Contextual factors associated with country-level suicide mortality in the Americas, 2000-2019: a cross-sectional ecological study.
Level 4 - case-series / case-control
Ecological study analyzing aggregate country-level longitudinal data.
PubMed 37095770 · doi:10.1016/j.lana.2023.100450
What was done
The authors analyzed trends and macro-level contextual determinants of sex-specific, age-standardized suicide mortality rates across countries in the WHO Region of the Americas from 2000 to 2019. Data were extracted from the World Health Organization Global Health Estimates database, the Global Burden of Disease 2019 study, and the World Bank. Temporal trends were evaluated using joinpoint regression, and associations between contextual covariates and suicide rates were analyzed using linear mixed models with stepwise variable selection.
What was found
The abstract reports directional associations without numerical effect sizes, confidence intervals, or p-values: - For males, country-level suicide mortality decreased as health expenditure per capita and moderate population density increased, and increased as homicide rates, intravenous drug use prevalence, risk-weighted alcohol use prevalence, and unemployment rates increased. - For females, country-level suicide mortality decreased as the number of employed doctors per 10,000 population and moderate population density increased, and increased as relative education inequality and unemployment rates increased.
Why it matters
The findings indicate that macro-level contextual drivers of suicide mortality in the Americas differ between sexes, suggesting that national suicide prevention strategies should incorporate sex-specific socioeconomic and healthcare determinants.
Limits
The ecological design relies on population-level aggregate data and cannot establish individual-level causality or risk. Data rely on modeled mortality and covariate estimates from global databases, which are vulnerable to reporting and registration discrepancies. The abstract does not report the total number of countries analyzed, specific effect sizes, or confidence intervals.
Cited by
- context Suicide rates are significantly increasing.