The 112 Emergency Service offers information of great interest for analysing the phenomenon of suicide from a community perspective: many acts of suicide are reported to 112, either by the victims themselves or by family members, acquaintances, or people unknown to them who are present at the time the suicidal act takes place. However, most research studies focus on mortality data and health records, with very few studies looking in depth at records of emergency calls to 112 (Marco et al., 2017, 2018). Furthermore, the covid-19 pandemic caused an increase in concerns about mental health and, among some sectors of the population, a growing tendency in suicidal conduct is noticed (Jollant et al., 2022; Zalsman et al., 2021). This study analyses the distribution of suicide-related calls in the city of Valencia during a six-year period (2017-2022) and explores the relationship between a high incidence of calls and the sociodemographic variables of the neighbourhood. 

During the period 2017-2022, the 112 Emergency Service in the city of Valencia attended 10,030 calls related with suicidal conduct. These ranged from cases of suicidal ideation to self-harm attempts and threats or death by suicide. Prominent are calls (60%) in which the person in crisis was a female. Figure 1 reflects the evolution of the calls, by quarters, during the six years of the study. In general, values are observed that vary between 315 and 425 calls per quarter in the first three years, which represents between 3 and 5 suicide-related calls per day in the city of Valencia. However, these figures increased progressively, until they exceeded 600 calls per quarter in 2022. In particular, in 2021 a change in the path occurred and the rate of increase was intensified. Prior to 2021, the third quarter (July-September) was the one that systematically registered the highest number of calls. However, in 2022, the second quarter (April-June) was the one that presented the highest incidence during the entire period under study. Over the course of 2017, a total of 1,334 suicide-related emergency calls were attended, while in 2022 the figure increased to 2,404 calls, which represents an increase of 80%. As a reference, it should be highlighted that the total calls to the Valencian Community 112 service (not only those related with suicide, but with any social or health emergency), remained stable across that same period, with an increase between the years 2017 and 2022 of barely 3%. 

The annual distribution of calls in the different age groups was also studied, as shown in figure 2. In the first two years of the study period (2017 and 2018), the middle-aged group showed the highest number of calls. However, from 2019 onwards there was a substantial increase in the number of calls from people in crisis aged between 15 and 20, with this eventually becoming the age group with the highest call volume over the entire period. Calls were also analysed by age group, taking into account the gender of the person in crisis (figure 3). The results reveal a distinct pattern by gender: females see an increase in calls in the 15-20 age group, which is consistent with the findings relating to general calls. However, this pattern is not observed in the case of males. While there has been an increase in the number of calls in the 15-20 age group, the middle-aged group still has a higher incidence, particularly between the ages of 50 and 55. Interestingly, in 2020 (the year the pandemic began), the group of males aged 15 to 20 made the highest number of calls.

To assess whether the calls followed a certain geographic pattern or whether, to the contrary, they occurred randomly in the city's neighbourhoods, a spatiotemporal study was conducted in which different neighbourhood variables that could be related to suicide were taken into account. The results show that these types of calls did not occur randomly, but occurred to a greater extent in places with specific sociodemographic characteristics. Specifically, areas with lower educational attainment, greater residential mobility, lower population density and ageing of the population, and higher concentration of immigrants showed a higher incidence of calls. Income levels and the percentage of people living alone were not relevant.

These results differ according to gender. In the case of females in crisis, areas with lower population density, higher population mobility and ageing, and a larger foreign population experienced more suicide calls. Furthermore, calls increased during the second quarter of the year (April-June). In the case of males, the areas that registered the most calls were those with the lowest level of educational attainment, lowest population density, higher mobility, a higher proportion of people living alone, and a higher level of ageing. In the third quarter of the year (July-September) there were more calls made than in any other quarter. Figure 4 displays the neighbourhood variables that showed a positive or negative relationship with suicide-related calls by gender.

The results show an upward trend in the number of suicide-related calls to 112 in the city of Valencia during the 2017-2022 period. In addition, there was a higher incidence of calls where the person in crisis was a female, despite the fact that studies show a higher rate of deaths by suicide in males (INE, 2022). Given that many of the calls were made to request help from the emergency services in the event of a suicide attempt, and did not involve actual deaths, these results may indicate that females are more likely to seek help than males, who may resort to more extreme methods of suicide. In addition, there has been a drastic increase in calls in the 15-20 age group, especially among females. It is important to analyse in depth what is happening with young people and minors, as well as the psychosocial aspects that explain this increase in calls; in this way, prevention strategies can be implemented that are adapted to their needs.

On the other hand, the results show that suicide-related calls do not occur randomly around the city, but that there are certain neighbourhood characteristics that are associated with the incidence of suicide-related calls. Thus, neighbourhoods with older people and a lower population density, where people enjoy more residential mobility, also have more suicide-related emergency calls. However, there are certain gender differences, thus areas with a lower level of education and a higher number of people living alone register more calls from males in crisis, but not from females. On the other hand, in the case of females in crisis, the concentration of immigrants in the neighbourhood is a risk factor. These results underscore the importance of taking gender differences into account when planning community-based suicidal behaviour prevention and intervention programmes.

The authors of this study would like to express their gratitude to the Valencian Community 1·1·2 Service (Valencian Security and Emergency Response Agency of the Valencian Generalitat) for the data provided. 

INSTITUTO NACIONAL DE ESTADÍSTICA (2022): Defunciones por suicidio. 

JOLLANT, F., I. BLANC-BRISSET, M. CELLIER, et al. (2022): «Temporal trends in calls for suicide attempts to poison control centers in France during the COVID-19 pandemic: a nationwide study», European Journal of Epidemiology, 37(9), 901-913.  

MARCO, M., E. GRACIA, A. LÓPEZ-QUÍLEZ, et al. (2018): «What calls for service tell us about suicide: A 7-year spatio-temporal analysis of neighborhood correlates of suicide-related calls», Scientific Reports, 8(1), 6746.  

MARCO, M., A. LÓPEZ-QUÍLEZ, D. CONESA, et al. (2017): «Spatio-Temporal Analysis of Suicide-Related Emergency Calls», International Journal of Environmental Research and Public Health, 14(7), 735.   

ZALSMAN, G., Y. LEVY, E. SOMMERFELD, et al. (2021): «Suicide-related calls to a national crisis chat hotline service during the COVID-19 pandemic and lockdown», Journal of Psychiatric Research, 139, 193-196.