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Association between homicide rates and suicide rates: a countrywide longitudinal analysis of 5507 Brazilian municipalities.

ABSTRACT: OBJECTIVE:To estimate the association between homicide and suicide rates in Brazilian municipalities over a period of 7 years. DESIGN:We conducted a longitudinal ecological study using annual mortality data from 5507 Brazilian municipalities between 2008 and 2014. Multivariable negative binomial regression models were used to examine the relationship between homicide and suicide rates. Robustness of results was explored using sensitivity analyses to examine the influence of data quality, population size, age and sex on the relationship between homicide and suicide rates. SETTING:A nationwide study of municipality-level data. PARTICIPANTS:Mortality data and corresponding population estimates for municipal populations aged 10 years and older. PRIMARY AND SECONDARY OUTCOME MEASURES:Age-standardised suicide rates per 100?000. RESULTS:Municipal suicide rates were positively associated with municipal homicide rates; after adjusting for socioeconomic and demographic factors, a doubling of the homicide rate was associated with 22% increase in suicide rate (rate ratio=1.22, 95%?CI: 1.13 to 1.33). A dose-response effect was observed with 4% increase in suicide rates at the third quintile, 9% at the fourth quintile and 12% at the highest quintile of homicide rates compared with the lowest quintile. The observed effect estimates were robust to sensitivity analyses. CONCLUSIONS:Municipalities with higher homicide rates have higher suicide rates and the relationship between homicide and suicide rates in Brazil exists independently of many sociodemographic and socioeconomic factors. Our results are in line with the hypothesis that changes in homicide rates lead to changes in suicide rates, although a causal association cannot be established from this study. Suicide and homicide rates have increased in Brazil despite increased community mental health support and incarceration, respectively; therefore, new avenues for intervention are needed. The identification of a positive relationship between homicide and suicide rates suggests that population-based interventions to reduce homicide rates may also reduce suicide rates in Brazil.

SUBMITTER: Machado DB

PROVIDER: S-EPMC7643512 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Association between homicide rates and suicide rates: a countrywide longitudinal analysis of 5507 Brazilian municipalities.

Machado Daiane Borges DB McDonald Keltie K Castro-de-Araujo Luis F S LFS Devakumar Delan D Alves Flávia Jôse Oliveira FJO Kiss Lígia L Lewis Glyn G Barreto Mauricio L ML

BMJ open 20201104 11

<h4>Objective</h4>To estimate the association between homicide and suicide rates in Brazilian municipalities over a period of 7 years.<h4>Design</h4>We conducted a longitudinal ecological study using annual mortality data from 5507 Brazilian municipalities between 2008 and 2014. Multivariable negative binomial regression models were used to examine the relationship between homicide and suicide rates. Robustness of results was explored using sensitivity analyses to examine the influence of data q ...[more]

PMID: 33148758

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Project description:IMPORTANCE:Previous studies have linked suicide risk with religious participation, but the majority have used ecologic, cross-sectional, or case-control data. OBJECTIVE:To examine the longitudinal association between religious service attendance and suicide and the joint associations of suicide with service attendance and religious affiliation. DESIGN, SETTING, AND PARTICIPANTS:We evaluated associations between religious service attendance and suicide from 1996 through June 2010 in a large, long-term prospective cohort, the Nurses' Health Study, in an analysis that included 89?708 women. Religious service attendance was self-reported in 1992 and 1996. Data analysis was conducted from 1996 through 2010. MAIN OUTCOMES AND MEASURES:Cox proportional hazards regression models were used to examine the association between religious service attendance and suicide, adjusting for demographic covariates, lifestyle factors, medical history, depressive symptoms, and social integration measures. We performed sensitivity analyses to examine the influence of unmeasured confounding. RESULTS:Among 89?708 women aged 30 to 55 years who participated in the Nurses' Health Study, attendance at religious services once per week or more was associated with an approximately 5-fold lower rate of suicide compared with never attending religious services (hazard ratio, 0.16; 95% CI, 0.06-0.46). Service attendance once or more per week vs less frequent attendance was associated with a hazard ratio of 0.05 (95% CI, 0.006-0.48) for Catholics but only 0.34 (95% CI, 0.10-1.10) for Protestants (P?=?.05 for heterogeneity). Results were robust in sensitivity analysis and to exclusions of persons who were previously depressed or had a history of cancer or cardiovascular disease. There was evidence that social integration, depressive symptoms, and alcohol consumption partially mediated the association among those occasionally attending services, but not for those attending frequently. CONCLUSIONS AND RELEVANCE:In this cohort of US women, frequent religious service attendance was associated with a significantly lower rate of suicide.

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Association between homicide rates and suicide rates: a countrywide longitudinal analysis of 5507 Brazilian municipalities.

Publications

Association between homicide rates and suicide rates: a countrywide longitudinal analysis of 5507 Brazilian municipalities.

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