Summary Background The mortality rate from suicide in the Region of the Americas has been increasing, while it has decreased in all other regions of the World Health Organization; highlighting the urgent need to improve prevention efforts. Gaining a better understanding of the population-level contextual factors associated with suicide can aid such efforts. Our objective was to evaluate contextual factors associated with sex-specific suicide mortality rates at the country level in the Region of the Americas for 2000-2019. Methods Annual age-standardized and sex-specific suicide mortality estimates were obtained from the World Health Organization (WHO) Global Health Estimates database. To investigate the trend of sex-specific suicide mortality rate over time in the region, we performed a joinpoint regression analysis. We then applied a linear mixed model to estimate the effects of specific contextual factors on the suicide mortality rate in countries in the region over time. All potentially relevant contextual factors, obtained from the covariates of the Global Burden of Disease Study 2019 and the World Bank, were selected in a stepwise manner. Results We found that the country-level mean suicide mortality rate among men in the region decreased as per capita health spending and the proportion of the country with moderate population density increased; and increased as the homicide mortality rate, the prevalence of intravenous drug use, the risk-weighted prevalence of alcohol use, and the unemployment rate increased. The national average suicide mortality rate among women in the region decreased as the number of physicians employed per 10,000 inhabitants and the proportion of the country with a moderate population density increased; and increased when relative educational inequality and the unemployment rate increased. Interpretation Although there was some overlap, the contextual factors that significantly affected the suicide mortality rate among men and women were very different, reflecting the current literature on individual-level suicide risk factors. Taken together, our data support that sex should be considered when tailoring and testing suicide risk reduction interventions and when developing national suicide prevention strategies. |
Age-standardized suicide mortality rates per 100,000 inhabitants among men in the Region of the Americas, 2019.
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Social determinants of health that affect suicide rates
A CAMH-led study of national suicide rates in 33 countries in the Americas over the past 20 years has found several key contextual factors associated with national suicide rates.
The authors say that while suicide rates in the rest of the world have decreased over the past two decades, they have increased in North, Central and South America, highlighting what they say is an urgent need for suicide prevention. improved and specific suicide.
The study, just published in The Lancet Regional Health – Americas , is believed to be the first of its kind to examine the impact of specific contextual factors associated with national suicide rates in the Americas. Using public health data from the World Health Organization’s Global Health Estimates database from 2000 to 2019, the authors found eight population-level factors associated with suicide rates:
- alcohol consumption
- Educational inequality
- Health spending
- Homicide rate
- Intravenous drug use
- Number of medical employees
- Population density
- Unemployment rate
"By quantifying the associations between these specific factors and country-level suicide rates, we can provide decision makers with the evidence they need to create effective national suicide prevention strategies," said author Dr. Shannon Lange. , independent scientist at the Institute of Mental Health. Research in Health Policies at CAMH. “Our results indicate that multisectoral measures aimed at health and social well-being should be emphasized.”
Overall, the study found that there are some significant differences in the factors associated with suicide rates for men and women . For example, when educational inequality (unequal distribution of academic resources) increased, the suicide rate among women, in particular, increased.
“Our findings highlight the vital importance of considering gender differences when developing, adapting and testing suicide risk reduction initiatives,” she said. Dr. Lange. “Gender norms and expectations are likely to influence suicide risk factors, so it cannot be a one-size-fits-all approach.”
Overall, Canadian men and women had the sixth highest suicide rate among the 33 countries studied in North, Central and South America.
The gender
According to the current literature, although there are some similarities in individual-level risk factors for suicidal behavior between the sexes, there is also evidence of sex-specific risk factors. With the current research, we extend these findings by showing that the contextual factors that are associated with the suicide mortality rate among men are not necessarily the same as those that are associated with the suicide mortality rate among women. There were only two contextual factors that were significantly associated with the suicide mortality rate among men and women (for which the effect sizes were different): population density and unemployment rate .
The difference in contextual factors associated with the suicide mortality rate between men and women was expected, given that there are important differences in suicidal behavior between sexes, in terms of etiology and epidemiology. Although there is much to learn about such sex differences in suicide, differences in norms, practices, and behaviors, as well as exposures and vulnerabilities, are likely part of the story. For example, men are less likely to engage in health-seeking behaviors and more likely to engage in risky behaviors, such as excessive alcohol consumption. In addition to affecting the existence and magnitude of the sex difference in the suicide mortality rate, gender norms and expectations are also likely to influence the factors that increase the risk of suicide for each sex and the strength of their effect. .
Although an in-depth review of each risk factor and its sex-specific mechanism is beyond the scope of this paper, the present study aims to evoke hypotheses and provoke further investigation into the sex-specific risk relationships for suicide mortality and its etiology. Our findings, together with the current literature, highlight that it is vitally important that sex be considered when developing, adapting and testing suicide risk reduction interventions, and when developing national suicide prevention strategies.
Added value of this study
Our findings provide evidence that certain contextual factors are associated with country-level suicide mortality rates in the Region of the Americas. Specifically, using 20 years of data , we identified the following contextual factors that contributed to suicide mortality rates in the region, namely: alcohol consumption, educational inequality, health spending, homicide rate, intravenous drug use, number of employed doctors, population density and unemployment rate. To our knowledge, this is the first study to estimate the impact of specific contextual factors on country-level suicide mortality rates in the region.
Implications of all available evidence
This study adds to growing evidence that certain country-level contextual factors are worth exploring as potential indirect suicide prevention mechanisms. Multisectoral measures targeting health and social well-being in society, which are informed and developed using evidence on local contextual factors, should be emphasized in suicide prevention initiatives.
Study findings suggest that increasing employment programs and services, health service access and capacity, including substance use treatment services, to name a few, may have the potential to reduce mortality rates from suicide in the respective country. Overall, our results indicate that multisectoral measures targeting health and social well-being in society, which are informed and developed using evidence about local contextual factors, should be emphasized in suicide prevention initiatives.
