBD data could influence our conclusions. The restricted time span (1990–2021) requires caution when generalising findings beyond this period. Moreover, the limitations in the GBD data restricted this study from thoroughly analysing several common factors influencing self‐harm, such as childhood experiences, mental health and family dynamics. Third, the GBD study's definitions and categorisations of self‐harm may not align with clinical diagnoses, potentially impacting the interpretation of results. Lastly, the cross‐sectional nature of our study precludes establishing causal relationships. Future research should consider individual‐level cohort studies to validate these associations.

Implications

The study observed a 43.96% rise in the absolute number of global self‐harm deaths among older adults alongside a 39.56% reduction in ASMR from 1990 to 2021, underscoring the impact of ageing and improvements in prevention. Significant regional disparities exist, with central sub‐Saharan Africa experiencing the highest burden and North Africa and the Middle East the lowest. Males exhibited a mortality rate 2.5 times higher than females, with the risk notably elevated among individuals aged 85 years and older. High alcohol use emerged as a key risk factor, with a greater attributable burden in males. Projections indicate that ASMR will continue to decline through 2050. These findings underscore the urgent need for developing a tiered intervention system that addresses sex, age and regional characteristics while enhancing social support and risk monitoring for older adults.

AUTHOR CONTRIBUTIONS

Jinjie Xu: Conceptualization; formal analysis; methodology; software; supervision; visualization; funding acquisition; writing—original draft; writing—review and editing. Yiman Guo: Conceptualization; formal analysis; methodology; software; writing—original draft; writing—review and editing. Zizhao Feng: Supervision; writing—review and editing. Meiti Wang: Supervision; writing—review and editing. Chengwei Guo: Supervision; writing—review and editing. Yuan Feng: Conceptualization; funding acquisition; project administration; supervision; writing—review and editing. Yuan Feng is responsible for the overall content as the guarantor, accepts full responsibility for the work and/or the conduct of the study, has access to the data, and controls the decision to publish.

FUNDING

This study was funded by Capital Health Research Development Special Project (2024‐2‐2124), Beijing Municipal Administration of Hospitals Incubating Program (PX2024068) and Beijing Anding Hospital, Capital Medical University (2024, No. 23).

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

ETHICS STATEMENT

Data were obtained from the GBD 2021 database (https://vizhub.healthdata.org/gbd‐results/). Data validation and visualisation were performed using the Global Health Data Exchange (https://www.healthdata.org/). Therefore, ethical approval documents are not required for this study.

PATIENT CONSENT FOR PUBLICATION

Not applicable.

Supporting information

Figures S1 and S2

GPS3-39-e70019-s001.docx (1.3MB, docx)

Tables S1–S8

GPS3-39-e70019-s002.xlsx (292.7KB, xlsx)

ACKNOWLEDGEMENTS

We appreciate the excellent work of the GBD 2021 collaborators.

Biography

Jinjie Xu earned her master's degree from Shanghai Jiao Tong University in China and is currently a psychiatrist at Beijing Anding Hospital in China. Her main research interests include mood disorders and public mental health.

graphic file with name GPS3-39-e70019-g004.gif

Contributor Information

Meiti Wang, Email: 15216651601@163.com.

Chengwei Guo, Email: gcw817gcw817@163.com.

Yuan Feng, Email: 19558051@qq.com.

DATA AVAILABILITY STATEMENT

Data are available in a public, open access repository. Data in this article were collected from the Global Health Data Exchange (https://vizhub.healthdata.org/gbd‐results/).

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Associated Data

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

Supplementary Materials

Figures S1 and S2

GPS3-39-e70019-s001.docx (1.3MB, docx)

Tables S1–S8

GPS3-39-e70019-s002.xlsx (292.7KB, xlsx)

Data Availability Statement

Data are available in a public, open access repository. Data in this article were collected from the Global Health Data Exchange (https://vizhub.healthdata.org/gbd‐results/).

Articles from General Psychiatry are provided here courtesy of Shanghai Mental Health Center

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