A spatio-temporal analysis of suicide in El Salvador

Abstract

BackgroundIn 2012, international statistics showed El Salvador’s suicide rate as 40th in the world and the highest in Latin America. Over the last 15 years, national statistics show the suicide death rate declining as opposed to an increasing rate of homicide. Though completed suicide is an important social and health issue, little is known about its prevalence, incidence, etiology and spatio-temporal behavior. The primary objective of this study was to examine completed suicide and homicide using the stream analogy to lethal violence within a spatio-temporal framework.MethodsA Bayesian model was applied to examine the spatio-temporal evolution of the tendency of completed suicide over homicide in El Salvador. Data on numbers of suicides and homicides at the municipal level were obtained from the Instituto de Medicina Legal (IML) and population counts, from the Dirección General de Estadística y Censos (DIGESTYC), for the period of 2002 to 2012. Data on migration were derived from the 2007 Population Census, and inequality data were obtained from a study by Damianović, Valenzuela and Vera.ResultsThe data reveal a stable standardized rate of total lethal violence (completed suicide plus homicide) across municipalities over time; a decline in suicide; and a standardized suicide rate decreasing with income inequality but increasing with social isolation. Municipalities clustered in terms of both total lethal violence and suicide standardized rates.ConclusionsSpatial effects for suicide were stronger among municipalities located in the north-east and center-south sides of the country. New clusters of municipalities with large suicide standardized rates were detected in the north-west, south-west and center-south regions, all of which are part of time-stable clusters of homicide. Prevention efforts to reduce income inequality and mitigate the negative effects of weak relational systems should focus upon municipalities forming time-persistent clusters with a large rate of death by suicide. In municipalities that are part of newly-formed suicide clusters and also are located in areas with a large rate of homicide, interrupting the expansion of spatial concentrations of suicide over time may require the implementation of both public health and public safety interventions.

Spatio-Temporal Analysis of Suicide-Related Emergency Calls

“…Although previous research has mainly focused on individual and familiar characteristics of suicide, an increasing number of studies have suggested that spatial patterns would also have an impact in suicide risk, in other words, that suicide would not be randomly distributed across the space, but subjected to underlying spatial patterns [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. In addition, other studies have shown the seasonality of suicide: previous research suggests that the prevalence of suicide deaths are not constant, but varies during the year [ 14 , 15 , 16 , 17 , 18 ].…”

“…Specifically, these studies have shown that there is a peak of suicide cases in spring and summer, and the findings are similar independently of the study country. Indeed, linking both ideas of area patterns and seasonality would result in the most appropriate approach to conduct an ecologic study of suicides [ 4 , 10 ].…”

Mortality from Suicide in the Municipalities of Mainland Portugal: Spatio-Temporal Evolution between 1980 and 2015

“…Os autores declaram que os procedimentos seguidos estavam de acordo com os regulamentos estabelecidos pelos responsáveis da Comissão de Investigação Clínica [38][39][40][41][42][43][44] e Ética e de acordo com a Declaração de Helsínquia da Associação Médica Mundial.…”

“…Desde então, tem sido amplamente estudada por diversos autores a influência do contexto no risco de morrer por suicídio: pobreza, 4,5 privação socioeconómica, [6][7][8][9] baixo rendimento, [10][11][12] desemprego, 10,13,14 mau acesso a equipamentos Loureiro A, et al Mortalidade por suicídio em Portugal continental entre 1980 e 2015, Acta Med Port 2018 Jan;31(1): [38][39][40][41][42][43][44] e serviços, 15,16 baixa utilização de espaços verdes, 17 ruralidade [18][19][20] e baixa densidade. 8,21,22 Para além do exposto, em contextos de crise, os efeitos tendem a agravar-se, aumentando as situações de vulnerabilidade e desigualdade, e, consequentemente, o risco e a mortalidade por suicídio.…”

“…As análises de padrões geográficos de mortalidade por suicídio têm-se destacado na literatura científica, nomeadamente no que diz respeito à identificação de excesso de mortes num determinado espaço e num determinado período de tempo. 9,[37][38][39][40] Conhecer o padrão espácio-temporal deste fenómeno é essencial para apoiar o desenvolvimento de estratégias de: i) prevenção da ideação de suicídio/ morte por suicídio, que facilitem a interação positiva dos indivíduos com os ambientes que os rodeiam, minimizando a exposição a eventos de stress ao longo da vida 41 e a ii) mitigação das desigualdades espaciais injustas, com foco nas áreas de maior risco.…”