Buscar en
Revista de Psiquiatría y Salud Mental (English Edition)
Toda la web
Inicio Revista de Psiquiatría y Salud Mental (English Edition) Divergent trends in suicide mortality by Autonomous Community and sex (1980–20...
Journal Information
Vol. 13. Issue 4.
Pages 184-191 (October - December 2020)
Visits
257
Vol. 13. Issue 4.
Pages 184-191 (October - December 2020)
Original article
Full text access
Divergent trends in suicide mortality by Autonomous Community and sex (1980–2016)
Tendencias divergentes en la mortalidad por suicidio según comunidad autónoma y sexo (1980-2016)
Visits
...
Lucía Cayuelaa,
Corresponding author
, Francisco José Pilo Ucedab, Agustín Sánchez Gayangoc, Susana Rodríguez-Domínguezb, Antonio Andrés Velasco Quilesc, Aurelio Cayuelad
a Servicio de Medicina Interna, Hospital Universitario Severo Ochoa, Leganés (Madrid), Spain
b Centro de Salud Pino Montano A, Distrito Sevilla, Sevilla, Spain
c Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Sur de Sevilla, Hospital de Valme, Sevilla, Spain
d Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Área de Gestión Sanitaria Sur de Sevilla, Hospital de Valme, Sevilla, Spain
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Tables (4)
Table 1. Suicide mortality in men per Autonomous Community (1980, 2016).
Table 2. Suicide mortality in women per Autonomous Community (1980, 2016).
Table 3. Suicide mortality trends in men according to Autonomous Community (1980–2016).
Table 4. Suicide mortality trends in women per Autonomous Community (1980–2016).
Show moreShow less
Abstract
Objectives

To analyse the changes in mortality trends by suicide according to Autonomous Community and sex in Spain during the period 1980–2016 using Joinpoint regression models.

Methods

Mortality data were obtained from the Instituo Nacional de Estadística. For each Spanish autonomous community and sex, crude and standardised rates were calculated. The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred.

Results

The joinpoint analysis allows to differentiate areas in which the rates remain stable in men (Cantabria, Castilla-La Mancha) and women (Canary and Cantabria) throughout the study period and others with a continued decline (Extremadura in both men and women and Castilla-La Mancha in women). In those communities where changes in the trend are observed, in almost all of them, there is a first period of increase in rates in both men and women. The most recent trends show divergences between the different autonomous communities and, in men, Andalusia, the Canary Islands, Castilla-León, the Valencian Community, Galicia, Murcia, the Basque Country and La Rioja show significant downward trends, while Catalonia and Madrid show significant increases (2007–2016: 2.4% and 2010–2016: 18.7% respectively). Something similar is observed in women where Andalusia, Castilla y León, Valencian Community, Galicia, Murcia, País Vasco and La Rioja show downward trends while in the Balearic Islands, Catalonia and Madrid the trend is upward (2001–2016: 5.0%; 2006–2016: 4.2% and 2010–2016: 18.7% respectively).

Conclusions

Suicide mortality varies widely among the Spanish autonomous communities, both in terms of mortality level and trends. Little is known about the determinants of observed trends and, therefore, more studies are needed.

Keywords:
Suicide
Epidemiology
Mortality
Trends
Resumen
Objetivos

Analizar los cambios en las tendencias de la mortalidad por suicidio según comunidad autónoma y sexo en España durante el período 1980-2016 utilizando modelos de regresión joinpoint.

Métodos

Los datos de mortalidad se obtuvieron del Instituto Nacional de Estadística. Para cada comunidad autónoma y sexo, se calcularon las tasas brutas y estandarizadas. El análisis de regresión joinpoint se utilizó para identificar los puntos más adecuados en los que se produjo un cambio estadísticamente significativo en la tendencia.

Resultados

El análisis joinpoint permite diferenciar comunidades en las que las tasas permanecen a lo largo de todo el periodo de estudio estables tanto en hombres (Cantabria, Castilla-La Mancha) como en mujeres (Canarias y Cantabria) y otras con un descenso continuado (Extremadura en hombres y mujeres y Castilla-La Mancha en mujeres). En aquellas comunidades en las que se observan cambios en la tendencia se aprecia, en casi todas ellas, un primer periodo de incremento en las tasas tanto en hombres como en mujeres. Las tendencias más recientes muestran divergencias entre las diferentes comunidades autónomas así, en los hombres, Andalucía, Canarias, Castilla-León, Comunidad Valenciana, Galicia, Murcia, País Vasco y La Rioja muestran tendencias descendentes significativas mientras que Cataluña y Madrid muestran incrementos significativos (2007-2016: 2,4% y 2010-2016: 18,7%, respectivamente). Algo similar se observa en las mujeres, para las que Andalucía, Castilla y León, Comunidad Valenciana, Galicia, Murcia, País Vasco y La Rioja muestran tendencias descendentes mientras que en Baleares, Cataluña y Madrid la tendencia es ascendente (2001-2016: 5,0%; 2006-2016: 4,2% y 2010-2016: 18,7% respectivamente).

Conclusiones

La mortalidad por suicidio varía ampliamente a nivel de comunidad autónoma, tanto en términos de nivel de mortalidad como de tendencias. Poco se sabe sobre los determinantes de las tendencias observadas y, por lo tanto, se necesitan más estudios.

Palabras clave:
Suicidio
Epidemiología
Mortalidad
Tendencias
Full Text
Introduction

Suicide is a complex public health problem and the leading cause of premature death.1 There were an estimated 788,000 suicides (rate of 10.7 per 100,000 people) in 2015, representing 1.4% of all deaths worldwide.2 In developed countries, a substantial proportion of the burden of mental illness is attributable to the high prevalence of suicide mortality.3

Suicide mortality differs between sexes, age groups, geographical areas, and socio-political environments, and is variably associated with different risk factors, indicating aetiological heterogeneity.1

In Spain, data provided by the National Institute of Statistics (INE) since 2008, places suicide as the primary unnatural cause of death and this situation remained unchanged until 2016 (the last available year), when suicide deaths are almost double those of road accidents.4 A recent article5 shows that age-adjusted suicide death rates increased in the period 1980–2016 for both men (from 9.8/100,000 in 1980 to 11.8 in 2016, with an average annual increase of .8%) and women (rates increased by 1.0% per year from 2.7/100,000 in 1980 to 3.7 in 2016).

In our country, several studies have been undertaken on the temporal evolution of suicide in some Autonomous Communities: Basque Country (2001–2012),6 Navarra (2000–2015),7 Galicia (1976–19988 and 1975–2012),9 Catalonia (1986–200210 and 2000–201111), Andalusia (1976–199512 and 1975–2012),13 Valencian Community (1976–1990),14 La Rioja (1980–2012)15 and Asturias (1975–199416 and 2002–201617). These studies have quite different objectives, methodologies (periods, standard populations and statistical methods) and ways of presenting results, which makes them difficult to compare.

Mortality trends can be analysed through various different statistical approaches.18 At the beginning of this century, a new method called “Poisson's segmented regression models” or Joinpoint regression analysis was proposed, which has proved useful to identify and describe varying data trends over time,19 and has been used in our context in suicide mortality.5,7,13,15

Taking into account all of the above, our aim was to provide updated information on suicide mortality in Spain and to analyse recent changes in the trend of this mortality in the period 1980–2016 according to Autonomous Community and sex, using Joinpoint regression models.

Patients and methods

Mortality data by autonomous community, age and sex correspond to those published by the INE for 1980–2016. Deaths by suicide were used (codes E950-E959 and X60-X84, Y87.0 of the 9th and 10th revisions of the International Classification of Diseases (ICD) for the periods 1980–1998 and 1999–2008, respectively). Populations estimated as of 1 July by the INE were used for the calculation of indicators.

For each Autonomous Community, the gross and standardised rates were calculated in men and women by the direct method, using the European population as the benchmark,20 and expressing them as rates per 100,000person/year.

Joinpoint regression models were used for trend analysis. The purpose of these models is twofold: to identify when significant changes in trend occur and to estimate the magnitude of the increase or decrease observed in each interval. In this way, the results expressed the years (period) making up each trend, as well as the annual percent change (APC) for each. Standardised mortality rates and their standard errors were used to estimate these models.

We set the minimum number of data in the linear trend at both ends of the period at 3. A maximum of 3 turning points was sought in each regression, for which the programme looks for the simplest model that fits the data using the weighted least squares technique and then estimates its statistical significance using Monte Carlo permutations.

To quantify the trend over the whole period, we calculated the average annual percent change (AAPC) as a geometric weighted average of the APCs of the joinpoint model. This represents a summary measure of the trend over the study period. If an AAPC is found entirely within a single segment, the AAPC will be equal to the APC for that segment.

When describing the results of trend analysis, the terms “increase” or “decrease” indicate statistical significance (p<.05), while non-significant results are reported as “stable”.

The software's pairwise comparison option was used to check whether trends were parallel according to sex.21 Statistical significance was set at .05.

All calculations were made with the Joinpoint Regression software.22

Results

Tables 1 and 2 show the number of deaths, populations, gross rate, and standardised rate for the years 1980 and 2016 per Autonomous Community and according to sex.

Table 1.

Suicide mortality in men per Autonomous Community (1980, 2016).

Men
  DeathsPopulationGRSR
Autonomous Community  1980  2016  1980  2016  1980  2016  1980  2016 
Andalusia  250  528  3,156,869  4,154,782  7.9  12.7  12.9  13.8 
Aragon  29  85  591,898  651,555  4.9  13.0  5.5  12.6 
Asturias  82  94  547,235  495,991  15.0  19.0  20.6  16.6 
Balearic Islands  18  67  319,663  571,360  5.6  11.7  7.3  12.2 
Canary Islands  56  143  674,546  1,064,556  8.3  13.4  14.1  13.1 
Cantabria  25  32  250,423  283,941  10.0  11.3  11.3  10.7 
Castilla y León  96  161  1,284,288  1,208,102  7.5  13.3  9.3  12.0 
Castilla-La Mancha  65  113  819,368  1,026,850  7.9  11.0  11.4  10.9 
Catalonia  104  355  2,897,292  3,629,959  3.6  9.8  5.7  10.0 
Valencian Community  128  255  1,771,111  2,432,475  7.2  10.5  10.3  10.7 
Extremadura  53  66  528,893  537,392  10.0  12.3  14.1  11.8 
Galicia  111  235  1,357,313  1,311,219  8.2  17.9  10.2  16.5 
Madrid  93  218  2,238,116  3,095,019  4.2  7.0  5.7  7.3 
Murcia  27  93  465,747  736,083  5.8  12.6  7.8  13.6 
Navarra  21  34  252,731  316,165  8.3  10.8  12.0  10.6 
Basque Country  47  132  1,056,230  1,049,554  4.4  12.6  7.8  12.1 
Rioja  17  19  126,382  154,371  13.5  12.3  23.8  11.7 
Spain  1237  2662  18,396,289  22,805,443  6.7  11.7  9.8  11.8 

GR: gross rate per 100,000persons/year; SR: standardised rates per 100,000persons/year (standard European population).

Table 2.

Suicide mortality in women per Autonomous Community (1980, 2016).

Women
  DeathsPopulationGRSR
Autonomous Community  1980  2016  1980  2016  1980  2016  1980  2016 
Andalusia  80  140  3,257,418  4,249,238  2.5  3.3  3.3  3.2 
Aragon  14  28  603,844  665,190  2.3  4.2  2.7  3.6 
Asturias  28  40  578,980  541,035  4.8  7.4  5.9  5.9 
Balearic Islands  25  328,544  571,931  2.1  4.4  2.6  4.3 
Canary Islands  26  40  678,290  1,077,722  3.8  3.7  5.1  3.6 
Cantabria  260,423  297,487  1.2  3.0  1.5  2.5 
Castilla y León  27  54  1,307,131  1,236,008  2.1  4.4  2.3  3.8 
Castilla-La Mancha  24  22  835,724  1,016,436  2.9  2.2  3.4  2.0 
Catalonia  26  155  3,013,875  3,786,574  0.9  4.1  1.2  4.1 
Valencian Community  58  81  1,842,047  2,495,436  3.1  3.2  3.9  3.1 
Extremadura  18  16  543,173  543,693  3.3  2.9  3.8  2.9 
Galicia  44  103  1,446,049  1,401,818  3.0  7.3  3.5  6.4 
Madrid  32  87  2,401,419  3,350,543  1.3  2.6  1.8  2.6 
Murcia  13  26  482,743  732,649  2.7  3.5  3.8  3.6 
Navarra  17  254,846  322,048  2.0  5.3  2.1  5.1 
Basque Country  47  1,074,717  1,115,571  0.8  4.2  1.2  4.0 
Rioja  126,865  158,268  0.8  5.7  1.1  4.9 
Spain  415  907  19,096,782  23,644,996  2.2  3.8  2.7  3.7 

GR: gross rate per 100,000persons/year; SR: standardised rates per 100,000persons/year (standard European population).

The number of deaths by suicide approximately doubled from 1980 to 2016 for both men (from 1237 in 1980 to 2662 in 2016) and women (from 415 in 1980 to 907 in 2016). At Autonomous Community level, there is great variability both in men (the ratio 2016/1980 ranges from 1.1 in La Rioja to 3.7 in the Balearic Islands) and in women (the figures range from .9 in Extremadura and Castile-La Mancha to 9.0 in La Rioja).

In 2016 Asturias and Galicia show the highest standardised rates for both men (16.6 and 16.4 respectively) and women (5.9 and 6.3 respectively).

Tables 3 and 4 show the results of the Joinpoint regression analysis, i.e., the points at which the rates change significantly and the annual percent change in each trend in men and women, respectively, per Autonomous Community. Likewise, the average annual percentage change (AAPC) for the study period (1980–2016) is shown.

Table 3.

Suicide mortality trends in men according to Autonomous Community (1980–2016).

Men
  1980–2016  Trend 1Trend 2Trend 3Trend 4
Autonomous Community  AAPC  Period  APC  Period  APC  Period  APC  Period  APC 
Andalusia  .3  1980–1986  9.4a  1986–1992  −4.3a  1992–1997  2.7  1997–2016  −1.7a 
Aragon  2.0a  1980–1990  9.2a  1990–2011  −2.0a  2011–2016  5.5     
Asturias  −.4  1980–1997  1.4a  1997–2005  −4.8a  2005–2016  .1     
Balearic Islands  2.3a  1980–1989  11.1a  1989–2016  −.5         
Canary Islands  .3  1980–1984  14.4  1984–1992  −7.1a  1992–1997  8.5  1997–2016  −1.4a 
Cantabria  −.3  1980–2016  −.3             
Castilla y León  .8  1980–1988  6.1a  1988–2016  −.7a         
Castilla–La Mancha  −.3  1980–2016  −.3             
Catalonia  2.6a  1980–1985  23.1a  1985–2002  −.0  2002–2007  −6.5  2007–2016  2.4 a 
Valencian Community  .1  1980–1993  3.1a  1993–2016  −1.5 a         
Extremadura  −.8a  1980–2016  −.8a             
Galicia  1.2a  1980–1987  8.8a  1987–2016  −.5a         
Madrid  1.2  1980–1999  −.5  1999–2003  12.3  2003–2010  −13.1a  2010–2016  18.7a 
Murcia  .3  1980–1998  2.9a  1998–2016  −2.3a         
Navarra  1.1  1980–1992  4.5a  1992–2016  −.6         
Basque Country  1.9a  1980–1990  8.5a  1990–2016  −.5a         
Rioja  −.3  1980–1990  5.3  1990–2016  −2.3a         
Spain  .8a  1980–1986  7.6a  1986–2000  .0  2000–2010  −2.1a  2010–2016  .7 

APC: annual percent change; AAPC: average annual percent change.

a

p<.05.

Table 4.

Suicide mortality trends in women per Autonomous Community (1980–2016).

Women
  1980–2016  Trend 1Trend 2Trend 3Trend 4
Autonomous Community  AAPC  Period  APC  Period  APC  Period  APC  Period  APC 
Andalusia  .3  1980–1986  9.4a  1986–1992  −4.3a  1992–1997  2.7  1997–2016  −1.7a 
Aragon  2.0a  1980–1990  9.2a  1990–2011  −2.0a  2011–2016  5.5     
Asturias  .3  1980–1991  4.5a  1991–1999  −7.4a  1999–2016  1.3     
Balearic Islands  2.7  1980–1990  8.8a  1990–2001  −5.5  2001–2016  5.0a     
Canary Islands  −.7  1980–2016  −.7             
Cantabria  −.3  1980–2016  −.3             
Castilla y León  .5  1980–1984  14.9  1984–2016  −1.2a         
Castilla-La Mancha  −1.2a  1980–2016  −1.2a             
Catalonia  3.7a  1980–1984  46.9a  1984–2002  −1.0a  2002–2006  −11.1  2006–2016  4.2a 
Valencian Community  −.1  1980–1992  3.5a  1992–2016  −1.9a         
Extremadura  −2.4a  1980–2016  −2.4a             
Galicia  1.2a  1980–1987  8.8a  1987–2016  −.5a         
Madrid  1.2  1980–1999  −.5  1999–2003  12.3  2003–2010  −13.1a  2010–2016  18.7a 
Murcia  .3  1980–1998  2.9a  1998–2016  −2.3 a         
Navarra  1.1  1980–1992  4.5a  1992–2016  −.6         
Basque Country  1.9a  1980–1990  8.5a  1990–2016  –.5a         
Rioja  −.3  1980–1990  5.3  1990–2016  −2.3 a         
Spain  1.0a  1980–1986  8.8a  1986–2004  –1.0a  2004–2010  −3.4  2010–2016  4.5a 

APC: annual percent change; AAPC: average annual percent change.

a

p<.05.

Analysis by Autonomous Community shows that there are different trends in standardised rates over the entire period. In men, Aragon, the Balearic Islands, Catalonia, and the Basque Country show a significant increase, Extremadura a significant decrease (−.8%) and the rest of the Communities remain stable. In women, a significant increase is observed in Aragon, Catalonia, Galicia and the Basque Country, a significant decrease in Castilla-La Mancha and Extremadura.

The joinpoint analysis allows us to differentiate between Communities in which the rates remain stable throughout the study period for both men (Cantabria, Castilla-La Mancha) and women (the Canary Islands and Cantabria) and others with a continuous decrease (Extremadura for men and women, and Castilla-La Mancha for women). There is an initial period of increase in the rates for both men and women in almost all the Communities where changes in trend are observed. The most recent trends show divergences between the different Autonomous Communities. Thus, in men, Andalusia, the Canary Islands, Castilla-Leon, the Valencian Community, Galicia, Murcia, the Basque Country and La Rioja show significant downward trends while Catalonia and Madrid have significant increases (2007–2016: 2.4% and 2010–2016: 18.7%, respectively). Something similar is observed in women, for whom Andalusia, Castilla and Leon, the Community of Valencia, Galicia, Murcia, the Basque Country and La Rioja show downward trends while in the Balearic Islands, Catalonia and Madrid the trend is upward (2001–2016: 5.0%; 2006–2016: 4.2% and 2010–2016: 18.7%, respectively).

The comparability test indicates that the rates followed parallel trends (p<.05) according to sex in Andalusia, Aragon, Cantabria, Galicia, Madrid, Murcia, Navarra, the Basque Country, and La Rioja.

Discussion

In the European Union (EU) (2015)23 10.9 suicides per 100,000 inhabitants were recorded. The lowest rates were in Turkey (2.2 deaths per 100,000 population) and Liechtenstein (2.5). In contrast, countries such as Lithuania and Slovenia had the highest rates (30.3 and 20.7 per 100,000, respectively). Our data places all the Autonomous Communities at figures below the EU average (17.8) for men, while for women La Rioja (4.9), Navarra (5.0), Asturias (5.9) and Galicia (6.3) they are slightly above (EU average: 4.8).

Our results, with higher suicide mortality rates in men (Tables 1 and 2) at national level and in all the Autonomous Communities are consistent with those of other studies that indicate a gender difference in suicide mortality.24 In 2016 the standardised rate ratio (male/female) in Spain was 3.2, which ranged from 2.1 in Navarra to 5.4 in Castilla-La Mancha.

Over the last decade, almost all countries in Europe have experienced marked increases in suicide mortality rates. Before the start of the economic recession (2007), suicide rates for men had fallen. However, this downward trend was reversed in 2008, when it increased by 9.5% and remained high until 2011.25 Over the period 2007–2011, suicide rates for men show 3 distinct trends: acceleration of the pre-existing upward trend (Poland), stability in rates (Austria) and reversal of downward trends (observed in most EU countries, although to varying degrees). Male suicides increased by over 15% in Greece, Ireland and Latvia, while in Bulgaria, France, Germany and Hungary the rate of increase was less than 3%.27 The rates of European women were unaffected and a relatively small increase (2.3%) was observed in U.S. women.28

In Spain, we observe that in women rates increased significantly in the period 2010–2016 (4.5%) while in men they remained stable (.7%, not significant). When analysing by Autonomous Community, the strong increase observed in Madrid (2010–2016: 18.7% in both sexes), the Balearic Islands (2001–2016: 5.0% in women) and Catalonia (2006–2016: 4.2% in women and 2007–2016; 2.4% in men) should be highlighted.

Our results in La Rioja (decrease in rates in both sexes since 1990) are in line with a previous study in which, on analysing the association between gross suicide rates and unemployment or poverty risk rates, no relationship was found (no change in trend was detected during the years affected by the 2008 crisis).15 The stable trend we observed in Navarra since 1992 coincides with that of a recent study which analyses the trend in suicide rates in Navarra (2000–2015).7

Since the approval of the General Health Law and the Report of the Ministerial Commission for Psychiatric Reform, there have been many political, legislative, conceptual and technical changes that affect the mental health of citizens which have been addressed differently in each Autonomous Community, generating rich diversity but also inequities.29

Thus, for example, in the absence of a plan, programme or strategy at national level for the prevention of suicide and the management of suicidal behaviour, experiences are limited to local30–34 or Autonomous Community35–38 initiatives.

Strengths and limitations

Although emphasis has been placed on the limitations of epidemiological findings based on mortality studies, these still represent a basic element for knowledge of the disease and its determinants. Thus, analysis of the temporal trend of suicide mortality is particularly important epidemiological information, as it can reveal risk factors inherent to the society and the environment in which people with suicidal ideation live. In fact, suicide rates are considered an indicator of the psychosocial well-being of the population and a criterion for evaluating the effectiveness of suicide prevention strategies.39

Why do some autonomous communities experience an increase in suicides and not others? These fluctuations could be an artifact, due to the small number of suicides in some communities (this is why the autonomous cities of Ceuta and Melilla have been excluded from our analyses) or due to the quality of the data. Since the 1980s, different mortality registers per Autonomous Region have been being implemented, which have introduced measures to improve the quality of death statistics.40,41 Part of the increase observed in Madrid, in both sexes (2010–2016: 18.7%), could be due to the fact that from 2013 the teams that code causes of death have access to the data of the Forensic Anatomical Institute of Madrid, which has allowed more precise classification of cause of death in deaths with judicial intervention.41 As a consequence, deaths designated as of ill-defined cause have been reassigned to specific external causes, and therefore this should be taken into account when interpreting the observed trend. Something similar may have happened in Catalonia,42 although the trend for women is more accentuated (2006–2016: 4.2%) than for men (2007–2016: 2.4%).

Despite this, the Joinpoint regression analysis (over a very long period of time) shows that the increases observed are significant deviations from previous trends, and therefore our results would reflect the interaction between possible risk factors (among them, mental illness),43 and possible measures for their control over time. Furthermore, this type of analysis can identify periods objectively. This avoids the need to pre-specify periods of time (which can bias the way in which trends are analysed) and makes it possible to describe the evolution of rates more thoroughly, as well as establish hypotheses about the temporal evolution of the changes described.

We know little about the determinants of the observed trends and therefore more studies are needed. A better understanding of these is essential to plan the most efficient possible intervention strategies to achieve the goal proposed by the World Health Organization of reducing suicide mortality.

Funding

None declared.

Conflict of interests

The authors have no conflict of interests to declare.

References
[1]
G. Turecki, D.A. Brent.
Suicide and suicidal behaviour.
Lancet, 387 (2016), pp. 1227-1239
[2]
WHO. Health statistics and information systems. Disease burden and mortality estimates 2000–2015. Available from: Http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html [accessed 14.04.18].
[3]
D. Vigo, G. Thornicroft, R. Atun.
Estimating the true global burden of mental illness.
Lancet Psychiatry, 3 (2016), pp. 171-178
[4]
Instituto Nacional de Estadística. Notas de prensa. Defunciones según la causa de muerte, año 2016 [Internet]. Available from: http://www.ine.es/prensa/edcm_2016.pdf [accessed 12.04.18].
[5]
A. Cayuela, L. Cayuela, A. Sánchez Gayango, S. Rodríguez-Domínguez, F.J. Pilo Uceda, A.A. Velasco Quiles.
Suicide mortality trends in Spain, 1980–2016.
Rev Psiquiatr Salud Ment, (2018),
[6]
C. Borrell, M. Marí-Dell’Olmo, M. Gotsens, M. Calvo, M. Rodríguez-Sanz, X. Bartoll, et al.
Socioeconomic inequalities in suicide mortality before and after the economic recession in Spain.
BMC Public Health, 17 (2017), pp. 772
[7]
J. Delfrade, C. Sayón-Orea, R. Teijeira-Álvarez, Y. Floristán-Floristán, C. Moreno-Iribas.
Divergent trends in suicide mortality in Navarra and Spain: 2000–2015.
Rev Esp Salud Publica, (2017), pp. 91
[8]
C.L. Vidal-Rodeiro, M.I. Santiago-Pérez, J. Paz-Esquete, M.E. López-Vizcaíno, S. Cerdeira-Caramés, X. Hervada-Vidal, et al.
Space-time distribution of suicide in Galicia Spain (1976–1998).
Gac Sanit, 15 (2001), pp. 389-397
[9]
P. Fernández-Navarro, M.L. Barrigón, J. Lopez-Castroman, M. Sanchez-Alonso, M. Páramo, M. Serrano, et al.
Suicide mortality trends in Galicia Spain and their relationship with economic indicators.
Epidemiol Psychiatr Sci, 25 (2016), pp. 475-484
[10]
M. Arán Barés, R. Gispert, X. Puig, A. Freitas, G. Ribas, A. Puigdefàbregas.
Geographical distribution and time trends of suicide mortality in Catalonia and Spain (1986–2002).
Gac Sanit, 20 (2006), pp. 473-480
[11]
C. Saurina, M. Marzo, M. Saez.
Inequalities in suicide mortality rates and the economic recession in the municipalities of Catalonia, Spain.
Int J Equity Health, 14 (2015), pp. 75
[12]
M. Ruiz Ramos, J. Muñoz Bellerín, J.M. Ramos León, J. Gil Arrones, I. Ruiz Pérez, R. Muriel Fernández.
The mortality trend in suicides in Andalucía from 1976 to 1995.
Gac Sanit, 13 (1999), pp. 135-140
[13]
J. Alameda-Palacios, M. Ruiz-Ramos, B. García-Robredo.
Suicide, antidepressant prescription and unemployment in Andalusia (Spain).
Gac Sanit, 28 (2014), pp. 309-312
[14]
S. Pérez-Hoyos, G. Fayos Miñana.
Evolution of suicide mortality in the Valencia Country 1976–1990.
[15]
E. Ruiz, E. Ramalle, R. Quiñones.
Tendencias temporales del suicidio en La Rioja y su relación con la crisis económica del año 2008.
Berceo, 166 (2014), pp. 99-113
[16]
C. Iglesias García, J.A. Alvarez Riesgo.
A study on suicide in Asturias: Increase of the frequency in the last two decades.
Actas Esp Psiquiatr, 27 (1999), pp. 217-222
[17]
P. Suárez, J.C. Alonso, I.E. Ferrero, D. Prieto.
Evolución de la mortalidad por suicidios en Asturias (2002-2016): ¿Ha influido la crisis económica?.
Gac Sanit, 32 (2018), pp. 259
[18]
P.V. Galvão, H.R. Silva, C.M. Silva.
Temporal distribution of suicide mortality: a systematic review.
J Affect Disord, 228 (2018), pp. 132-142
[19]
H.-J. Kim, M.P. Fay, E.J. Feuer, D.N. Midthune.
Permutation tests for joinpoint regression with applications to cancer rates.
[20]
EUROSTAT. Methodologies and Working papers. Revision of the European Standard Population. Report of Eurostat's task force. Available from: http://ec.europa.eu/eurostat/product?code=KS-RA-13-028 [accessed 23.03.18].
[21]
H.J. Kim, et al.
Comparability of segmented line regression models.
Biometrics, 60 (2004), pp. 1005-1014
[22]
National Cancer Institute, Joinpoint Regression Program [Software], Versión 4.5.0.1 Statistical Research and Applications, National Cancer Institute, June 2017. Avaialble from: http://srab.cancer.gov/joinpoint.
[23]
Eurostat. Death due to suicide, by sex http://ec.europa.eu/eurostat/data/database [last accessed 14.04.18].
[24]
C. Borrell, M. Marí-Dell’Olmo, M. Gotsens, M. Calvo, M. Rodríguez-Sanz, X. Bartoll, et al.
Socioeconomic inequalities in suicide mortality before and after the economic recession in Spain.
BMC Public Health, 17 (2017), pp. 772
[25]
D. Stuckler, S. Basu, M. Suhrcke, A. Coutts, M. McKee.
Effects of the 2008 recession on health: a first look at European data.
[27]
B. Barr, D. Taylor-Robinson, A. Scott-Samuel, M. McKee, D. Stuckler.
Suicides associated with the 2008-10 economic recession in England: time trend analysis.
BMJ, 345 (2012), pp. e5142
[28]
S.S. Chang, D. Stuckler, P. Yip, D. Gunnell.
Impact of 2008 global economic crisis on suicide: time trend study in 54 countries.
BMJ, 347 (2013), pp. f5239
[29]
M. Desviat.
Psychiatric reform 25 years after the General Law of Health.
Rev Esp Salud Publica, 85 (2011), pp. 427-436
[30]
M.C. Tejedor, A. Díaz, G. Faus, V. Pérez, I. Solà.
Resultados del programa de prevención de la conducta suicida Distrito de la Dreta de l”Eixample de Barcelona.
Actas Esp Psiquiatr, 39 (2011), pp. 280-287
[31]
A.I. Cebrià, I. Parra, M. Pàmias, A. Escayola, G. García-Parés, J. Puntí, et al.
Effectiveness of a telephone management programme for patients discharged from an emergency department after a suicide attempt: controlled study in a Spanish population.
J Affect Disord, 147 (2013), pp. 269-276
[32]
P.A. Sáiz, J. Rodríguez-Revuelta, L. González-Blanco, P. Burón, S. Al-Halabí, M. Garrido, et al.
Study protocol of a prevention of recurrent suicidal behaviour program based on case management (PSyMAC).
Rev Psiquiatr Salud Ment, 7 (2014), pp. 131-138
[33]
J. Lopez-Castroman, P. Mendez-Bustos, M. Perez-Fominaya, L.B. Villoria, M.J. Zamorano, C.A. Molina, et al.
Code 100: a study on suicidal behavior in public places.
Actas Esp Psiquiatr, 43 (2015), pp. 142-148
[34]
T. Reijas, R. Ferrer, A. González, F. Iglesias.
Evaluación de un programa de intervención intensiva en conducta suicida.
Actas Esp Psiquiatr, 41 (2013), pp. 279-286
[35]
Generalitat Valenciana. Conselleria de Sanitat Universal i Salut Pública. Vivir es la salida. Plan de prevención del suicidio y manejo de la conducta suicida. Available from: http://www.san.gva.es/documents/156344/6939818/Plan+prevenci%C3%B3n+de+suicidio\_WEB\_CAS.pdf [last accessed April 2018].
[36]
Servei Català de la Salut. Atenció a les persones en risc de suïcidi. Codi risc de suïcidi (CRS). http://catsalut.gencat.cat/web/.content/minisite/catsalut/proveidors_professionals/normatives_instruccions/any_2015/instruccio_10_2015/instruccio-codi-risc-suicidi-8-9-2015.pdf [last accessed April 2018].
[37]
Gobierno de Navarra. Prevención y actuación ante conductas suicidas. Protocolo de colaboración interinstitucional. Available from: http://www.navarra.es/NR/rdonlyres/1C0C8294-D0FD-405F-B7CC-85CAFFBDC9BB/291404/00ProtocoloPrevencionSuicidio3.pdf [last accessed April 2018].
[38]
Servizo Galego de Saúde. Plan de prevención del suicidio en Galicia. Available from: https://www.sergas.es/Asistencia-sanitaria/Plan-de-prevenci%C3%B3n-do-suicidio-en-Galicia?idioma=es [last accessed April 2018].
[39]
P. Värnik, M. Sisask, A. Värnik, E. Arensman, C. Van Audenhove, C.M. van der Feltz-Cornelis, et al.
Validity of suicide statistics in Europe in relation to undetermined deaths: developing the 2-20 benchmark.
[40]
M. Gotsens, M. Marí-Dell’Olmo, M. Rodríguez-Sanz, D. Martos, A. Espelt, G. Pérez, et al.
Validation of the underlying cause of death in medicolegal deaths.
Rev Esp Salud Publica, 85 (2011), pp. 163-174
[41]
E. Barbería, R. Gispert, B. Gallo, G. Ribas, A. Puigdefàbregas, A. Freitas, et al.
Improving suicide mortality statistics in Tarragona (Catalonia, Spain) between 2004–2012.
Rev Psiquiatr Salud Ment, (2016),
[42]
E. Barbería, A. Xifró, J. Arimany-Manso.
Impacto beneficioso de la incorporación de las fuentes forenses a las estadísticas de mortalidad.
Rev Esp Med Legal, 43 (2017), pp. 1-4
[43]
P. Qin, E. Agerbo, P.B. Mortensen.
Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997.
Am J Psychiatry, 160 (2003), pp. 765-772

Please cite this article as: Cayuela L, Pilo Uceda FJ, Sánchez Gayango A, Rodríguez-Domínguez S, Velasco Quiles AA, Cayuela A. Divergent trends in suicide mortality by Autonomous Community and sex (1980-2016). Rev Psiquiatr Salud Ment (Barc.). 2020;13:184–191.

Copyright © 2019. SEP y SEPB
Article options
Tools
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos