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Revista de la Facultad de Medicina Humana

Print version ISSN 1814-5469On-line version ISSN 2308-0531

Rev. Fac. Med. Hum. vol.21 no.4 Lima Oct./Dec. 2021 

Original article

Epidemiological statistics of adolescent suicide during confinement due to the Covid-19 pandemic in Ecuador

Andrés Joaquín Guarnizo Chávez1  , University Master in Health Management

Nathaly Alejandra Romero Heredia2  , University Master in Drug Addiction and Other Addictions

1Private practice, Quito, Ecuador

2Analyst of the Proyecto Prevención del Embarazo en Niñas y adolescentes, Ministerio de Salud Pública (MSP), Quito, Ecuador



Adolescent suicide is a public health problem that has been neglected due to the pandemic and confinement.


To describe the characteristics of adolescent suicide, during the period of confinement due to pandemic in the year 2020 in Ecuador.


An observational, descriptive, cross-sectional, retrospective study was carried out, with the information from the database of violent deaths of the Ministry of Government, from March 17 to September 13, which lasted through the state of emergency. The analysis was carried out by province, sex, age, suicide method and frequency in days after the event occurred. The suicide mortality rate (per 100,000 inhabitants) was estimated for each province.


During confinement due to a state of emergency in 2020 in Ecuador, 97 suicides were registered among adolescents between 10 and 19 years of age. The highest number was estimated in males between 15 and 19 years of age, with the most frequent age being 19. The most frequent day of removal of corpses was on Mondays, and the preferred mode of suicide was by hanging with 81 reported cases. followed by intoxication and poisoning.


No increases were found in the suicide mortality rate during the state of emergency in 2020. However, it must be considered that the context of COVID-19 has increased the burden of psychological suffering, which may lead adolescents to think about suicide.

Keywords: public health; suicide; quarantine; adolescent; isolation (Source: MeSH NLM).


Data reported by the World Health Organization, indicate that since 2012 an average of 804,000 annual suicides exist, which represent a rate of 11.4 suicidal deaths per every 100,000 inhabitants. Furthermore, the same report indicates that for each accomplished suicide, there are 20 unsuccessful attempts, numbers that historically have been higher among the masculine sex with a proportion of 15 men per every 8 women.1On their part, the Pan American Health Organization, in their 2014 regional report on mortality by suicide in the Americas, indicates that Latin America has suicidal rates lower than the world average in all these years.2

Suicide is a public health problem, even more among vulnerable groups such as adolescents, where it has been evidenced a gradual increase of this phenomenon lately, to the point of being considered the most frequent second cause of mortality among adolescents 12 to 19 years of age,3and at the same time among the five main causes of death between 15 to 19 years of age.4While in the adolescent population, suicide attempts have a lower fatality than in young adults,5determinants of age change exist which should be studied. The majority of suicidal thoughts and actions are associated to social isolation and loneliness, situations that have exacerbated with the health emergency since suicidal risk increases as people lack connections with others. Adolescence is a difficult period of social and personal adaptation, on its own, and in times of health contingency, closure of educational institutions, cancellation of public activities, restrictive measures of communication and social interaction have made them lose youth-related moments that influence in the proper development of psychological stability among young people.6

In the COVID-19 pandemic, exacerbation psychological disorders, such as anxiety and depression, have been evidenced, as well as high levels of emotional stress and post-traumatic symptoms, factors directly proportional to the appearance of suicidal thoughts.7The strict measures of security, such as social isolation, have had negative repercussions not only in physical health, but mainly in mental health among vulnerable groups such as children and adolescents.8

Nationally, the adolescent suicide problem has manifested itself even before the pandemic, with a total of 4,885 suicides in this age group between 2001 and 2014, with the highest risk in males over 15 years of age and residents of provinces from the Amazon, and in second place in provinces of the Ecuadorian mountains. IN the same manner, the literature indicates that the method of suicide most used has been by hanging, followed by intoxication by pesticides.9) Suicides in the period of the pandemic have not been well described so far, however, local reports indicate that far from decreasing, they have remained constant, for example, the Consejo de Protección de los Derechos de Quito, reported in 2020, a total of 10 suicides in underaged, including a boy 9 years of age.10For this reason, in this article we intended to give adolescent suicidal characteristics on a national level, according to databases of violent deaths from the Ministry of Government.


Design and Area of Study

For this article, we carried out an observational, descriptive, cross-sectional, retrospective study, which collected the statistical data referencing the deaths of suicidal cause on a national level, during the state of emergency in 2020, which lasted 181 days, from March 17 to September 13.

Population and sample

The population was made up of all deaths by suicide cause in the period described, among ages between 10 and 19 years of age registered in the database of violent deaths, in the Dirección de Estudios de la Seguridad, belonging to the Ministry of Government of the Republic. Exclusion criteria included deaths with inconsistencies in their diagnosis, and cases with incomplete information. 97 cases were obtained according to the criteria mentioned.

Variables and instruments

The information provided by the consulted data base was gathered directly onto the data matrix to be analyzed. The variables were: sex, age, province, suicide cause, and frequency of removal of corpses by days of the week.


Information was directly gathered from the data base of violent deaths, from the Dirección de Estudios de la Seguridad, belonging to the Ministry of Government of the Republic. From here, we considered, as inclusion criteria, all deaths by suicide cause in the time period described, in the ages from 10 to 19 years of age. Exclusion criteria included deaths by inconsistencies in their diagnosis, and cases with incomplete information. 97 cases were obtained according to the criteria mentioned.

Statistical analysis

Regarding age, we obtained the measures of central tendency, such as mean, median and mode. Data were also divided in two groups, from 10 to 14 years, and 15 to 19, following the range as noted in the Modelo de Atención Integral del Sistema Nacional de Salud Familiar, Comunitario e Intercultural (MAIS- FCI), and for the sex variable, men and women. In turn, the variables regarding the total adolescent population per province, was obtained from the Proyección por edades, provincias y nacional 2010-2020, from the Instituto Nacional de Estadísticas y Censos (INEC), which allowed the calculation of the rate of suicides in provinces per every 100,000 inhabitants. It should be emphasized that out of the 24 provinces in the Ecuadorian territory, four did not present cases of suicidal deaths, which is why they were not included in the description. Finally, the frequency of suicide cases according to the method applied by adolescents to carry out this act, and the frequency of days in which this reported incident occurred, with their respective corpse removal. Chi squared tests and Fischer exact teste were performed accordingly to carry out some comparisons of frequencies.

Ethical aspects

In this study data was collected from a database without data that allowed patient identification, therefore, it was not necessary that the study go through the ethics committee.


Suicide etiology by sex and age. - As has been described before, the data base of violent deaths 2020 reports in the period established by the study, a total of 97 deaths by suicide cause, of which the majority, meaning 59, correspond to the masculine sex, divided into 19 cases of adolescents from 10 to 14 years, and 40 cases of adolescents from 15 to 19 years old. (Figure 1). Regarding the frequency, we obtained 61% of suicide in males and a greater frequency of suicide in the range of 15 -19 years, with a 69% in both sexes. (Table 1)

Figure 1: Number of suicide deaths in adolescents by sex and age during the state of emergency 2020 

Table 1.  Total percentages of adolescent suicides during the state of emergency 2020 

2019 2020
From 10 to 14 years From 15 to 19 years TOTAL From 10 to 14 years From 15 to 19 years TOTAL
MEN 16 46 62 (60%) 19 40 59 (61%)
WOMEN 13 28 41 (40%) 11 27 38 (39%)
TOTAL 29 (28%) 74 (72%) 103 30 (31%) 67 (69%) 97

On the other hand, the measures of central tendency showed the following results; The arithmetic mean or total average of registered suicides were 15.91 years, and the median was 16. Regarding the mode, the age that was repeated the most among deceased adolescents was 19 years of age.

Provincial statistics. - Ecuador carries a political division of 24 provinces, of which, during the study period, four did not present cases of adolescent deaths, which are: Cañar, Galápagos, Bolívar and Pastaza. The remaining provinces that are described, vary in quantity, leading with Pichincha y Azuay with 14 cases each, followed by Guayas with 10 cases. The suicide rate was determined according to international parameters established by the WHO and found that Orellana had the highest rate of 13.73 deaths per 100,000 inhabitants, followed by Azuay with 8.84 and Cotopaxi with 7.07, respectively. (Table 2)

Table 2.  Provincial suicide rate per 100 000 inhabitants during the state of emergency 

  2019 2020
PROVINCE No Adolescent population 2019 rate x 100.000 hbt. No Adolescent population 2020 Rate x 100.000 hbt.
ORELLANA 0 35517 0 5 36437 13,72
AZUAY 15 157712 9,51 14 158326 8,84
COTOPAXI 9 98445 9,14 7 99319 7,05
SANTO DOMINGO 0 90479 0 5 90913 5,5
LOJA 6 100495 5,97 5 100311 4,98
TUNGURAHUA 9 103133 8,73 5 103384 4,84
IMBABURA 2 92084 2,17 4 92080 4,34
SUCUMBIOS 3 46914 6,39 2 47456 4,21
CHIMBORAZO 4 103019 3,88 4 103180 3,88
ZAMORA CHINCHIPE 1 25758 3,88 1 26163 3,82
NAPO 3 29338 10,23 1 29633 3,37
EL ORO 1 131902 0,76 4 132291 3,02
CARCHI 2 34748 5,76 1 34615 2,89
ESMERALDAS 1 139816 0,72 4 141354 2,83
LOS RIOS 4 184658 2,17 5 185820 2,69
PICHINCHA 23 546917 4,21 14 552101 2,54
MORONA SANTIAGO 1 45126 2,22 1 45894 2,18
MANABI 3 306502 0,98 4 305751 1,31
SANTA ELENA 0 77252 0 1 78870 1,27
GUAYAS 11 792819 1,39 10 797963 1,25
BOLÍVAR 1 44230 2,26 0 44723 0
PASTAZA 1 24022 4,16 0 24373 0
CAÑAR 3 55362 5,42 0 55838 0
TOTAL 103 3266248 3,15 97 3286795 2,95

Suicide method. - Out of the total registered deaths, hanging was the method of choice by a great difference, with a total of 81 cases, divided into 51 for the masculine sex and 30 for the feminine. They are followed in frequency by intoxication/poisoning with 10 reports, with women choosing this method slightly more. Deaths by firearms, falls, submersions and suffocation follow, with low frequency. (Table 3)

Table 3.  Suicide methods during the state of emergency 2020 in adolescents 

  2019 2020
HANGING 55 29 84 52 30 81
INTOXICATION 2 12 14 4 6 10
FIREARMS 1 0 1 2 1 3
SUBMERSION 0 0 0 1 0 1
KNIFE 2 0 2 0 0 0
TOTAL 62 41 103 59 38 97

Frequency of removal of corpses per days. - Since the data base of violent deaths do not carry an informed detail of the post-mortem examination report that allows a chronological determination of death, in order to know if the day of death is the same day of corpse removal or prior to it, it has been considered pertinent to include the frequency of days when the removal of corpse has been carried out, with Monday being the day of greater prevalence with 21.65% in relation to other days of the week. (Table 4). In comparision with the dates included in 2019, a tendency to decrease as the week passes, while pre-pandemic, increased as the weekend approached. (Figure 2)

Table 4.  Frequency of removal of corpses per days of the week 

  2019 2020
DAYS No % No %
MONDAY 13 12,62 21 21,65
TUESDAY 10 9,71 16 16,49
WEDNESDAY 15 14,56 9 9,28
THURSDAY 18 17,48 12 12,37
FRIDAY 15 14,56 13 13,40
SATURDAY 12 11,65 12 12,37
SUNDAY 20 19,42 14 14,43
Total 103 100 97 100

Figure 2: Trend according to the frequency of corpse removal by days of the week 


Recent studies point out that there have not been statistically significant increments registered in suicide rates worldwide, at least during the first months of the pandemic, and in various countries evidence of a decrease in cases is demonstrated.11) In our study the reports have remained with the same expected rate, at least during the most problematic time such as the state of emergency in the year 2020. According to INEC, MSP and MINSA, suicide rate nationwide had increased in 380% between the ages of 10 to 14 years until 2017, and an increase of 36% between 15 to 19 years.12

Although our statistics show an evident male predominance, in line with world figures (of around 79% of all deaths due to suicide), 13 authors point out that, in age groups from 10 to 19 years of age, this difference does not is significant, in contrast to the data reported in young adults, where the difference ratio reaches up to 4.3: 1 in favor of the male sex. 14 It has also been described in the literature that, although completed suicide is higher in In men, suicidal ideation and suicide attempt are much more common in women. 15

Although the numbers of suicides by province have varied in the pandemic, it is interesting to note that the province of Azuay remains in second place in frequency, both before and during it, being necessary in the future to study the determinants for such prevalence. In both periods of time, the hegemony of the method by hanging is noted, followed by intoxication, the latter more frequent in women. Finally, it is necessary to note that in 2019 suicidal deaths had a tendency to increase as the days of the week progressed, being more frequent on Sunday, while, in the confinement of 2020, it became more frequent on Monday with a tendency to go down in the rest of the week. This difference is not so marked, perhaps due to the same confinement condition, where most of the people saw the time go by indiscriminately, without any variation between the days.

The psychosocial determinants of adolescent suicide are a separate issue, which must be analyzed in order to address them in a comprehensive manner. The context of COVID-19 has increased the burden of psychological suffering, situations such as fear of infection, anxiety, stress, depression, loss of family or friends, which can lead adolescents to think about suicide. 16The evidence suggests that, to counteract the statistics of self-inflicted deaths in times of a Pandemic, they must be correctly identified in the ideation phase.17 An important factor in suicidal ideation is the subjective or objective feeling of isolation and loneliness, which must be intervened to recognize and avoid the inherent risk.18 The actions and public policies that must be taken to protect the health of the population in general, and of adolescents based on their special needs, should not be focused solely on the disease infectious disease, but also to improve the individual and collective mental state of a population hard hit by the pandemic.19

The present study had as a limitation that secondary data were handled that were not designed to answer a research question as such, however, the data are useful to describe an important reality. On the other hand, as they are only reported cases, there could be an underreporting, despite this, we consider that the information is useful because it serves to characterize this problem, which is the objective of the study.


In Ecuador there was a slight total decrease in deaths due to suicidal etiology in adolescents, during the period called “state of exception” that comprised 181 days from March 17 to September 13, 2020, this if we compare it with the same period of days in the year 2019 as a pre-pandemic reference, we note that, during both periods, the trend of being mostly of the victims, males between 15 and 19 years of age, with an increase in frequency as age increases, hanging was the preferred method, and the most frequent day during confinement was Monday. Adolescent suicide deserves special attention in our environment, as it is a public health problem, influenced by various psychological and emotional factors, which can be neglected in a context of pandemic and isolation. It is therefore essential psychosocial interventions aimed at mitigating the mental effects of the pandemic and confinement, as well as promoting prevention and mental health programs in the adolescent population.


To Richard Milton Carvajal Salazar, analyst of security information in the Ministry of Government of the Republic of Ecuador, who kindly provided the data regarding violent deaths in 2020; information necessary to carry out the present study.


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Funding sources: Self-financing.

Received: June 07, 2021; Accepted: September 20, 2021

Correspondence: Andrés Joaquín Guarnizo Chávez Address: 170105 Quito - Ecuador Telephone:+593 958957098

Authorship contributions: The authors participated in the idea genesis, Project design, data collection and interpretation, results analysis and manuscript preparation of this research work.

Conflicts of interest: The authors declare having no conflicts of interest.

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