Global, regional, and national burden of suicide mortality 1990 to 2016: systematic analysis for the Global Burden of Disease Study 2016

I congratulate Naghavi and the Global Burden of Disease Self-Harm Collaborators on this timely paper, showing a marked decrease in the global suicide mortality 1990 to 2016.
As well as the global suicide mortality, this paper also comprehensively analyzed age and sex-stratified suicide mortality by geographic regions. The authors tried to explain the imbalanced sex ratio by using the socio-demographic index (a composite measure of fertility, income, and education), but there were inconsistencies among countries. As the authors stated in Introduction, the high male-to-female ratio of suicide mortality has been shown consistently for a long time, regardless of the geographic regions.
There should be further efforts to identify possible correlates of the increasing suicide mortality. However, there is only brief mention for the five countries (Zimbabwe, Jamaica, Paraguay, Zambia, and Belize), in which the suicide mortality statistically increased the most. Additionally, we should not underestimate the statistically insignificant findings. For example, the suicide mortality of Jamaica, in which the suicide mortality increased by 70.9% (21.0% to 128.2%), is only 2.9 per 100,000 in 2016. On the other hand, the suicide mortality in South Korea was 25.1, which was increased by 77.3% (-29.9% to 172.3%). It was the highest suicide mortality in the Organization for Economic Co-operation and Development countries for 12 consecutive years.1 The case of South Korea is particularly contrasted to the China. South Korea and China have traditionally shared East Asian cultures and recently achieved economic growth. However, as the authors emphasized in this paper, suicide mortality in China decreased by 64.1% (57.1% to 66.7%).
Although the suicide is the individual choice, the social upheaval has substantial influence on the individual behaviors.2 Like the fall of the Soviet Union in the East European countries and the bailout from the International Monetary Fund in in South Korea, there would be overriding socioeconomic phenomenon in countries where the suicide mortality increases.
Soon, along with other available data, I hope this comprehensive data can be used to identify social factors of the increasing suicide mortality in some countries.

References
1. OECD. Suicide rates (indicator) 2016 [Available from: https://data.oecd.org/healthstat/suicide-rates.htm.
2. Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet 2016;387(10024):1227-39. doi: 10.1016/S0140-6736(15)00234-2 [published Online First: 2015/09/20]