Spatiotemporal Suicide Risk in Germany: A Longitudinal Study 2007–11

Abstract

Despite comprehensive prevention programs in Germany, suicide has been on the rise again since 2007. The underlying reasons and spatiotemporal risk patterns are poorly understood. We assessed the spatiotemporal risk of suicide per district attributable to multiple risk and protective factors longitudinally for the period 2007–11. Bayesian space–time regression models were fitted. The nationwide temporal trend showed an increase in relative risk (RR) of dying from suicide (RR 1.008, 95% credibility intervals (CI) 1.001–1.016), whereas district-specific deviations from the grand trend occurred. Striking patterns of amplified risk emerged in southern Germany. While the number of general practitioners was positively related (RR 1.003, 95% CI 1.000–1.006), income was negatively and non-linearly related with suicide risk, as was population density. Unemployment was associated and showed a marked nonlinearity. Neither depression prevalence nor mental health service supply were related. The findings are vital for the implementation of future suicide prevention programs. Concentrating preventive efforts on vulnerable areas of excess risk is recommended.

Spatial patterning, correlates, and inequality in suicide across 432 neighborhoods in Taipei City, Taiwan

“…Data were aggregated across years (2004)(2005)(2006)(2007)(2008)(2009)(2010) to ensure for a sufficient number of suicides in small areas. Any changes in the spatial patterning of suicide during the study period were not considered, and this may be further investigated using space-time models in future research (Helbich et al, 2017b).…”

Urban–rural inequalities in suicide mortality: a comparison of urbanicity indicators

“…Reducing mental health disparities between urban and rural settings is receiving considerable attention in both scientific and policy debates [ 1 – 4 ], as is suicide mortality [ 5 – 9 ]. In industrialized nations, suicide is a major cause of death [ 10 ], whereas suicide rates vary greatly across regions [ 11 – 14 ].…”

“…Whereas the living environment also seems to have neurobiological effects that contribute to differences in psychiatric illness [ 18 ], research has also found that urbanity/rurality shapes intra-regional differences in suicide [ 12 , 14 , 19 – 26 ]. There are many possible explanations for an increased suicide risk in rural areas [ 9 , 12 , 14 , 20 , 26 , 27 ]. For instance, despite popular clichés about anonymous city-dwelling, rural living can lead to social isolation, resulting in less intimate face-to-face contact with family and friends, which, in turn, increases the risk for suicidal behavior [ 19 ].…”

“…Country living is often related to a lower socioeconomic status as well as stigmatized attitudes toward visiting mental healthcare facilities (e.g., general practitioner (GP), psychiatrists), and long travel distances diminish the demands for specialized healthcare providers [ 14 , 28 ]. Several empirical studies emphasized an elevated vulnerability in rural areas [ 9 , 12 , 14 , 26 , 27 ], whereas others drew an opposite conclusion [ 21 , 23 , 29 ].…”

“…The rationale for selecting Germany is twofold. First, Germany experienced an increase in suicides in 2007–11 [ 9 , 42 ], despite the country’s suicide prevention program [ 43 ]. Second, whereas several Anglophone studies [ 8 , 19 , 21 , 24 , 44 , 45 ] and Asian studies [ 6 , 7 , 27 , 37 ] exist, research on intra-national differences in continental Europe is underrepresented [ 14 , 38 , 46 ].…”