Association of Selected Area-Level Indicators With Suicide Mortality in Slovenian Municipalities
Abstract
Abstract.Background: With an average suicide rate of 20 per 100,000 in the last decade, Slovenia is above the EU average. There are considerable regional differences in suicide mortality within the country. Aim: We aimed to investigate the relationship between selected indicators at area level and the suicide rate in Slovenian municipalities. Method: Sociodemographic, socioeconomic, and (mental) health data in the years 2012–2016 were analyzed for 212 municipalities. Robust correlation and regression analyses were performed to determine the relationship between different variables and the suicide rate. Results: The suicide rate was positively associated with the percentage of male inhabitants, the high social cohesion in the neighborhood, and the number of sick leave days per capita. It was negatively related to the net income per capita, the marriage rate, the divorce rate, and the availability of professional mental healthcare services. Limitations: The small suicide frequencies within municipalities constitute a limitation of the study. Conclusion: Factors at local, municipal level can be linked to the risk of suicide. In Slovenia, neighborhood cohesion is one of the factors that should be considered when designing suicide prevention measures in a community.
References
2014). Associations between number of sick-leave days and future all-cause and cause-specific mortality: A population-based cohort study. BMC Public Health, 14, 733. 10.1186/1471-2458-14-733
(Ed.) (1951). Suicide: A study in sociology (J. A. Spaulding & G. Simpson, Trans.). Free Press.
(Eurostat . (2013). European Health Interview Survey (EHIS wave 2): Methodological manual. https://ec.europa.eu/eurostat/documents/3859598/5926729/KS-RA-13-018-EN.PDF/26c7ea80-01d8-420e-bdc6-e9d5f6578e7c2001). Social cohesion, social capital and the neighbourhood. Urban Studies, 38(12), 2125–2143. 10.1080/00420980120087081
(2014). Relationship of suicide rates to economic variables in Europe: 2000–2011. The British Journal of Psychiatry, 205(6), 486–496. 10.1192/bjp.bp.114.147454
(2017). A cross-national study on gender differences in suicide intent. BMC Psychiatry, 17(1), 234. 10.1186/s12888-017-1398-8
(2013). Antidepressant utilization and suicide in Europe: An ecological multi-national study. PLoS One, 8(6). 10.1371/journal.pone.0066455
(2017). Spatiotemporal suicide risk in Germany: A longitudinal study 2007–11. Scientific REPOrtS, 7, 7673. 10.1038/s41598-017-08117-4
(2014). Suicide in rural areas: An updated review of the literature. Journal of Rural Mental Health, 38(2), 65–78. 10.1037/rmh0000018
(2011).
(Time to change direction in suicide research . In R. O’ConnorJ. Pirkis (Eds.), The international handbook of suicide prevention (pp. 696–709). John Wiley & Sons.>2010). Availability of mental health service providers and suicide rates in Austria: A nationwide study. Psychiatric Services, 61(12), 1198–1203. 10.1176/appi.ps.61.12.1198
(2016). Association between the density of physicians and suicide rates in Japan: Nationwide ecological study using a spatial Bayesian model. PLoS ONE, 11(2), e0148288. 10.1371/journal.pone.0148288
(2013). Availability of mental health service providers and suicide rates in Slovenia: A nationwide ecological study. Croatian Medical Journal, 54, 444–452. 10.3325/cmj.2013.54.444
(2015). Impact of unemployment variations on suicide mortality in Western European countries (2000–2010). Journal of Epidemiology and Community Health, 69(2), 103–109. 10.1136/jech-2013-203624
(2017). Suicide rates across income levels: retrospective cohort data on 1 million participants collected between 2003 and 2013 in South Korea. Journal of Epidemiology, 27(6), 258–264. 10.1016/j.je.2016.06.008
(2001). Sociološki vidiki samomorilnosti v Sloveniji
([Sociological aspects of suicidality in Slovenia] . Zdravstveno varstvo, 40, 41–50.2005). Socio-economic inequalities in suicide: A European comparative study. British Journal of Psychiatry, 187(1), 49–54.
(2019). robustbase: Basic Robust Statistics R package version 0.93-5 [Computer software]. http://CRAN.R-project.org/package=robustbase
(2015). Impact of income inequality and other social determinants on suicide rate in Brazil. PLoS ONE, 10(4),
(e0124934 . 10.1371/journal.pone.01249342019). Robust statistical methods in R using the WRS2 package. Behavior Research Methods, 52, 464–488. 10.3758/s13428-019-01246-w
(2001). Genetic risk factors as possible cause of the variation in European suicide rates. British Journal of Psychiatry, 179, 194–196. 10.1192/bjp.179.3.194
(2004). Association between mortality from suicide in England and antidepressant prescribing: An ecological study. BMC Public Health, 4, 63. 10.1186/1471-2458-4-63
(National Institute of Public Health of the Republic of Slovenia . (2019a). Database of healthcare providers [Data file].National Institute of Public Health of the Republic of Slovenia . (2019b). European Health Interview Survey Database [Data file].National Institute of Public Health of the Republic of Slovenia . (2019c). Health statistics database [Data file].National Institute of Public Health of the Republic of Slovenia . (2019d). Mortality database [Data file].2000).
(Suicidal behaviour and the labor market . In K. HawtonK. van Heeringen (Eds.), The international handbook of suicide and attempted suicide (pp. 309–384). John Wiley.2010). Antidepressants and suicide risk: a comprehensive overview. Pharmaceuticals, 3(9), 2861–2883. 10.3390/ph3092861
(2013). National suicide rates and mental health system indicators: An ecological study of 191 countries. International Journal of Law and Psychiatry, 36(5–6), 339–342. 10.1016/j.ijlp.2013.06.004
(2018). R: A language and environment for statistical computing [Computer software]. R Foundation for Statistical Computing, Vienna. https://www.R-project.org
. (2018). psych: Procedures for personality and psychological research [Computer software]. Northwestern University, Evanston, Illinois, USA. https://CRAN.R-project.org/package=psych (Version = 1.8.12)
(2015). Suicide in Slovenia between 1997 and 2010: Characteristics, trends, and preventive activities. Crisis, 36(2), 126–134. 10.1027/0227-5910/a000298
(2012). The gender paradox in suicidal behavior and its impact on the suicidal process. Journal of Affective Disorders, 138(1–2), 19–26. 10.1016/j.jad.2011.03.050
(2010). The relationship between general population suicide rates and mental health funding, service provision and national policy: A cross-national study. International Journal of Social Psychiatry, 56(4), 448–453. 10.1177/0020764009342384
(1993). Marital status, alcohol consumption, and suicide: An analysis of national data. Journal of Marriage and Family, 55(4), 1018–1024. 10.2307/352781
(Statistical Office of the Republic of Slovenia . (2019). SiStat [database]. https://pxweb.stat.si/SiStat/en2001). Suicide, serotonin and the brain. Crisis, 22(2), 66–70. 10.1027//0227-5910.22.2.66
(2019). robust: Port of the S+ "Robust Library". R package version 0.4-18.1 [Computer software]. https://CRAN.R-project.org/package=robust
(