Geographical clusters and social risk factors for suicide in the city of São Paulo, 2006–2015: An ecologic study

Abstract

Background: To identify geographical clusters of suicide in São Paulo, Brazil (2006–2015) and to verify the associations of suicide with sociocultural characteristics of its 96 districts. Methods: Spatial scan test was used to detect the geographical clusters. Correlation and multiple regression techniques were used to estimate the association of socioeconomic and cultural variables with suicide. Results: The mean suicide rate was 4.8/100,000. Three clusters were identified which are as follows: one of increased risk in downtown and two of decreased risk in the South and in the Southeast. The mean suicide rate of the high-risk clustered districts (7.99/100,000) presented significantly higher average incomes per household, higher proportion of formally educated, of no religious affiliation, of recent migrants, of all-times migrants and lower proportion of married. The multiple model selected two independent risk factors – people with no religious affiliation (β = 0.182) and of recent migrants (β = 0.278) – and two protective factors – the proportion of married (β = –0.185) and of total migrants (β = –0.075), which jointly explained 58.4% of the variance. Conclusion: Durkheimian social and cultural risk factors for suicide were confirmed. Compared to a previous study period (1996–2005), suicide rates and geographical clusters remained relatively stable in the subsequent decade (2006–2015).

Spatial patterns and epidemiological characterization of suicides in the Chapecó micro-region, Santa Catarina, Brazil: an ecological study, 1996-2018

“…The spatial analysis used geoprocessing techniques to prepare thematic maps, according to the chorochromatic and choropleth cartographic methods, 6 , 10 , 15 using the ArcGIS 10.6 geographic information system. Scan statistics were applied using the SaTScan application to identify high-risk spatial clusters and those at lower risk for suicide.…”

“…Scan statistics were applied using the SaTScan application to identify high-risk spatial clusters and those at lower risk for suicide. 6 , 10 , 16 This statistic inserts a circular window of variable size on the map surface, in such a way as to allow its center to move - for a given position and size - and the window-circle to include a different set of neighboring municipalities. If this “window’s” view reaches the geographic centroid of a neighboring municipality, the entire area of the municipality will be taken into consideration in the circumscribed cluster.…”

“… 6 , 8 According to the 2017 Global Burden of Disease study estimate, Southern Brazilian also had the highest prevalence of mental disorders, with the state of Santa Catarina in the lead (15.5%), followed by Rio Grande do Sul (15.2%) and Paraná (15.0%). 9 Considering Brazil’s different territories and their characteristics, important variations were found in suicide rates between states, 5 municipalities 6 and neighborhoods (of a municipality), 10 possibly related to sociocultural factors.…”

Mortalidade por suicídio na cidade de São Paulo: caracterização, tendências e análise de efeito idade-período-coorte (1996-2018)

“…A região compreendida pela Coordenadoria Regional de Saúde (CRS) do Centro foi a área com maiores taxas de suicídio, em geral e para ambos os sexos, enquanto que as menores taxas ocorreram nas CRS Sudeste e Sul. Segundo Bando et al (2020), houve a formação de um cluster de maiores taxas de suicídio nos distritos administrativos centrais do Município de São Paulo, em relação aos demais, e dois clusters de menor risco, formados por distritos das regiões Sudeste e Sul. A identificação dessas três aglomerações espaciais está em consonância com os achados descritivos do presente trabalho.…”

“…A condição de imigrante é bastante associada ao suicídio (WHO, 2002(WHO, , 2014, inclusive com evidências de associação na própria cidade de São Paulo: maior risco de suicídio em imigrantes em relação a nascidos no Brasil (Bando et al, 2012a) e de maiores taxas de suicídio em áreas com maior proporção de imigrantes (Bando et al, 2020).…”