Descriptive study of the epidemiological profile of deaths by suicide in the state of Roraima , Brazil , from 2014 to 2017

Introduction: Suicide is one of the top three reasons of death worldwide for the 15to 44-year age range. The Brazilian state of Roraima has shown indicators that draw attention when compared to national rates of suicide. In this sense, for the proposal of preventive measures appropriate to the state’s reality, it is important to understand the local epidemiological particularities. Objective: to identify the epidemiological profile of deaths by suicide in the state of Roraima, Brazil, between 2014 and 2017. Methods:  Descriptive, population-based documentary research. The source of information was the database from the Brazilian public health system (DATASUS). The analysis included deaths by residence caused by suicide from 2014 to 2017. Cut-outs were established according to the variables incidence by municipality, marital status, age, gender, color/race, place of occurrence and method of suicide. Results: 176 deaths were reported in the state of Roraima during the period studied. The average mortality coefficient was 8,6/100.000 inhabitants. Deaths  were more frequent among men (73.9%), aged 20 to 29 years (31.2%), resident in the state capital (52.8%), brown (64.2%) or indigenous (25.6%) and single (69.9%). The  main suicide method was hanging, strangulation and suffocation (87.5%), with the domicile being the most usual place (72.1%). Conclusion: The results imply the need to act on the problem, which grows in proportion and gains prominence in the national indicators. Suspicion of suicidal behavior in the face of consolidated data may reduce the incidence.


INTRODUCTION
Suicide is among the top three causes of death between 15 and 44 years of age in the world 1 . Ideation, planning and evaluation of the possible impact caused on people are part of the suicidal behavior spectrum 2 . Such actions, in general, aim to resolve unbearable issues for the individual, starting from conception to the consummation of suicide, an act of intentional and self-harm with fatal outcome 2 . Suicide is also responsible for being one of the oldest themes related to individual and community health. In historical terms, it is studied with exclusion identified since Ancient Greece, today being a social phenomenon that is recurrently worked on 3 . It is a serious public health problem, Macedo  Globally, suicide is stigmatized, treated as a taboo and marked as "unspoken" 11 . Reporting death generates commotion and fraternity. However, when the cause of suicide is exposed, there is sometimes embarrassment and silence. The topic is avoided socially and, in general, the population tends to hide this serious action against the natural flow of life 11 .
Thus, in order to build effective preventive strategies that are appropriate to the reality of the State of Roraima, once certain suicide indicators are perceived as leading national rates, it is important to study the local epidemiological particularities.
Given the above, the objective of this work is to describe the epidemiological profile of suicide mortality in the state of Roraima, Brazil. It is intended to collect and analyze data that supports future research in the field and serves as guidance in the construction of public policies to face this problem.

METHODS
Descriptive, population-based documentary research. As a source of information, the platform of the informatics of the    Total  2014  1  5  4  3  1  1  ---15  2015  6  8  23  5  5  2  3  --52  2016  4  15  18  9  8  3  1  -1  59  2017  3  9  10  13  6  3  3  3  -50  Total  14  37  55  30  20  9  7  3 1 176 -Numeric data equal to zero, not resulting from rounding.  The literature shows that suicide mortality rates are underestimated, thus making it difficult to obtain a more accurate measure to avoid this type of death 6 . When analyzing a study on suicide, data underreporting is one of the most critical aspects and, therefore, This fact corroborates the perception that the sociodemographic factors linked to a higher risk of suicide include being male 15 .
Again, however, underreporting in cases of death in women cannot fail to be considered in the interpretation of the reasons obtained, given the remarkable imbalance found.
Another predominant factor in relation to individuals who committed suicide is that, in all the years of study, the majority were residents of Boa Vista. This is explained by the capital's characteristic of concentrating almost two thirds of the population of Roraima, being the main urban center of the State 13 .
Regarding age, the most observed age groups (from 20 to 29 and from 15 to 19 years old) coincide with other studies and literature, which refer to greater involvement in the 15-year-old age groups 14,15,18,19 . It is documented that suicide, as it mainly affects young people and young adults, impacts on the socioeconomic, family, and community fields. Until adolescence, abuses of all kinds and issues such as sexual orientation are important triggers, and difficulties in relationships with family members, partners and isolation are also relevant 4 .
Roraima recorded, in line with other states in national studies 18,20 , during the period evaluated, that the main mechanism for committing suicide was hanging, strangulation or suffocation.
The use of hanging as a method is a challenge to prevention, as it is a highly lethal mechanism and can be carried out with homemade materials 21 . Nevertheless, several evidences point to the preventive efficiency of the restriction of access to firearms and toxic compounds 1,21 methods that also appear in those observed in this study, in lower frequencies.
The percentage of suicides in terms of skin color, in Roraima, predominated among browns. There are divergent data in a study in a municipality in southern Brazil 15 , which found a death rate of 86.6% for white individuals, but the brown portion of the population was also a majority in a study in the State of Pará 18  The most common place of death in Roraima was home. Other national studies have described similar results 18,20,23 . This again corroborates the relationship with the most common method in Roraima (hanging, strangulation and suffocation), which causes high lethality in a short period of time and demands materials common to the domestic environment 21,24 .
In terms of marital status, single people died in greater proportion, similar to other national studies 18,20,23 . In a survey conducted in Teresina, Piauí, Brazil, it was shown that social isolation is an important risk factor for suicidal practice, with a percentage of 54.9% of deaths among singles 25 , while in a study conducted in Santa Catarina it was found 26.5% 25,26 . The relationship between a higher risk of suicide among single, widowed and divorced people is documented 27,28 , and these factors are recognized as triggers of dissatisfaction and stress 23 .
The understanding of the peculiarities and indicators related to suicide in Roraima should guide the prevention of mortality from such cause in the State. The observed results indicate the need to act in face of the problem, which both grows in proportion and gains prominence in the face of regional and national indicators. There is, in view of the data, the perception of remarkable characteristics of the suicide profile in Roraima: they are more frequent among men, young people, residents in urbanized areas, browns or indigenous people and singles. Victims generally opt for methods with high lethality and immediacy -hanging, strangulation and suffocation, with the place of the execution at home.
Such factors hinder the intervention and performance of health services. It is imperative, therefore, to carry out targeted and efficient prevention.
For that, it is important to have detailed knowledge of risk factors on the part of health professionals and the community.
Suspecting suicidal behavior in the face of local epidemiology can reduce new cases, given that suicide has no single reason, but results from a complex interplay of factors, making it difficult to establish conducts when the evidence is unknown.
It is believed that it is necessary to deepen the study in order to expand knowledge, in order to achieve the prevention dimension.
Thus, it will be possible to structure care for people who exhibit risky behaviors, as well as to plan strategies that can minimize situations or experiences of risky experience, highlighting prevention efforts, treating cases of depression in general health services and reducing the risk of suicide.

ACKNOWLEDGMENTS
We would like to thank Mr. Alísio Steiner Soares de Macedo for the great technical contribution, which made the study possible.