Suicide Prevention as a Pillar of Sustainable Mental Health: Policy and Practice in the Post-COVID-19 European Union

1. Introduction

Mental health is a cornerstone of sustainable development, yet suicidality continues to be a major public health concern across the European Union (EU) [1,2]. The COVID-19 pandemic exposed and exacerbated existing vulnerabilities in mental health care systems, prompting renewed attention to suicide prevention as a fundamental goal of health policy [3]. The relevance of suicide prevention to sustainable development is underscored by its inclusion in Goal 3 of the United Nations (UN) Sustainable Development Goals (SDGs), which addresses “Good Health and Well-being”. While the target of Goal 3 primarily tracks suicide mortality rates, these rates represent an important population-level indicator of overall mental health, particularly in the absence of other routinely collected epidemiological data with nationwide geographical coverage [4].

National suicide prevention programs were introduced in the 1990s in an effort to effectively address suicidality [5]. To date, approximately 29 countries have published national strategies, mostly aiming at identifying vulnerable groups, improving care for those with self-injurious behaviour, and enhancing research and surveillance [6]. Such programs also focus on raising awareness and reducing the stigma around suicide and mental disorders [7]. The World Health Organization (WHO), the International Association for Suicide Prevention (IASP) and other relevant organizations have set guidelines, emphasizing the need for: (a) addressing both suicide and self-injury (suicidal and non-suicidal), (b) strengthening the support of rehabilitation of at-risk individuals, (c) mobilizing national governments to scaling-up financial and technical support, (d) setting measurable objectives and conducting methodologically robust research on a regular and systematic basis [7].

Based on this approach, a set of recommendations and policies to prevent suicidality as part of a broader approach to mental health practices and promotion of well-being have evolved to address sustainability in the post-COVID era [8]. By examining the diverse mental health practices across the EU in relation to suicidality following the aftermath of the COVID-19 pandemic, the objective is to determine whether it has accelerated or hindered progress towards good mental health and well-being in the context of sustainable development.

The present review aimed to evaluate and compare the current national suicide prevention strategies within the EU, with particular attention to post-pandemic developments. It explored how EU member states adapted their health policies to address suicidality in a sustainable manner, identified demographic and socio-cultural vulnerabilities, and highlighted best practices and future directions for equitable and resilient mental health systems.

2. Materials and Methods

2.1. Conceptual Orientation and Design of the Review

The study adopted a narrative review methodology aiming to synthesize and interpret existing literature on suicide epidemiology and prevention strategies across the European Union (EU). Narrative reviews are particularly suited for examining complex public health issues that involve heterogeneous evidence sources, including epidemiological studies, policy analyses, and program evaluations. Unlike systematic reviews, which aim to aggregate findings through strict protocols and quantitative synthesis, narrative reviews allow for a broader interpretive integration of diverse types of evidence.

This approach was considered appropriate because suicide prevention policies in Europe involve multiple dimensions, including demographic trends, behavioral risk factors, health system responses, and policy implementation mechanisms. The narrative review therefore enabled the integration of empirical findings with policy documentation and surveillance reports in order to provide a comprehensive understanding of how suicide prevention strategies have evolved across EU member states, particularly in relation to the societal disruptions associated with the COVID-19 pandemic.

2.2. Aim and Research Questions

The aim of the present narrative review was twofold: (i) to describe and compare national suicide prevention strategies within the EU, and (ii) to examine demographic, temporal, behavioral, and contextual factors associated with suicidality in the EU, before and after the COVID-19 pandemic. Within this framework, the review sought to synthesize epidemiological evidence together with policy developments to identify patterns, risk determinants, and prevention priorities across the region.

Accordingly, the review focused on the following objectives:

A) Description of gender- and age-specific patterns of suicide in Europe, also giving emphasis on adolescents and young adults, who have been identified as a priority group in several prevention frameworks.

B) Examination of gender differences in suicide methods and their implications for means-restriction and other evidence-based preventive strategies.

C) Identification of seasonal and temporal variations in suicide rates, and flucations across demographic groups.

D) Exploration of the relationship between non-suicidal self-injury, substance use, and suicide risk.

E) Assessment of the contribution of surveillance systems, data quality, and media practices to the design and effectiveness of suicide prevention strategies.

These objectives collectively guided the selection, analysis, and synthesis of the relevant data.

2.3. Literature Search Strategy

A purposive literature search was employed to identify relevant scientific publications, epidemiological data sources and policy reports published from 2000 to 2025. This period was chosen as relevant to the development of several national suicide prevention strategies within Europe as well as the emergence of the COVID-19 pandemic and its potential psychosocial consequences. Databases searched included PubMed, Scopus, PsychInfo, Embase and Google Scholar.

Search terms were developed based on the research objectives and included combinations of keywords related to suicide epidemiology and prevention policies, and included: suicide, suicidal behaviour, suicide prevention, self-harm, non-suicidal self-injury, substance use, suicide methods, gender differences, youth suicide, seasonality, European Union, and national suicide prevention strategies. Boolean operators (AND, OR) were applied to refine the search and identify relevant combinations of terms. This search was last updated on March 2026.

In addition to peer-reviewed literature, grey literature sources were systematically consulted in order to capture policy documents and official reports that are often not indexed in academic databases. These included publications from international organizations, European institutions, and national public health authorities. Particular attention was given to documents addressing suicide monitoring systems, policy frameworks, and post-pandemic mental health responses.

The search strategy also incorporated reference list screening and citation tracking of key publications in order to identify additional relevant sources.

2.4. Study Selection and Eligibility Criteria

The selection of data followed a structured screening process based on predefined inclusion and exclusion criteria.

Inclusion criteria comprised: a) peer-reviewed empirical studies or systematic analyses addressing suicide or suicidal behaviour in European populations, b) publications examining suicide prevention policies, national strategies, or public health interventions within EU member states, c) studies focusing on demographic patterns, suicide methods, temporal trends, or associated behavioural risk factors, d) reports and policy documents from reputable governmental or international organizations, e) publications written in English and published between 2000 and 2025.

Studies conducted outside Europe unless they provided relevant comparative insights for EU policy development, as well as publications lacking empirical, epidemiological, or policy relevance were excluded, as did duplicated records or sources with insufficient methodological information.

The selection process involved an initial title and abstract screening, followed by full-text review to confirm the relevance of the selected studies to the objectives of the narrative review.

2.5. Data Extraction, Organization and Synthesis Approach

Relevant data from the selected literature was systematically extracted and organized to facilitate comparative analysis. Specifically, this data was organized in thematic matrices to allow the identification of recurring patterns, differences between countries, and emerging policy trends. This process facilitated the integration of epidemiological findings with policy-level evidence. Then, the emerged data was analyzed using a thematic narrative synthesis approach. This involved identifying recurring themes across data and integrating findings within broader conceptual categories relevant to suicide prevention. The analysis focused on the following thematic domains: (a) demographic and gender differences in suicide patterns, (b) preferred suicide methods and implications for means restriction policies, (c) seasonal and temporal variations in suicide rates, (d) behavioral risk factors such as non-suicidal self-injury and substance use, (e) structural and policy-related determinants, including surveillance systems and media reporting practices.

Through this process, the review sought to identify commonalities and contrasts in epidemiological trends and policy implementation across EU member states. Particular attention was given to changes observed before and after the COVID-19 pandemic, as this period has been associated with substantial social, economic, and mental health challenges.

Consistent with narrative review methodology, this manuscript adopts an integrated results–discussion structure. Within this format, findings are presented together with their interpretative commentary in thematic subsections, enabling a continuous synthesis of evidence and facilitating the contextualization of epidemiological and policy-related insights across the reviewed literature.

2.6. Ensuring Transparency and Methodological Rigor

Although narrative reviews do not follow the strict protocols of systematic reviews, several measures were implemented to enhance transparency and methodological rigor. These included the explicit definition of research objectives, the use of multiple academic databases, the application of predefined eligibility criteria, and the inclusion of both peer-reviewed and grey literature sources.

Furthermore, the synthesis emphasized critical appraisal of the included evidence, taking into account methodological limitations, differences in national data collection systems, and variations in reporting practices across countries. By combining epidemiological data with policy documentation and surveillance reports, the review aimed to provide a comprehensive and balanced overview of suicide prevention efforts within the European Union.

3. Results and Discussion

3.1. National Strategies Towards Suicide Prevention

According to the suggestion of IASP, the WHO [9] and UN’ SDGs (https://sdgs.un.org/goals), the majority of European countries have published national strategies towards suicide prevention, while in some countries, including Greece and the Republic of Cyprus (RC), these are under development.

In the United Kingdom (UK) the policy paper “Suicide Prevention in England: 5-year Cross-sector Strategy” was published in September 2023 [10]. The goal of this strategy was the reduction of the number of individuals dying by suicide over the next 5 years, starting from 2023. The areas of focus of this strategy include: (a) improving data and evidence to inform effective interventions, (b) providing personalized and targeted support to priority groups, (c) addressing risk factors, (d) online safety, (e) technology and media, (f) providing appropriate and effective crisis support, (g) tackling methods and means of suicide, (h) providing timely and effective support to suicide-bereaved survivors.

Similarly, the Swedish new national strategy for mental health and suicide prevention contained nine strategic areas of action with relevant goals and indicators for follow-up [11]. Equally, the Finish Institute for Health and Welfare published the national “Suicide Prevention Program for 2020-2030”, which contains 36 objectives and related actions, aiming to prevent suicide deaths. The implementation and effectiveness of the actions encompassed in each objective are monitored according to relevant indicators [12]. The main topics are (a) awareness raising, (b) impacting the means of suicide, (c) early intervention, (d) supporting risk groups, (e) developing care options, (f) increasing media competence, (g) strengthening knowledge basis and research, (h) monitoring of the suicide prevention program and proposals for indicators. An overview of national efforts towards suicide prevention in the Nordic countries (Denmark, Faroe islands, Finland, Greenland, Iceland, Norway Sweden and Aaland) has been recently published [13].

In the RC, a national strategy for mental health is currently under development, under the guidance of the newly established WHO country office. This process follows a participatory approach involving key stakeholders, by including people with living experience and carers, an approach that remains relatively uncommon in the national context of the RC.

In parallel, recent epidemiological research has provided important evidence to inform suicide prevention policy. Specifically, Chatzittofis et al. [14] examined trends in suicide mortality rates in the RC prior to the COVID-19 pandemic, representing the first systematic monitoring effort of its kind in the country. The findings highlighted concerning trends and underscored the urgent need for the development of a national suicide prevention strategy.

Moreover, the study emphasized the importance of targeted preventive measures for high-risk groups, considering available resources and the unique legal and cultural context of each country. Continuous monitoring of suicide trends and patterns was identified as essential for evaluating and refining prevention measures strategies, both in the RC and in other under-represented countries with similar contexts.

3.2. Demographic, Temporal, Behavioral, and Contextual Factors Associated with Suicidalit in Europe Before and After the COVID-19 Pandemic

3.2.1. Suicide by Gender and Age

Suicide rates in the RC were found to be four times higher in men than in women, with violent methods accounting for approximately 80% of suicides in both genders [14]. The male suicide rate doubled during the first part of the study period, peaking between 2004 and 2012, before the trend reversing from 2013 to 2020. However, this decline was not uniform across age groups; the rate for men aged 45-64 continued to rise, surpassing the high rate previously recorded in men aged 25-44 years [14].

One possible explanation was that men aged 45-64 were more severely affected by the 2008 and 2012 financial crises, probably given their greater family and economic responsibilities. This is consistent with international data showing a rise in suicide rates in men aged 45-64 following the 2008 financial crisis [15,16]. Indeed, similar trends were seen across Europe during the Great Recession (2008-2010), where increased job loss, debt, and foreclosure were associated with an increase in suicide deaths, especially in men [15]. In Greece, which was also severely affected by the 2008 financial crisis, male suicide rates increased by 22% between 2007 and 2011, with the highest increases in men aged 45-64 [17]. In Austria, however, no similar trend was observed, as preventive mental health interventions to address both financial and psychological challenges were in place [15]. This offers an example of the importance of cross-sectoral action for the prevention of suicide, especially at times of societal crises. Implementing financial and psychological support measures targeted at men in this age group can help mitigate the impact of economic downturns on mental health. Indeed, the experience from Sweden and Finland has also confirmed that gender-specific suicide prevention strategies may interrupt the link between economic challenges and increasing suicide rates [(15]. In particular, active labor market programs combined with interventions that promote access to mental health care have proven effective, supporting men to find employment and preventing suicides during economic crisis [15]. These paradigms show the importance of incorporating gender-specific supportive programs into suicide prevention strategies, along with an assessment of their success in impacting gender-specific suicide rates.

Of course, financial burden was also evident during the COVID-19 pandemic especially among vulnerable populations [18], and remains in the post-COVID period [19]. Financial difficulties during the pandemic have been linked with symptoms of mental health problems [18]. Moreover, long COVID has been linked with financial disruption across four population surveys in the UK, supporting that extending employment protection and financial support to people with long COVID is crucial to prevent further deterioration of their health status, both physical and mental [19]. Thus, strategic planning to support mental health in the post-COVID period needs to include economic support towards population groups that are critically affected by the pandemic, with special focus on males of 45-64 age group [15], highlighting the close link between UN’ SD Goal 3 and Goal 8 for “Decent Work and Economic Growth”.

Indeed, men in mid-to-late working life have been identified as a priority group in the consideration for personalized, targeted suicide preventive actions in national strategies from the start of the post-pandemic period to date, as, for instance, in the UK [10]. The highest suicide rates registered in 2023 in England and Wales were among men aged 45 to 64 years, which were also the highest recorded across all age-groups since 2010, underlining the necessity of priority-setting based on age- and gender-specific suicide rates in suicide prevention programs [20]. The “Living with COVID” and the “Coronavirus Statutory Sick Pay Rebate Scheme” programs were introduced by the UK government during the pandemic to address these issues. Other programmes introduced during the pandemic targeting recovery included the “Kickstart scheme”, the “Recovery Loan Scheme” and the “Job Entry Targeted Support programme”. Additionally, a unique package to support the lowest-paid and unemployed individuals was further introduced, including the “Coronavirus Job Retention Scheme” and the “Self-Employment Income Support Scheme” [21]. Similar initiatives to provide debt relief and access to financial support for individuals facing severe economic hardships were launched in other European countries with the support of the European Commission, such as Germany and Denmark, where targeted financial and mental health support programs were directed at at-risk groups, considering gender and age [22].

Regarding females, Chatzittofis et al. [14] identified a declining trend in suicide rates in the RC during the study period (2004-2020), in contrast to an earlier recorded upward trend between 1988 and 1999. While the reasons for this decline are unclear, this reflects the well-established gender differentials in suicide trends. The highest suicide rates among females were recorded in the 45-64 age group, followed by the 25-44 age group, though the much small number of female suicides in a country the size of the RC significantly limits the ability to draw inferences about the observed differences and trends. Unfortunately, the study period did not include the pandemic years; thus, it is not clear whether the previously declining trend in females continued or reversed during the pandemic or in the post-pandemic years. While it would be important to monitor suicide trends in the subsequent period, it should be noted that delays in recording systems may be longer in the RC than elsewhere. Even though this is a universal phenomenon to a larger or lesser degree, it is highly depended on death certification, coroner and registration practices in each country.

Nevertheless, it should be noted that, unlike several countries, suicide mortality monitoring is not routine practice in the RC. Data on deaths by suicide are recorded by the Health Monitoring Unit as part of the Death Registry, but these are neither openly available to the research community nor included in annual Mortality Reports by the Cyprus Ministry of Health at a disaggregated and meaningful level. Data are only available by request and, thus, the responsibility for monitoring suicide trends and patterns falls to the local research community [14]. Other than introducing further delays, the misplacement of this essential public health operation contributes to the research-practice gap. The National Suicide Strategy for Mental Health currently under development should remedy the situation.

Internationally, targeted programs implemented during the pandemic to support women’s mental health primarily focused on survivors of intimate partner and domestic violence [23]. Many of these initiatives relied on a wide range of technology-based solutions. Yet, empirical data of the effectiveness of these programs in the post-COVID period remains limited, as does evidence on their sustainability and on the risks linked with technology-based interventions, including privacy violations and security issues in online environments. Most importantly, from a socio-ecological perspective, the majority of these interventions were implemented at the individual level rather than at the community and societal levels. This approach effectively shifts the burden of healthcare onto survivors, instead of placing responsibility on governments and structural systems [23].

3.2.2. Suicide Methods by Gender

Consistent with international trends, hanging is currently the most common method in males, replacing self-poisoning, self-shooting, and other methods that were more prevalent in previous decades [14,24]. The rise in hanging as a method in many European countries may be linked to prevention efforts aimed at reducing access to firearms and pesticides [25,26]. For instance, suicide rates by poisoning declined in the UK following the introduction of pesticide control laws in the 1990s [20]. However, hanging remains the most prevalent suicide method in the post-COVID period in the UK as well as other European countries [20].

Chatzittofis et al. [14] reported that self-shooting remained the second most common suicide method in males in the RC. The militarization of the RC and the widespread availability of firearms was provided as the most likely explanation for this. Yet, it is important to note that no women were reported to have used firearms for suicide in the RC, despite similar access to these weapons, suggesting that cultural or biological factors may impact women’s choice of less violent methods. Access to the means along with the socio-cultural context are significant determinants of the choice of suicide method. Thus, there is necessity to inform prevention strategies accordingly [25]. Specifically, suicide preventive measures need to be gender- but also social and cultural-specific. So far, European countries that have implemented gender-specific measures to prevent suicide in terms of access to means are mainly focusing on male suicide patterns, most likely driven by the large gender differentials with persistently high male-to-female suicide rate ratios. For instance, Austria and Germany have restricted access to firearms, while Switzerland has mainly restricted access to lethal pesticides and firearms, all three primarily addressing observed male suicide patterns [27]. With the notable exception of the UK, which has implemented measures such as paracetamol sales restrictions to reduce access to medication overdose in the past [28], the unique patterns of self-injurious behaviors in women have not been adequately addressed.

Relevant and updated efforts as part of broader strategies to tailor interventions based on observed gender differences in suicide methods are needed, given in parallel the changing profile of suicide among women. For instance, violent methods such as hanging and jumping were the most common suicide methods in women in the RC [14], challenging the assumption that women typically use less violent means like drug overdose. This change in method profiles suggests a shift in suicidal behavior that warrants further investigation, and most importantly research-informed interventions to address the specific factors which influence women’s mental health and their choice of self-injury methods.

Data from European countries confirm this trend with a growing number of women choosing violent methods like hanging and jumping in recent years [29]. Preventing programs towards this trend in European countries in the post-COVID years will benefit from a comprehensive approach which integrates various interventions and collaboration across sectors, and of course from increased funding for research in this area of women’s public mental health [27. So far, there are insufficient data on gender-specific suicide preventive interventions for women [27]. The majority of related interventions, while indirectly benefiting women, are not really women-specific, and include psycho-therapeutic programs on effective coping and help-seeking behaviors, mental health screening programs, campaigns aimed at de-stigmatizing mental health treatment, targeted support programs to identify and support those at higher risk, digital platforms and hotlines offering anonymous support.

3.2.3. Seasonal Trends, Gender and Age Groups

A seasonality pattern in suicide was identified in the RC with male suicides more frequent in the spring and summer [14], a pattern previously observed in Northern Hemisphere countries. This seasonality may be linked to bioclimatic factors, such as sunlight exposure, or increased social and outdoor activity during these months. Seasonality and related factors have been included in the suicide preventive strategic planning in some countries. For instance, in Sweden and Norway, mental health programs that specifically target vulnerable populations during high-risk months for suicide, such as spring and summer, have been established. These programs often involve increased awareness and accessibility to support services during these times. The national action program for suicide prevention introduced in Sweden as early as 2008 includes specific strategies for addressing seasonal suicide risks. This includes collaboration across various governmental and non-governmental organizations to provide mental health support during these critical periods [13].

In France, preventive campaigns addressing seasonal spikes in suicide are also implemented. These efforts focus on increasing public awareness and providing resources, particularly during spring and summer, when suicide rates tend to rise. This is part of a broader national effort to align mental health services with seasonal risks and ensure that vulnerable groups, and especially those who had attempted suicide before receive the necessary support [30]. Indeed, interventions such as sunlight exposure and increased outdoor activity interventions, reflect the broader shift in mental health strategies to account for bioclimatic factors which are linked to seasonal increases in suicide risk [31]

3.2.4. Suicide in Young People

Although suicide rates in individuals under-20s are generally lower by comparison to older age groups across Europe, suicide rates in young people have been rising over the last decade in some countries, such the UK and specifically in England and Wales [20]. This increase was clearly demonstrated in females under 25 years. Similarly, suicidal ideation appears to have doubled in adolescent females in 2021 compared to pre-pandemic level in the USA; 30% of them reported that they had considered suicide [32].

To address the rise in youth mental health challenges, England has incorporated targeted actions within mental health policies focused on supporting young people. These efforts include expanded funding for school-based mental health programs, designed to facilitate early detection of mental health issues, alongside community-based initiatives that extend support beyond conventional healthcare environments. Digital outreach is also a key component, with increased access to mental health resources via mobile apps and online counselling, enabling services to reach adolescents in familiar digital spaces. Additionally, stigma reduction campaigns, resilience workshops, and peer-support networks are now central elements in youth suicide prevention efforts [20].

Collaboration with mental health organizations and educational institutions has further embedded these initiatives within schools, universities, and local networks. This integrated approach promotes proactive engagement with mental health resources among young people and enhances the accessibility of early intervention services. Regular evaluation of these programs will be essential to determine their impact and to refine strategies for youth mental health and suicide prevention moving forward [33].

3.2.5. Non-Suicidal Self- Injury

The absence of data on non-suicidal self-injury calls for further research to fully understand these trends. Indeed, relevant studies during the pandemic and in the post-COVID period have not yet adequately addressed this topic. Research from European countries, including Spain and Italy, as well as non-European countries such as South Korea, is beginning to explore the rise in non-suicidal self-harm (NSSH), especially among younger populations affected by the social and economic consequences of the pandemic [33]. Studies in the pre-COVID period show an increase of NSSI in adolescents, with mental disorders, adverse childhood experiences, female gender, low health literacy, exposure to bullying, difficulties in adjustment and physical symptoms being the most important risk factors for engagement into NSSI behaviors [34,35].

Interventions to enhance access to mental health services is a crucial strategy to prevent the implications of NSSI, including suicidality [35 McManus et al. 2019). In England, although the prevalence of NSSH has increased, with approximately one in five female 16-24 years old reporting NSSH, access to mental health services was low. Towards this goal, NHSE continues to invest in mental health services through the NHS Long Term Plan and aims to improve access to NHS-funded mental health support for people up to the age of 25 [20].

3.2.6. Drug Use and Suicidality in Europe

Substance use and substance use disorders, particularly among men, are strongly associated with increased suicide risk, a trend exacerbated during the COVID-19 pandemic [37,38]. In response, many European countries have implemented suicide preventive programs that emphasize intervention and support, providing targeted resources through hotlines, online services, and public awareness campaigns focused on the risks of substance use for mental health deterioration [39,40]. Relevant programs aim to reduce alcohol and drug use by offering region-specific counseling for high-risk populations and by fostering collaboration between health agencies and local organizations. Moreover, many of these preventive programs include suicidality screenings at addiction clinics and community health centers, as well as advanced training for healthcare providers to recognize and address suicide risk in individuals with substance use disorders. Through a combination of early intervention, community support, and crisis resources, these programs work to mitigate the mental health and suicidality impacts of substance use across diverse populations [40].

3.2.7. Documentation and Monitoring

Periodic fluctuations in suicide rates have been reported internationally [41]. These fluctuations may be influenced by several factors, including economic conditions, societal changes, and public health interventions can Further analysis of trends in relation to unemployment and other socio-economic indicators is warranted, alongside continuous monitoring of trends. Additionally, future studies should incorporate data on co-morbidity, especially in terms of physical illnesses which are highly correlated with suicide, to better elucidate underlying causes and inform effective preventive strategies.

Importantly, Werdin and Wyss [26] underlined the lack of robust systems to document and monitor suicide attempts in many European countries. While recording suicide attempts is inherently more challenging than documenting suicide deaths, establishing a standardized definition of suicide attempts, along with a clear and concise monitoring system would ensure consistency and accuracy in reporting. Such a system would also strengthen the evidence base for the development and evaluation of preventive programs.

Furthermore, Werdin and Wyss [26] underlined that despite advances in national suicide prevention strategies across many European countries, persistent challenges remain. These include stigma, resource constrains, and structural shortcomings in mental heath and psychotherapeutic care. Key areas for improvement that were pointed out include: (a) development of preventive programs for males and the elderly, (b) enhanced collaboration across sectors, various professions and stakeholders, and (c) increased involvement of individuals with living experience of mental health challenges in policy making processes.

The fact that RC’s suicide rate remains among the lowest in Europe and the Eastern Mediterranean may be attributed to underreporting. Although the RC mandates that police investigation of all violent or unnatural deaths, a process that may itself contribute to stigma, suicides may still be underreported due to social stigma, religious beliefs, and the absence of a structured psychological autopsy system. Given that the majority of the population in the RC is Christian Orthodox, stigma surrounding suicide may further discourage accurate reporting. However, anecdotal evidence suggests that attitudes toward suicide within the Church in the RC have become less rigid in recent years. International experience highlights the importance of addressing religious stigma; for instance, reforms to Ireland’s Coroner’s Act in 2019 partially reeduced religious stigma associated with suicide reporting, thus leading to more accurate reporting of suicide mortality data and more targeted mental health interventions [42].

Other countries have also addressed underreporting through legislative and procedural reforms. Sweden and the Netherlands, for instance, have implemented robust psychological autopsy protocols to improve the investigation and classification of unnatural deaths [43]. Nevertheless, concealed suicides, including cases of undetermined death intent, ill-defined causes and accidental deaths mainly those due to drowning or poisoning, remain a important issue [44]. The prevalence of such cases varies considerably across countries. Data from Finland and the UK indicate that a substantial proportion of suicides are classified as accidental or undetermined, contributing to the underestimation of true suicide rates, too [20]. Consequently, interventions to address misclassification and underreporting are needed across many European countries.

The extent of suicide undercounting is relevant not only for international comparisons, but also for exploring temporal patterns within countries, especially when recording practices or socio-cultural attitudes towards suicide change over time. Future studies, should, therefore also consider any temporal patterns in accidental and ill-defined deaths in order to better understand potential misclassification. Finally, it is important to note that in some countries, age-, gender- and cause-specific mortality statistics are available only upon request from national health monitoring units. This contrasts to many other European countries where aggregate mortality data by cause of death are openly accessible.

3.2.8. Suicide Prevention and the Role of Media

The COVID-19 pandemic has not only intensified challenges in mental healthcare sector but also has heightened the emphasis on self-injurious behavior prevention within the media spheres. In the post-COVID period, the media may significantly contribute to suicide prevention by responsible reporting through careful language, context and presentation during coverage of suicide cases [45]. It has been suggested that, at least in certain contexts, the media have played a critical role during the pandemic and in the post-Covid period by raising awareness, providing accurate information on mental health resources, and reducing stigma around mental health issues [26,46,47]. Additionally, through campaigns and public service announcements, the media may contribute to a suicide prevention by providing a broader understanding of mental health challenges and the importance of seeking help. Equally, positive media portrayals that focus on recovery and resilience may encourage the adoption of constructive coping strategies and the availability of evidence-based support resources.

Moreover, the digital age has expanded the media’s influence, with social media platforms providing unique opportunities for peer support and the dissemination of mental health resources. For instance, the Australian #chatsafe is a suicide prevention program, which purposes to empower and equip young people with the skills to safely communicate online about self-harm and suicide [48]. Social media platforms offer an anonymous space where individuals can openly share thoughts, feelings, and experiences related to suicide. These expressions can serve as a supplementary source for assessing and forecasting suicide rates, especially in countries lacking robust suicide statistics. Additionally, social media enables real-time monitoring of suicide risks, functioning as an early warning system for potential cases. Recognizing areas with high suicide risk concentration is essential for location-specific mental health strategies, facilitating targeted suicide prevention and intervention efforts in a manner that is both time-sensitive and geographically precise [49].

4. Conclusions

Numerous European countries have introduced or expanded suicide preventing programs and related initiatives in the post-COVID period, striving to counter the rise in mental health issues that the pandemic has worsened. For instance, telehealth services for mental health and substance use treatment were expanded, mainly in underserved areas, and new crisis lines were introduced [32]. Additionally, interventions like school-based mental health services and economic support programs were implemented globally, recognizing the link between financial strain and mental health [50]. Overall, suicide prevention programs need to focus on long-term strategies to mitigate the mental health impacts intensified by the pandemic, particularly in individuals with pre-existing mental health challenges [50]. Most importantly, the implementation of suicide preventive measures needs to be developed under the framework of a National Strategy in order to effectively reduce suicide rates [7]. Reduction of suicide rates requires coordinated cross-sectoral efforts and the adoption of a complimentary set of measures across multifaceted preventing strategies, rather than single measures or a single strategy [7].

Overall, the COVID-19 pandemic has amplified challenges within mental healthcare services, while simultaneously has strengthened the focus on suicide prevention in policymakers [26]. Indeed, many countries have established new or expanded previous suicide preventing programs and related interventions in the post-COVID period, aiming to address the increase in mental health challenges exacerbated during the pandemic [51].

However, some European countries, such as the RC and Greece, still lack established national suicide prevention strategies. These countries could benefit from the experience of other countries that have already implemented such strategies. However, in order for a healthcare system to undertake the development of a national suicide prevention strategy, national suicidality statistical data are essential to support an evidence-based approach, tailored to socio-cultural contexts.