Spatial patterning, correlates, and inequality in suicide across 432 neighborhoods in Taipei City, Taiwan

Abstract

More than half of the world's population now lives in urban areas. Understanding the spatial distribution of suicide in these settings may inform prevention. Previous analyses of the spatial distribution of suicide in cities were mostly restricted to Western nations. We investigated the spatial pattern of suicide and factors associated with its spatial distribution in Taipei City, Taiwan. We estimated smoothed standardized mortality ratios for overall suicide and suicide by sex/age group across 432 neighborhoods (mean population size: 5,500) in Taipei City, Taiwan (2004-2010) using Bayesian hierarchical models. A range of area-level characteristics including socioeconomic deprivation, social fragmentation, income inequality, and linking social capital were investigated for their associations with suicide mortality. Overall suicide rates were below average in the city center, whereas above average rates were found in some suburbs. The cartogram highlighted the concentration of suicide burden in the western area of the city. Male suicides demonstrated generally similar spatial patterning across age groups, while the geographic distribution of female suicides differed by age. After adjusting for other variables, two area characteristics were found to be associated with area suicide rates: the proportion of divorced/separated adults (rate ratio [RR] per one standard deviation increase =1.08, 95% confidence interval 1.01-1.16), an indicator of social fragmentation; and median household income (RR=0.80, 0.73-0.86), an indicator of socioeconomic deprivation. There was a 1.8-fold difference in suicide rates between neighborhood quintiles with the lowest and the highest median household income, with middle-aged males showing the largest gradient (3.2-fold difference). The geography of suicide in Taipei City showed spatial patterning and socioeconomic correlates distinct from cities in Western nations. There is a need for future research to better understand the correlates of change in the geographic distribution of suicide throughout the process of urban development.

The geography of suicide in older adults in Hong Kong: An ecological study

“…In Hong Kong, higher suicide clusters were mainly found in the New Territories where the population density was low . This pattern is consistent with the findings in China, Japan, and Taiwan where the higher rates of elderly suicide were found to be higher in the rural areas . Contributors to the higher rate of elderly suicide in the lower‐density population areas include social isolation, lack of services, physical disconnectedness, stigma toward mental disorder, and concentration of the minority groups.…”

Spatial patterning and correlates of self-harm in Manchester, England

“…We found similar spatial patterning of self-harm across sex/age groups except the elderly group, which showed no obvious spatial patterning. A few previous studies that investigated sex- and age-specific spatial patterning of suicide similarly showed a higher degree of spatial variations in younger than older groups (Chang et al ., 2011; Lin et al ., 2019). Our regression analyses suggested that younger people living in areas characterised by high levels of unemployment, limiting longstanding illness, lone-parent households and White-British ethnicity had higher rates of self-harm.…”

Socio-economic Characteristics Associated with Increased Suicide Risk Across 1887 Municipalities in Japan, 2009-2017.

“…Regarding socio-economic factors associated with area-speci c suicide risk, it has been pointed out that ndings from Asian countries may be different from those of Western countries. 15 The results from the UK tended to show that area-speci c suicide risk was more strongly associated with social fragmentation than socioeconomic deprivation. 11,12,14,16,17 In contrast, studies from Taiwan and Hong Kong have shown that indicators of socioeconomic deprivation appear to affect area-speci c suicide risk as strong or stronger than those of social fragmentation.…”

“…11,12,14,16,17 In contrast, studies from Taiwan and Hong Kong have shown that indicators of socioeconomic deprivation appear to affect area-speci c suicide risk as strong or stronger than those of social fragmentation. 3,15,18 Although it is not clear why the ndings of Asian countries are different from those of the UK, Lin et al suggested that one of the reasons may be the differences in social protection measures between the UK and Asian countries. 15 That is, social protection measures might be relatively more comprehensive in the UK than in Asian countries and offset some of the suicide risk in deprived areas.…”