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BMC Psychiatry
Published in: BMC Psychiatry 1/2012

Open Access 01-12-2012 | Research article

Suicide rates and income in São Paulo and Brazil: a temporal and spatial epidemiologic analysis from 1996 to 2008

Authors: Daniel H Bando, Andre R Brunoni, Isabela M Benseñor, Paulo A Lotufo

Published in: BMC Psychiatry | Issue 1/2012

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Abstract

Background

In a classical study, Durkheim noted a direct relation between suicide rates and wealth in the XIX century France. Since that time, several studies have verified this relationship. It is known that suicide rates are associated with income, although the direction of this association varies worldwide. Brazil presents a heterogeneous distribution of income and suicide across its territory; however, evaluation for an association between these variables has shown mixed results. We aimed to evaluate the relationship between suicide rates and income in Brazil, State of São Paulo (SP), and City of SP, considering geographical area and temporal trends.

Methods

Data were extracted from the National and State official statistics departments. Three socioeconomic areas were considered according to income, from the wealthiest (area 1) to the poorest (area 3). We also considered three regions: country-wide (27 Brazilian States and 558 Brazilian micro-regions), state-wide (645 counties of SP State), and city-wide (96 districts of SP city). Relative risks (RR) were calculated among areas 1, 2, and 3 for all regions, in a cross-sectional approach. Then, we used Joinpoint analysis to explore the temporal trends of suicide rates and SaTScan to investigate geographical clusters of high/low suicide rates across the territory.

Results

Suicide rates in Brazil, the State of SP, and the city of SP were 6.2, 6.6, and 5.4 per 100,000, respectively. Taking suicide rates of the poorest area (3) as reference, the RR for the wealthiest area was 1.64, 0.88, and 1.65 for Brazil, State of SP, and city of SP, respectively (p for trend <0.05 for all analyses). Spatial cluster of high suicide rates were identified at Brazilian southern (RR = 2.37), state of SP western (RR = 1.32), and city of SP central (RR = 1.65) regions. A direct association between income and suicide were found for Brazil (OR = 2.59) and the city of SP (OR = 1.07), and an inverse association for the state of SP (OR = 0.49).

Conclusions

Temporospatial analyses revealed higher suicide rates in wealthier areas in Brazil and the city of SP and in poorer areas in the State of SP. We further discuss the role of socioeconomic characteristics for explaining these discrepancies and the importance of our findings in public health policies. Similar studies in other Brazilian States and developing countries are warranted.
Appendix
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Literature
1.
Hawton K, van Heeringen K: Suicide. Lancet. 2009, 373 (9672): 1372-1381. 10.1016/S0140-6736(09)60372-X.CrossRefPubMed
2.
3.
Baudelot C, Establet R: Suicide: The hidden side of mordernity. 2008, Cambridge: Polity Press,
4.
Morselli EA: Suicide: an essay on comparative moral statistics. 1882, New York: Appleton,
5.
Durkheim É: Suicide: a study in sociology. 1951, New York: Simon & Schuster,
6.
Baller RD, Richardson KK: Social Integration, Imitation, and the Geographic Patterning of Suicide. Am Sociol Rev. 2002, 67: 873-888. 10.2307/3088974.CrossRef
7.
Giddens A: Introduction. Suicide and the meaning of civilization. Edited by: Masaryk TG. 1970, Chicago and London: The University of Chicago Press, xix-xli.
8.
Hacking I: The Taming of Chance. 1990, Cambridge: Cambridge University Press,CrossRef
9.
Masaryk TG: Suicide and the meaning of civilization. 1881/1970, Chicago and London: The University of Chicago Press,
10.
Douglas JD: The Social Meanings of Suicide. 1970, Princeton: Princeton University Press,
11.
Gibbs JP, Martin WT: Status integration and suicide: a sociological study. 1964, Eugene: University of Oregon Books,
12.
Lester D: Suicide from a sociological perspective. 1989, Springfield: Charles C Thomas,
13.
Henry AF, Short JF: Suicide and homicide: some economic, sociological, and psychological aspects of aggression. 1954, New York: Free Press,
14.
Shneidman ES: Comprehending Suicide: Landmarks in 20Th-Century Suicidology. 2001, Washington, DC: American Psychological Association,CrossRef
15.
Halbwachs M: The causes of suicide. 1930/1978, New York: The free press,
16.
Rehkopf DH, Buka SL: The association between suicide and the socio-economic characteristics of geographical areas: a systematic review. Psychol Med. 2006, 36 (2): 145-157.CrossRefPubMed
17.
Tondo L, Albert MJ, Baldessarini RJ: Suicide rates in relation to health care access in the United States: an ecological study. J Clin Psychiatry. 2006, 67 (4): 517-523. 10.4088/JCP.v67n0402.CrossRefPubMed
18.
Fukuda Y, Nakamura K, Takano T: Cause-specific mortality differences across socioeconomic position of municipalities in Japan, 1973–1977 and 1993–1998: increased importance of injury and suicide in inequality for ages under 75. Int J Epidemiol. 2005, 34 (1): 100-109.CrossRefPubMed
19.
Chang SS, Sterne JA, Wheeler BW, Lu TH, Lin JJ, Gunnell D: Geography of suicide in Taiwan: spatial patterning and socioeconomic correlates. Health Place. 2011, 17 (2): 641-650. 10.1016/j.healthplace.2011.01.003.CrossRefPubMed
20.
Taylor R, Page A, Morrell S, Harrison J, Carter G: Mental health and socio-economic variations in Australian suicide. Soc Sci Med. 2005, 61 (7): 1551-1559. 10.1016/j.socscimed.2005.02.009.CrossRefPubMed
21.
Rezaeian M, Dunn G, St Leger S, Appleby L: Ecological association between suicide rates and indices of deprivation in the north west region of England: the importance of the size of the administrative unit. J Epidemiol Community Health. 2006, 60 (11): 956-961. 10.1136/jech.2005.043109.CrossRefPubMedPubMedCentral
22.
Maki N, Martikainen P: The role of socioeconomic indicators on non-alcohol and alcohol-associated suicide mortality among women in Finland. A register-based follow-up study of 12 million person-years. Soc Sci Med. 2009, 68 (12): 2161-2169. 10.1016/j.socscimed.2009.04.006.CrossRefPubMed
23.
Maki NE, Martikainen PT: Socioeconomic differences in suicide mortality by sex in Finland in 1971–2000: a register-based study of trends, levels, and life expectancy differences. Scand J Public Health. 2007, 35 (4): 387-395. 10.1080/14034940701219618.CrossRefPubMed
24.
Martiello MA, Giacchi MV: Ecological study of isolation and suicide in Tuscany (Italy). Psychiatry Res. 2012, [Epub ahead of print]
25.
Ying YH, Chang K: A study of suicide and socioeconomic factors. Suicide Life Threat Behav. 2009, 39 (2): 214-226. 10.1521/suli.2009.39.2.214.CrossRefPubMed
26.
Vijayakumar L, Nagaraj K, Pirkis J, Whiteford H: Suicide in developing countries (1): frequency, distribution, and association with socioeconomic indicators. Crisis. 2005, 26 (3): 104-111. 10.1027/0227-5910.26.3.104.CrossRefPubMed
27.
Moniruzzaman S, Andersson R: Economic development as a determinant of injury mortality - a longitudinal approach. Soc Sci Med. 2008, 66 (8): 1699-1708. 10.1016/j.socscimed.2007.12.020.CrossRefPubMed
28.
Ceccherini-Nelli A, Priebe S: Economic factors and suicide rates: associations over time in four countries. Soc Psychiatry Psychiatr Epidemiol. 2010, 46 (10): 975-982.CrossRefPubMed
29.
Desaulniers J, Daigle MS: Inter-regional variations in men's attitudes, suicide rates and sociodemographics in Quebec (Canada). Soc Psychiatry Psychiatr Epidemiol. 2008, 43 (6): 445-453. 10.1007/s00127-008-0340-2.CrossRefPubMed
30.
Yang B, Lester D, Yang CH: Sociological and economic theories of suicide: a comparison of the U.S.A. and Taiwan. Soc Sci Med. 1992, 34 (3): 333-334. 10.1016/0277-9536(92)90275-U.CrossRefPubMed
31.
Bando DH, Barrozo LV: Suicídio na cidade de São Paulo - Uma análise sob a perspectiva da geografia da saúde. 2010, São Paulo: Ed. Humanitas,
32.
Bando DH, Brunoni A, Fernandes T, Bensenor IM, Lotufo PA: Suicide rates and trends in São Paulo, Brazil according to gender, age and demographic aspects: A Joinpoint Regression Analysis. Rev Bras Psiquiatr. 2012, 34 (3): 286-293.CrossRefPubMed
33.
Diekstra RF: The epidemiology of suicide and parasuicide. Acta Psychiatr Scand Suppl. 1993, 371: 9-20.CrossRefPubMed
34.
Mello-Santos C, Bertolote JM, Wang YP: Epidemiology of suicide in Brazil (1980–2000): characterization of age and gender rates of suicide. Rev Bras Psiquiatr. 2005, 27 (2): 131-134.CrossRefPubMed
35.
Lovisi GM, Santos SA, Legay L, Abelha L, Valencia E: [Epidemiological analysis of suicide in Brazil from 1980 to 2006]. Rev Bras Psiquiatr. 2009, 31 (Suppl 2): S86-S94.PubMed
36.
Vichi M, Masocco M, Pompili M, Lester D, Tatarelli R, Vanacore N: Suicide mortality in Italy from 1980 to 2002. Psychiatry Res. 2010, 175 (1–2): 89-97.CrossRefPubMed
37.
Ahmad OB, Boschi-Pinto C, Lopez A, Murray C, Lozano R, Inoue M: A new WHO standard population. Age standardization of rates: a new WHO standard.GPE Discussion Paper Series. 2001, Geneva: World Health Organization, 31-
38.
39.
40.
41.
42.
43.
44.
Auger N, Zang G, Daniel M: Community-level income inequality and mortality in Quebec, Canada. Public Health. 2009, 123 (6): 438-443. 10.1016/j.puhe.2009.04.012.CrossRefPubMed
45.
Milner A, McClure R, De Leo D: Socio-economic determinants of suicide: an ecological analysis of 35 countries. Soc Psychiatry Psychiatr Epidemiol. 2010, 47 (1): 19-27.CrossRefPubMed
46.
Yur’yev A, Varnik A, Varnik P, Sisask M, Leppik L: Employment status influences suicide mortality in Europe. Int J Soc Psychiatry. 2010, 58 (1): 62-68.CrossRefPubMed
47.
Chuanc H-L, Huang W-C: Economic and social correlates of regional suicide rates: A pooled cross-section and time-series analysis. Journal of Socio-Economics. 1997, 26: 277-89. 10.1016/S1053-5357(97)90021-4.CrossRef
48.
Yamasaki A, Araki S, Sakai R, Yokoyama K, Voorhees AS: Suicide mortality of young, middle-aged and elderly males and females in Japan for the years 1953–96: time series analysis for the effects of unemployment, female labour force, young and aged population, primary industry and population density. Ind Health. 2008, 46 (6): 541-549. 10.2486/indhealth.46.541.CrossRefPubMed
49.
Page A, Morrell S, Taylor R, Carter G, Dudley M: Divergent trends in suicide by socio-economic status in Australia. Soc Psychiatry Psychiatr Epidemiol. 2006, 41 (11): 911-917. 10.1007/s00127-006-0112-9.CrossRefPubMed
50.
Hooghe M, Vanhoutte B: An ecological study of community-level correlates of suicide mortality rates in the flemish region of belgium, 1996–2005. Suicide Life Threat Behav. 2011, 41 (4): 453-464. 10.1111/j.1943-278X.2011.00047.x.CrossRefPubMed
51.
Baller RD, Shin DJ, Richardson KK: An extension and test of Sutherland's concept of differential social organization: the geographic clustering of Japanese suicide and homicide rates. Suicide Life Threat Behav. 2005, 35 (3): 343-355. 10.1521/suli.2005.35.3.343.CrossRefPubMed
52.
Gunnell D, Wheeler B, Chang SS, Thomas B, Sterne JA, Dorling D: Changes in the geography of suicide in young men: England and Wales 1981–2005. J Epidemiol Community Health. 2010, 66 (6): 536-543.CrossRefPubMed
53.
Rezaeian M, Dunn G, St Leger S, Appleby L: Do hot spots of deprivation predict the rates of suicide within London boroughs?. Health Place. 2007, 13 (4): 886-893. 10.1016/j.healthplace.2007.02.004.CrossRefPubMed
54.
Zhang J, Ma J, Jia C, Sun J, Guo X, Xu A, Li W: Economic growth and suicide rate changes: a case in China from 1982 to 2005. Eur Psychiatry. 2010, 25 (3): 159-163. 10.1016/j.eurpsy.2009.07.013.CrossRefPubMed
55.
Paugam S: Desqualificação social – ensaio sobre a nova pobreza. 2003, São Paulo: Educ & Cortez,
56.
Castel R: Metamorfoses da questão social. 1998, Rio de Janeiro: Vozes,
57.
Szwarcwald CL, Leal Mdo C, de Andrade CL, Souza PR: [Infant mortality estimation in Brazil: what do Ministry of Health data on deaths and live births say?]. Cad Saude Publica. 2002, 18 (6): 1725-1736. 10.1590/S0102-311X2002000600027.CrossRefPubMed
58.
Jackson MC, Huang L, Luo J, Hachey M, Feuer E: Comparison of tests for spatial heterogeneity on data with global clustering patterns and outliers. Int J Health Geogr. 2009, 8: 55-10.1186/1476-072X-8-55.CrossRefPubMedPubMedCentral
Metadata
Title
Suicide rates and income in São Paulo and Brazil: a temporal and spatial epidemiologic analysis from 1996 to 2008
Authors
Daniel H Bando
Andre R Brunoni
Isabela M Benseñor
Paulo A Lotufo
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2012
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-12-127

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