Abstract
Place of residence can influence suicide acts, beyond individual characteristics. The aim of this study was to identify areas with a greater risk of suicide, identify possible associations with ecological risk factors and develop a risk map of suicide in Portugal. Spatial scan statistic was used to identify critical areas and associations were analyzed through logistic regression models. The results indicate that the spatial distribution of suicides could be determined by a set of ecological risk factors, and that being a foreigner (OR 26.64; 95% CI 13.15–53.97), having no religion (OR 8.65; 95% CI 4.62–16.19) and having lower levels of education (OR 1.20; 95% CI 1.09–3.64) are associated with a higher risk of suicide in Portugal. Results indicate that local risk factors should be taken into account, in accordance to the priority Health Program in the Mental Health area of the Directorate-General for Health of Portugal.
Similar content being viewed by others
References
Bando, D. H., Brunoni, A. R., Benseñor, I. M., & Lotufo, P. A. (2012). Suicide rates and income in São Paulo and Brazil: A temporal and spatial epidemiologic analysis from 1996 to 2008. BMC Psychiatry,12(1), 127.
Bonelli, R. M., & Koenig, H. G. (2013). Mental disorders, religion and spirituality 1990 to 2010: A systematic evidence-based review. Journal of Religion and Health,52(2), 657–673. https://doi.org/10.1007/s10943-013-9691-4.
Chang, S.-S., Gunnell, D., Sterne, J. A. C., Lu, T.-H., & Cheng, A. T. A. (2009). Was the economic crisis 1997–1998 responsible for rising suicide rates in East/Southeast Asia ? A time–trend analysis for Japan, Hong Kong, South Korea. Social Science & Medicine,68(7), 1322–1331. https://doi.org/10.1016/j.socscimed.2009.01.010.
Chen, Y., Sf, P., Lee, C., Fan, H., & Fu, K. (2010). Economic fluctuations and suicide: A comparison of Taiwan and Hong Kong. Social Science and Medicine,71(12), 2083–2090. https://doi.org/10.1016/j.socscimed.2010.09.043.
Cheung, Y. T. D., Spittal, M. J., Pirkis, J., & Yip, P. S. F. (2012). Spatial analysis of suicide mortality in Australia: Investigation of metropolitan-rural-remote differentials of suicide risk across states/territories. Social Science and Medicine,75(8), 1460–1468. https://doi.org/10.1016/j.socscimed.2012.04.008.
Couceiro, L., Santana, P., & Nunes, C. (2011). Pulmonary tuberculosis and risk factors in Portugal: A spatial analysis. The International Journal of Tuberculosis and Lung Disease,15(11), 1445–1455. https://doi.org/10.5588/ijtld.10.0302.
Direção Geral da Saúde de Portugal. (2016). Saúde Mental em Números—2015. Retrieved from: https://www.dgs.pt/estatisticas-de-saude/estatisticas-de-saude/publicacoes/portugal-saude-mental-em-numeros-2015-pdf.aspx.
Durkheim, É. (1897). Le suicide: étude de sociologie.
Exeter, D. J., & Boyle, P. J. (2007). Does young adult suicide cluster geographically in Scotland? Journal of Epidemiology and Community Health,61(8), 731–737. https://doi.org/10.1136/jech.2006.052365.
Garroutte, E. M., Goldberg, J., Beals, J., Herrell, R., Manson, S. M., & Team, A. (2003). Spirituality and attempted suicide among American Indians. Social Science and Medicine,56(7), 1571–1579.
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (1998). Multivariate data analysis. Upper Saddle River, NJ: Prentice Hall.
Hawkley, L. C., Hughes, M. E., Waite, L. J., Masi, C. M., Thisted, R. A., & Cacioppo, J. T. (2008). From social structural factors to perceptions of relationship quality and loneliness: The Chicago health, aging, and social relations study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences,63(6), 375–384.
Jones, P., Gunnell, D., Platt, S., Scourfield, J., Lloyd, K., Huxley, P., …, Dennis, M. (2013). Identifying Probable Suicide Clusters in Wales Using National Mortality Data. PLoS ONE, 8(8), e71713. https://doi.org/10.1371/journal.pone.0071713.
Kimura, T., Iso, H., Honjo, K., Ikehara, S., Sawada, N., Iwasaki, M., …, Study, J. (2016). Educational levels and risk of suicide in Japan : The Japan Public Health Center Study (JPHC) Cohort I. Journal of Epidemiology, 26(6), 315–321.
Kulldorff, M. (1997). A spatial scan statistic. Communications in Statistics-Theory and Methods,26(6), 1481–1496. https://doi.org/10.1080/03610929708831995.
Laanani, M., Ghosn, W., Jougla, E., & Rey, G. (2015). Impact of unemployment variations on suicide mortality in Western European countries (2000–2010). Journal of Epidemiology and Community Health,69(2), 103–109. https://doi.org/10.1136/jech-2013-203624.
Li, Z., Page, A., Martin, G., & Taylor, R. (2011). Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: A systematic review. Social Science and Medicine,72(4), 608–616. https://doi.org/10.1016/j.socscimed.2010.11.008.
Lipsicas, C. B., Mäkinen, I. H., Apter, A., Leo, D. De, Kerkhof, A., Lönnqvist, J., …, Wasserman, D. (2012). Attempted suicide among immigrants in European countries: An international perspective. Social Psychiatry and Psychiatric Epidemiology, 47(2), 241–251. https://doi.org/10.1007/s00127-010-0336-6.
Lizardi, D., & Gearing, R. E. (2010). Religion and suicide: Buddhism, Native American and African religions, atheism, and agnosticism. Journal of Religion and Health,49(3), 377–384. https://doi.org/10.1007/s10943-009-9248-8.
Lorant, V., Kunst, A. E., Huisman, M., Costa, G., & Mackenbach, J. (2005). Socio-economic inequalities in suicide: A European comparative study. British Journal of Psychiatry,187(1), 49–54.
Martiello, M. A., & Giacchi, M. V. (2012). Ecological study of isolation and suicide in Tuscany (Italy). Psychiatry Research,198(1), 68–73. https://doi.org/10.1016/j.psychres.2011.11.013.
Ngui, A. N., Apparicio, P., Moltchanova, E., & Vasiliadis, H.-M. (2014). Spatial analysis of suicide mortality in Québec: Spatial clustering and area factor correlates. Psychiatry Research,220(1–2), 20–30. https://doi.org/10.1016/j.psychres.2014.07.033.
Pompili, M., Vichi, M., Innamorati, M., Leo, D. De, & Girardi, P. (2015). Does the level of education influence completed suicide? A nationwide register study. Journal of Affective Disorders,147(1–3), 437–440. https://doi.org/10.1016/j.jad.2012.08.046.
Qi, X., Hu, W., Page, A., & Tong, S. (2012). Spatial clusters of suicide in Australia. BMC Psychiatry,12(1), 86.
Rego, C., Mendes, M. F., Rebelo, J., & Magalhães, G. (2010). Perfil dos imigrantes em Portugal: por países de origem e regiões de destino. Portuguesa de Estudos Regionais,24, 17–39.
Santana, P., Costa, C., Cardoso, G., Loureiro, A., & Ferrão, J. (2015). Suicide in Portugal: Spatial determinants in a context of economic crisis. Health & Place,35, 85–94. https://doi.org/10.1016/j.healthplace.2015.07.001.
Santos, J. P., Tavares, M., & Barros, P. P. (2016). More than just numbers: Suicide rates and the economic cycle in Portugal (1910–2013). SSM—Population Health,2, 14–23. https://doi.org/10.1016/j.ssmph.2015.11.004.
Savikko, N., Routasalo, P., & Tilvis, R. S. (2005). Predictors and subjective causes of loneliness in an aged population. Archives of Gerontology and Geriatrics,41, 223–233. https://doi.org/10.1016/j.archger.2005.03.002.
Spallek, J., Reeske, A., Norredam, M., Nielsen, S. S., Lehnhardt, J., & Razum, O. (2014). Suicide among immigrants in Europe—A systematic literature review. The European Journal of Public Health,25(1), 63–71. https://doi.org/10.1093/eurpub/cku121.
Stack, S., & Kposowa, A. J. (2011). Religion and suicide: Integrating four theories cross-nationally religion and suicide acceptability: A cross-national analysis. In R. C. O’Connor, S. Platt, & J. Gordon (Eds.), International handbook of suicide prevention: Research, policy and practice (pp. 235–252). Hoboken: Wiley. https://doi.org/10.1002/9781119998556.ch14.
Stravynski, A., & Boyer, R. (2001). Loneliness in relation to suicide ideation and parasuicide: A population-wide study. Suicide and Life-Threatening Behavior,31(1), 32–40. https://doi.org/10.1521/suli.31.1.32.21312.
World Health Organization. (2014). Preventing suicide: A global imperative.
World Health Organization. (2015). Suicide rates (per 100,000 population). Retrieved from http://www.who.int/gho/mental_health/suicide_rates/en/.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Rocha, J.V.M., Nunes, C. Can We Develop a Risk Map for Suicide Rates? An Ecological Study in Portugal. Community Ment Health J 56, 532–539 (2020). https://doi.org/10.1007/s10597-019-00510-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-019-00510-9