Effect of the Brazilian cash transfer programme on suicide rates: a longitudinal analysis of the Brazilian municipalities

Social Psychiatry and Psychiatric Epidemiology volume 54, pages599–606(2019)Cite this article

Abstract

Purpose

There is a growing awareness of the economic and contextual factors that may play a role in the aetiology of suicide. The Programa Bolsa Família (PBF) the Brazilian conditional cash transfer programme, established in 2004, aims to attenuate the effects of poverty of Brazilians. Our study aims to evaluate the effect of Bolsa Família Programme (BFP) coverage on suicide rates in Brazilian municipalities.

Methods

We conducted an ecological study using 2004–2012 panel data for 5507 Brazilian municipalities. We calculated age-standardized suicide rates for each municipality and year. BFP coverage was categorized according to three levels (< 30%, ≥ 30% and < 70% and ≥ 70%) and duration (coverage ≤ 70% for all years, ≥ 70% for 1 year, ≥ 70% for 2 years, ≥ 70% for 3 or more years). We used negative binomial regression models with fixed effects, adjusting for socio-economic, demographic and social welfare co-variables.

Results

An increase in BFP coverage was associated with a reduction in suicide rates. The strongest effect was observed when in addition to greater municipal coverage (RR 0.942, 95% CI 0.936–0.947), the duration of the high coverage was maintained for 3 years or more (RR 0.952 95% CI 0.950–0.954).

Conclusions

The results provide evidence that the conditional cash transfer programme may reduce suicide in Brazilian municipalities, mitigating the effect of poverty on suicide incidence.

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References

  1. 1.

    World Health Organization (WHO) (2014) Preventing suicide: a global imperative. World Health Organization, Geneva

    Google Scholar 

  2. 2.

    Machado DB, Santos DN (2015) Suicídio no Brasil, de 2000 a 2012. J Bras Psiquiatr 64(1):45–54

    Article  Google Scholar 

  3. 3.

    Rehkopf DH, Buka SL (2006) The association between suicide and the socio-economic characteristics of geographical areas: a systematic review. Psychol Med 36:145–157

    Article  PubMed  Google Scholar 

  4. 4.

    Stack S (2000) Suicide: a 15-year review of the sociological literature part I: cultural and economic factors. Suicide Life Threat Behav 30:145–162

    CAS  PubMed  Google Scholar 

  5. 5.

    Iemmi V, Bantjes J, Coast E, Channer K, Leone T, Mcdaid D, Palfreyman A, Stephens B, Lund C (2016) Suicide and poverty in low-income and middle-income countries: a systematic review. Lancet Psychiatry 3(8):774–83. https://doi.org/10.1016/S2215-0366(16)30066-9

    Article  PubMed  Google Scholar 

  6. 6.

    Yur’yev A, Varnik A, Varnik P, Sisask M, Leppik L (2011) Role of social welfare in European suicide prevention. Int J Soc Welfare 21:26–33

    Article  Google Scholar 

  7. 7.

    Minoiu C, Rodríguez A (2008) The effect of public spending on suicide: evidence from US state data. J Soc Econ 37:237–261

    Article  Google Scholar 

  8. 8.

    Bertolote JM, Fleischmann A, De Leo D, Wasserman D (2004) Psychiatric diagnoses and suicide: revisiting the evidence. Crisis 25(4):147–155

    Article  PubMed  Google Scholar 

  9. 9.

    Lund C, De Silva M, Plagerson S, Cooper S, Chisholm D, Das J, Knapp M, Patel V (2011) Poverty and mental disorders: breaking the cycle in low-income and middle-income countries. Lancet 378:1502–1514

    Article  PubMed  Google Scholar 

  10. 10.

    INAGAKI K (2010) Income inequality and the suicide rate in Japan: evidence from cointegration and LA-VAR. J Appl Econ 13 Sup(1):113–133

    Article  Google Scholar 

  11. 11.

    Hong J, Knapp M, McGuire A (2011) Income-related inequalities in the prevalence of depression and suicidal behaviour: a 10-year trend following economic crisis. World Psychiatry 10(1):40–44

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Christian C, Roth C (2016) Can cash transfers prevent suicides? Experimental evidence from Indonesia. Social Science Electronic Publishing. Outubro, 2016. Disponível em SSRN. https://ssrn.com/abstract=2716684. https://doi.org/10.2139/ssrn.2716684

  13. 13.

    Brasil. Ministério do Desenvolvimento social. MDS. Accessed (2016) http://mds.gov.br/assuntos/bolsa-familia. Accessed May 2016

  14. 14.

    Paes-Sousa R, Santos LM, Miazaki ÉS (2011) Effects of a conditional cash transfer programme on child nutrition in Brazil. Bull World Health Organ 89(7):496–503

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Rasella D, Aquino R, Barreto ML (2013) Impact of income inequality on life expectancy in a highly unequal developing country: the case of Brazil. J Epidemiol Commun Health 67 Sup 8:661

    Article  Google Scholar 

  16. 16.

    Nery JS, Pereira SM, Rasella D, Penna MLF, Aquino R, Rodrigues LC,  Barreto ML, Penna GO (2014) Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy. PLoS Neglect Trop Dis 8(11):e3357

    Article  Google Scholar 

  17. 17.

    Brasil. Ministério da Saúde. Departamento de Informática do SUS (2016) http://www2.datasus.gov.br/DATASUS/index.php. Accessed Jan 2016

  18. 18.

    Instituto Brasileiro de Geografia e Estatística (IBGE) (2016) http://www.ibge.gov.br/home. Recovered in Jan 2016

  19. 19.

    MI. MATRIZ DE INFORMAÇÃO SOCIAL [Social Information Matrix]. MDS. http://aplicacoes.mds.gov.br/sagi/mi2007/tabelas/mi_social.php. Accessed 18 May 2016

  20. 20.

    Hilbe JM (2007) Negative binomial regression. Cambridge University Press, Cambridge

    Google Scholar 

  21. 21.

    Andrade CLT, Szwarcwald CL (2007) Socio-spatial inequalities in the adequacy of Ministry of Health data on births and deaths at the municipal level in Brazil, 2000–2002 (in Portuguese). Cad Saúde Publ 23(5):1207–1216

    Article  Google Scholar 

  22. 22.

    Kilburn K, Thirumurthy H, Halpern CT, Pettifor A (2016) Effects of a large-scale unconditional cash transfer program on mental health outcomes of young people in Kenya: a cluster randomized trial (working paper). J Adolesc Health 58:223–229

    Article  PubMed  Google Scholar 

  23. 23.

    Baird S, De Hoop J, Ozler B (2011) Income shocks and adolescent mental health. World Bank Working Paper. WPS5644, Washington DC

    Google Scholar 

  24. 24.

    Haushofer J, Shapiro J (2016) The short-term impact of unconditional cash transfers to the poor: evidence from Kenya. Q J Econ 131(4):1973–2042

  25. 25.

    Hidrobo M, Amber P, Lori H (2016) The effect of cash, vouchers and food transfers on intimate partner violence: evidence from a randomized experiment in Northern Ecuador. Am Econ J Appl Econ 8:284–303

    Article  Google Scholar 

  26. 26.

    Quisumbing AR, Maluccio JA (2000) Intrahousehold allocation and gender relations: new empirical evidence from four developing countries. International Food Policy Research Institute, Washington, DC

    Google Scholar 

  27. 27.

    Rego WL, Pinzani A (2013) Vozes do Bolsa Família: autonomia, dinheiro e cidadania. Unesp, São Paulo, p 249

    Google Scholar 

  28. 28.

    Moreira NC, Ferreira MA, de Freitas Carvalho AA, Ckagnazaroff IB (2012) Empoderamento das mulheres beneficiárias do Programa Bolsa Família na percepção dos agentes dos Centros de Referência de Assistência Social. Rev Admin Publ 46(2):403–423

    Google Scholar 

  29. 29.

    Buller AM, Hidrobo M, Peterman A, Heise L (2015) The way to a man’s heart is through his stomach?: A mixed methods study on causal mechanisms through which cash and in-kind food transfers decreased intimate partner violence. BMC Public Health 16:488

    Article  Google Scholar 

  30. 30.

    Rasella D, Aquino R, Santos CA, Paes-Sousa R, Barreto ML (2013) Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities. Lancet 382:57–64

    Article  PubMed  Google Scholar 

  31. 31.

    Szwarcwald CL (2008) Strategies for improving the monitoring of vital events in Brazil. Int J Epidemiol 37(4):738–744

    Article  PubMed  Google Scholar 

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Affiliations

  1. Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz (FIOCRUZ), Parque Tecnológico, Edf. Tecnocentro, Sala 315, Rua Mundo, nº 121, Salvador, Bahia, Brazil

    Flávia Jôse Oliveira Alves, Daiane Borges Machado & Maurício L. Barreto

  2. Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil

    Flávia Jôse Oliveira Alves & Maurício L. Barreto

  3. Centre for Global Mental health (CGMH), London School of Hygiene and Tropical Medicine, London, UK

    Daiane Borges Machado

Authors
  1. Flávia Jôse Oliveira Alves
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  2. Daiane Borges Machado
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  3. Maurício L. Barreto
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Correspondence to Flávia Jôse Oliveira Alves.

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Alves, F.J.O., Machado, D.B. & Barreto, M.L. Effect of the Brazilian cash transfer programme on suicide rates: a longitudinal analysis of the Brazilian municipalities. Soc Psychiatry Psychiatr Epidemiol 54, 599–606 (2019). https://doi.org/10.1007/s00127-018-1627-6

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Keywords

  • Conditional cash transfer programme
  • Suicide
  • Attempted suicide
  • Impact evaluation