Impact of Income Inequality and Other Social Determinants on Suicide Rate in Brazil

Abstract

Studies about suicide worldwide have mainly focused on individual-level psychiatric risk factors. In Brazil, suicide is an important public health problem. Brazil has evidenced important socioeconomic changes over the last decades, leading to decreasing income inequality. However, the impact of income inequality on suicide rate has never been studied in the country.PurposeTo analyze whether income inequality and other social determinants are associated with suicide rate in Brazil.MethodThis study used panel data from all 5,507 Brazilian municipalities from 2000 to 2011. Suicide rates were calculated by sex and standardized by age for each municipality and year. The independent variables of the regression model included the Gini Index, per capita income, percentage of individuals with up to eight years of education, urbanization, average number of residents per household, percentage of divorced people, of Catholics, Pentecostals, and Evangelicals. A multivariable negative binomial regression for panel data with fixed-effects specification was performed.ResultsThe Gini index was positively associated with suicide rates; the rate ratio (RR) was 1.055 (95% CI: 1.011–1.101). Of the other social determinants, income had a significant negative association with suicide rates (RR: 0.968, 95% CI: 0.948–0.988), whereas a low-level education had a positive association (RR: 1.015, 95% CI: 1.010–1.021).ConclusionsIncome inequality represents a community-level risk factor for suicide rates in Brazil. The decrease in income inequality, increase in income per capita, and decrease in the percentage of individuals who did not complete basic studies may have counteracted the increase in suicides in the last decade. Other changes, such as the decrease in the mean residents per household, may have contributed to their increase. Therefore, the implementation of social policies that may improve the population’s socioeconomic conditions and reduce income inequality in Brazil, and in other low and middle-income countries, can help to reduce suicide rates.

Comparative analysis of death by suicide in Brazil and in the United States: descriptive, cross-sectional time series study

“…Individual factors that affect the risk of suicide include mental disorders, genetics, drug misuse, psychological states and cultural, family and social situations, and some of these frequently coexist. [5][6][7] A correlation between suicidal intent and lethality has also been reported in the literature. 19 Socioeconomic problems such as unemployment, poverty, homelessness and discrimination may also trigger suicidal behavior.…”

“…However, Machado et al 6 and Kim 28 concluded that inequality is an important determinant of suicide, both in Brazil and in the US.…”

“…5 Supposedly, social determinants such as decreased income inequality and increased income per capita may have positive associations with decreased suicide rates. 6 A previous study showed that Rio Grande do Sul has the highest suicide rate among Brazilian states, and it has been suggested that ethnicity, culture, social crises and even the local climate might be factors influencing this. 7 The suicide rate in the United States (US) is 12.1 deaths per 100,000 inhabitants, and this is the 10 th largest general cause of death for all ages.…”

“…To increase knowledge of suicide risk factors in specific contexts, effective prevention strategies need to be adopted. 6 Therefore, the objective of the present study was to ascertain whether income inequality, through the Gini coefficient, is associated with mortality due to suicide, specifically by contrasting Brazil and the US. It was hypothesized that reduction of income inequality would be accompanied by reduction of suicide rates, as suggested in the literature.…”

Prevalência e risco de suicídio no Brasil e na cidade de Barra do Garças (MT): revisão de literatura

“…O estudo dessa questão e suas associações é importante, pois sua ocorrência teve aumento global nas últi mas décadas 2 , e no Brasil, entre 1996 e 2010, houve um aumento de 6,4 vezes por 100 mil habitantes 3 . A cidade de Barra do Garças (MT) acompanha o país nessa epidemiologia, sendo a única cidade do Mato Grosso que possui trabalhos estatí sti cos sobre o tema, com análises sobre prevalência e incidência nos diversos grupos sociais 4 .…”