The suicide rate in Uruguay increased once again last year, reaching a new record and cementing the small country’s position as an outlier in the region.

The South American country’s suicide rate reached 23.3 deaths per 100,000 people in 2022, when the number of deaths by suicide totaled 823, marking an increase from the previous record of 21.6 that had been set in 2021, according to figures from Uruguay’s Health Ministry released this week.

"Suicide rates have been on the rise since the 1990s up until the present, with some minimal declines in a few years," said Gonzalo Di Pascua, a psychologist who is a member of the Coordinator of Psychologists of Uruguay and has studied suicide extensively. "The pandemic, much like in numerous other areas of healthcare and mental health, mainly exacerbated a pre-existing trend, which was the increasing suicide rate."

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Uruguay is by far an outlier in the Americas, where the average suicide rate was nine per 100,000 people in 2019, according to the latest available numbers by the World Health Organization.

The high suicide rate in Uruguay contrasts with the way that the country is often seen as a paragon of economic stability in the southern cone. Uruguay enjoys the highest ranking of all South American countries in the United Nations’ World Happiness Ranking, coming in at 28, compared to 49 for Brazil and 52 for Argentina.

Yet the two Uruguay neighbors have far lower suicide rates, with Argentina recording 8.4 per 100,000 people in 2019 and Brazil, 6.9.

Eduardo Katz, who leads the mental health department at Uruguay’s State Health Services Administration, says part of the disparity may be due at least in part to "underreporting in neighboring countries." Although he admits that hardly tells the full story.

"Another very important factor is that there is little adherence to religion in Uruguay" compared to neighboring countries, Katz said, noting that the view of suicide as a sin "also creates a sense of restraint and deterrence."

Experts also speculate that Uruguay’s small population – totaling some 3 million – makes it more difficult for people who are facing mental health challenges to seek out help due to fear that they will be judged by members of their community.

"We’re few and we all know each other," Katz said.

There’s also a strong stigma against asking for help.

"Uruguay continues to have the prejudice that mental health services are for the crazy," Di Pascua said. "There’s still a lot of prejudice in terms of talking about mental health, and even more so when we talk about suicide."

That is even more pronounced in rural areas, which have the highest rates of suicide, and among men, who make up almost eight-in-10 of total suicides in the country.

"A man is less likely to speak out when he feels down because he faces a social interdiction, a social prohibition due to the false machismo that exists of saying ‘I’m sad,’ ‘I feel bad’," Katz said. "It’s seen as a symbol of weakness."

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Despite years of high suicide rates, Katz said only recently has Uruguay started to change its approach to tackle the scourge.

The healthcare system has not prioritized "reducing the demand, meaning working on prevention," Katz said. "That's what we're starting to do now."

Di Pascua, for his part, said Uruguay has long had a "very individual focus on the person who carries out the attempt and not in a solution that is more community-oriented."

Despite the recent change in focus, there’s little optimism that it will lead to immediate changes in the country’s high rates of suicide.

"Obviously there’s no magic wand that can reverse this type of trend overnight. This will take quite some time," Katz said. "It’s very challenging to reverse a trend, but I have faith that we’ll achieve it."