Regional distribution of suicide mortality rates in mainland Portugal: a community perspective from General and Family Medicine

Roberta Barros, Andreia Maria Bandeira, Inês Vasconcelos, Magda Cardoso

Keywords: Suicide, Portugal

Background:

Suicide is an important public health issue, causing 700,000 annual deaths worldwide. Portugal has a lower suicide mortality rate (SMR) than other countries in the European Union, though with marked regional differences. Thus, it is essential to maintain a community approach in the practice of General and Family Medicine.

Research questions:

The primary aim of our study was to characterize the regional differences in SMR in mainland Portugal in 2020. Additionally, we aimed to identify the impact of specific socio-economic determinants and healthcare accessibility.

Method:

We developed an ecological, descriptive study. Data from 2020 (the last available) was obtained from Eurostat, INE and BI-CSP. The SMR of each region was defined as the independent variable, and the dependent variables were: illiteracy, elderly dependency index, use of Primary Healthcare appointments, registered physicians, general practitioners (GP) and psychiatrists per 10,000 inhabitants, unemployment, atheism, population density, rurality index and Gross Disposable Income (GDI). Pearson correlation was used to correlate the SMR with the dependent variables and linear regression was used for bivariate analysis.

Results:

In 2020, the SMR’s (per 100,000 inhabitants) regional distribution in Portugal was: North (6.25), Algarve (15.63), Center (8.39), Lisbon Metropolitan Area (7.09) and Alentejo (16.34).
There was a greater male excess mortality by suicide in the Center and Alentejo regions, whereas the elderly excess mortality rate was greater in Alentejo.
There was a strong correlation between SMR, and doctors (r=-0.82), GPs (r=-0,92) and psychiatrists (r=-0,89); a moderate correlation with the illiteracy rate (r=0.65) and the rurality index (r=0.63); and a weak correlation for all others. In linear regression, there was an association between SMR and total physicians, GPs and psychiatrists per population (p value<0,05).

Conclusions:

The geographical suicide differences in Portugal could be related to physicians’ regional distribution, however the interaction between biopsychosocial and accessibility determinants must be further characterized to improve suicide prevention.

Points for discussion:

Why do physicians’ number could be related to suicide?

How do you think access to health can impact suicide rates trends?

How do you explain the familial or communitarian pattern often seen in suicide?

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