Worldwide impact of economic cycles on suicide trends over 3 decades: differences according to level of development. A mixed effect model study

Abstract

ObjectivesTo investigate the trends and correlations of gross domestic product (GDP) adjusted for purchasing power parity (PPP) per capita on suicide rates in 10 WHO regions during the past 30 years.DesignAnalyses of databases of PPP-adjusted GDP per capita and suicide rates. Countries were grouped according to the Global Burden of Disease regional classification system.Data sourcesWorld Bank's official website and WHO's mortality database.Statistical analysesAfter graphically displaying PPP-adjusted GDP per capita and suicide rates, mixed effect models were used for representing and analysing clustered data.ResultsThree different groups of countries, based on the correlation between the PPP-adjusted GDP per capita and suicide rates, are reported: (1) positive correlation: developing (lower middle and upper middle income) Latin-American and Caribbean countries, developing countries in the South East Asian Region including India, some countries in the Western Pacific Region (such as China and South Korea) and high-income Asian countries, including Japan; (2) negative correlation: high-income and developing European countries, Canada, Australia and New Zealand and (3) no correlation was found in an African country.ConclusionsPPP-adjusted GDP per capita may offer a simple measure for designing the type of preventive interventions aimed at lowering suicide rates that can be used across countries. Public health interventions might be more suitable for developing countries. In high-income countries, however, preventive measures based on the medical model might prove more useful.

Suicides in the Island of Mauritius over a decade (2000 to 2010)

“…This trend is similar to those observed in high income European countries, Canada, Australia and New Zealand where suicide rates are decreasing with improvements in GDP per capita adjusted for PPP and contrast with other countries in Latin America and the Caribbean region where economic growth has been accompanied by a rise of suicide rates indicating that income inequality and adequacy of mental health infrastructures also modulate effects of increasing GDP per capita in countries [11]. The finding in our study may be explained by the fact that Mauritius has aimed for equitable income distribution and has made provision for a free public health care system.…”

Suicide and poverty in low-income and middle-income countries: a systematic review

“…We assessed 29 (78%) studies to be of high [30][31][32][33][34][35][36][37][38][39][40][41][42][43] or acceptable [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] quality (Table 3). Eight studies [59][60][61][62][63][64][65][66] were of low quality due to problems with risk of bias: performance, attrition and detection bias (interrupted-time series); selection bias, unclear case definitions, detection bias, lack of adjustment for confounding factors (case-control studies); detection bias, lack of adjustment for confounding factors (cross sectional and ecological studies).…”

“…However, seven studies 33,40,44,45,47,60,66 investigated the relationship between suicide and national income. Three studies using bivariate analysis had mixed results: one 33 positive with the inflation rate in South Africa, one 45 negative with Purchasing Power Parity-adjusted GDP per capita across multiple countries, and one 60 unclear association with GDP per capita in Brazil. When multivariate analyses were performed, results continued to be mixed with two positive associations with per capita real income in Turkey (long-run elasticity of suicide with respect to income -0•41) 44 and with per capita GDP adjusted for inflation in urban (beta=-0•57, SE=0•20) and also in rural China (beta=-0•68, SE=0•06).…”

Variables relacionadas con la tentativa suicida en una provincia de España durante tres años (2009-2011)

“…In fact, some studies identify separated or divorced individuals as being most at risk of making a suicide attempt 25 , whereas others suggest that the single population is the most at-risk group 26 or even that marital status has no bearing whatsoever on suicide attempt 8,27 . Other variables such as economic situation and unemployment have a decisive impact on completed suicide rates, especially in developed and developing countries 2,3,28 . However, results that emerge from analyses of unemployment and suicide attempt are limited, in particular during times of financial crisis 21 .…”