Divergent suicide mortality trends across South America, 2000–2021: a 12-country joinpoint regression analysis by sex

Suicide mortality trends across South America are diverse and remain poorly characterized at the regional level. Most regional studies of the past few years have focused narrowly on whether the COVID-19 pandemic produced a short-term change; far fewer have placed the pandemic within the longer trajectory of suicide mortality. No prior study has analyzed all twelve South American countries simultaneously using a uniform methodology, disaggregated by sex, across the full 2000–2021 period. Ecological time-series study using WHO Global Health Observatory age-standardized suicide mortality estimates for the twelve South American countries. Log-linear joinpoint regression was applied to each of the 36 country–sex strata to estimate segment-specific Annual Percent Change (APC) and the full-period Average Annual Percent Change (AAPC). The false discovery rate (Benjamini–Hochberg) procedure was applied across all segment estimates to correct for multiple comparisons. A population-weighted regional trend was computed, and the male-to-female mortality ratio was analyzed across the full series with decomposition into male and female contributions. After correction, 66 estimates remained statistically significant (43 segment-specific APCs and 23 full-period AAPCs). National trajectories were diverse (AAPC from − 2.24% in Chile to + 3.23% in Paraguay) and were grouped into five temporal profiles. The population-weighted regional rate was stable through the 2000s and rose modestly after 2015. Set against two decades of change, the 2019–2021 window was unremarkable: the most pronounced changes were declines in Chile (− 12.65%), Argentina (− 8.61%), and among Bolivian women (− 19.68%), and no country showed a significant increase. Suicide mortality followed diverse, country-specific trajectories, with no evidence of a pandemic-related increase within the observed window. Viewing the full 2000–2021 series shows that pre-pandemic inflections were often larger than any pandemic-period change, a perspective missed by studies centered on COVID-19 alone. Prevention priorities include both countries with rising trends and those with sustained high burden.