Antidepressant sales and regional variations of suicide mortality in Germany

Blüml, Victor; Helbich, Marco; Mayr, Michael; Turnwald, Roland; Vyssoki, Benjamin; Lewitzka, Ute; Hartung, Sebastian; Plener, Paul L.; Fegert, Jörg M.; Kapusta, Nestor D.

doi:10.1016/j.jpsychires.2016.12.013

Cited by 7 publications

(10 citation statements)

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“…As we confirmed for Germany, striking spatial disparities in suicide risk are found 13 – 16 , 36 . The regional variation in suicide risk were similar to those found by an Austrian study 31 .…”

Section: Discussionsupporting

confidence: 81%

“…This study was one of the first to explore the space–time patterning of suicide, and is unique in dealing with the German context. Challenging previous studies 10 , 21 , 36 , a major advantage was gained by using a longitudinal research design. Further, we considered time-varying covariate, non-linearities, and both spatial dependence and temporal trends within a uniform model.…”

Section: Discussionmentioning

confidence: 99%

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Spatiotemporal Suicide Risk in Germany: A Longitudinal Study 2007–11

Helbich

Plener

Hartung

et al. 2017

Sci Rep

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Despite comprehensive prevention programs in Germany, suicide has been on the rise again since 2007. The underlying reasons and spatiotemporal risk patterns are poorly understood. We assessed the spatiotemporal risk of suicide per district attributable to multiple risk and protective factors longitudinally for the period 2007–11. Bayesian space–time regression models were fitted. The nationwide temporal trend showed an increase in relative risk (RR) of dying from suicide (RR 1.008, 95% credibility intervals (CI) 1.001–1.016), whereas district-specific deviations from the grand trend occurred. Striking patterns of amplified risk emerged in southern Germany. While the number of general practitioners was positively related (RR 1.003, 95% CI 1.000–1.006), income was negatively and non-linearly related with suicide risk, as was population density. Unemployment was associated and showed a marked nonlinearity. Neither depression prevalence nor mental health service supply were related. The findings are vital for the implementation of future suicide prevention programs. Concentrating preventive efforts on vulnerable areas of excess risk is recommended.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Spatiotemporal Suicide Risk in Germany: A Longitudinal Study 2007–11

Helbich

Plener

Hartung

et al. 2017

Sci Rep

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“…The dataset comprised all suicides of persons residing in Germany who were issued a death certificate by an authorized physician [ 47 ]. As suicide data per district are sparse, and to circumvent stochastic annual variations, the average annual number of suicide cases per district was determined [ 11 ]. A similar procedure was employed for the population at risk (2007–11; German Federal Statistical Office) to determine the expected number of suicides (i.e., multiplying the German-wide suicide rate for the observation period by the average population size of each district).…”

Section: Methodsmentioning

confidence: 99%

“…Reducing mental health disparities between urban and rural settings is receiving considerable attention in both scientific and policy debates [ 1 – 4 ], as is suicide mortality [ 5 – 9 ]. In industrialized nations, suicide is a major cause of death [ 10 ], whereas suicide rates vary greatly across regions [ 11 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Urban–rural inequalities in suicide mortality: a comparison of urbanicity indicators

et al. 2017

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BackgroundUrban–rural disparities in suicide mortality have received considerable attention. Varying conceptualizations of urbanity may contribute to the conflicting findings. This ecological study on Germany assessed how and to what extent urban–rural suicide associations are affected by 14 different urban–rural indicators.MethodsIndicators were based on continuous or k-means classified population data, land-use data, planning typologies, or represented population-based accessibility indicators. Agreements between indicators were tested with correlation analyses. Spatial Bayesian Poisson regressions were estimated to examine urban–rural suicide associations while adjusting for risk and protective factors.ResultsUrban–rural differences in suicide rates per 100,000 persons were found irrespective of the indicator. Strong and significant correlation was observed between different urban–rural indicators. Although the effect sign consistently referred to a reduced risk in urban areas, statistical significance was not universally confirmed by all regressions. Goodness-of-fit statistics suggested that the population potential score performs best, and that population density is the second best indicator of urbanicity. Numerical indicators are favored over classified ones. Regional planning typologies are not supported.ConclusionsThe strength of suicide urban–rural associations varies with respect to the applied indicator of urbanicity. Future studies that put urban–rural inequalities central are recommended to apply either unclassified population potentials or population density indicators, but sensitivity analyses are advised.Electronic supplementary materialThe online version of this article (10.1186/s12942-017-0112-x) contains supplementary material, which is available to authorized users.

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“…These issues might be addressed by the use of objective health indicators such as medication prescription rates [31]. Antidepressant medication is widely utilized for depression treatment [32,33] and represents an ideal proxy for depression prevalence [34]. Apart from two contradictory studies in the UK [35,36], little is known about how green space is related to antidepressant prescription rates.…”

Section: Introductionmentioning

confidence: 99%

More green space is related to less antidepressant prescription rates in the Netherlands: A Bayesian geoadditive quantile regression approach

Helbich

Klein

Roberts

et al. 2018

Environmental Research

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Our findings imply that an increased availability of green space within a municipality may contribute to a reduction in the number of antidepressant prescriptions dispensed. Green space is thus a central health and community asset, whilst a minimum level of 28% needs to be established for health gains. The highest effectiveness occurred at a municipality surface percentage higher than 79%. This inverse dose-dependent relation has important implications for setting future community-level health and planning policies.

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Antidepressant sales and regional variations of suicide mortality in Germany

Cited by 7 publications

References 50 publications

Spatiotemporal Suicide Risk in Germany: A Longitudinal Study 2007–11

Spatiotemporal Suicide Risk in Germany: A Longitudinal Study 2007–11

Urban–rural inequalities in suicide mortality: a comparison of urbanicity indicators

More green space is related to less antidepressant prescription rates in the Netherlands: A Bayesian geoadditive quantile regression approach

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