Impacto de factores socioeconómicos en la mortalidad por suicidios en Colombia, 2000-2013 / Impact of Socioeconomic Factors on Suicide Mortality in Colombia, 2000-2013 / Impacto de fatores socioeconómicos na mortalidade por suicídios na Colômbia, 2000-2013

Resumen El objetivo fue analizar la tendencia, el impacto y los factores socioeconómicos asociados con la mortalidad por suicidios en Colombia entre el 2000 y el 2013, por sexo, grupos de edad y estratos del índice de necesidades básicas insatisfechas (INB). Se calcularon tasas estandarizadas de mortalidad, años de vida perdidos (AVP) y un análisis de regresión múltiple binomial negativa. La mortalidad por suicidios disminuyó en Colombia entre el 2000 y el 2013. El estrato medio INB tuvo la mayor mortalidad por suicidios; el estrato muy bajo presentó la mayor disminución; y el estrato muy alto tuvo la menor mortalidad. La desigualdad del ingreso se asoció positivamente con el riesgo de fallecer por suicidio, al igual que la tasa de desempleo y la pobreza tienen una relación negativa con la mortalidad de suicidios. Además de los factores de riesgo individuales del suicidio, las condiciones socioeconómicas del entorno deben ser considerados factores de riesgo de suicidio en Colombia.

Abstract This aarticle analyzes the trend, the impact, and the socioeconomic factors associated with suicide mortality in Colombia between 2000 and 2013, according to gender, age groups, and strata of the unsatisfied basic needs index (AVP). We calculated the standardized mortality, lost years of life (AVP), and carried out a negative binomial multiple regression analysis. Mortality from suicides decreased in Colombia between 2000 and 2013. The middle-income stratum INB had the highest mortality from suicides; the very low income stratum showed the greatest decrease; and the very high income stratum had the lowest mortality. Income inequality was positively associated with the risk of dying from suicide, just as the unemployment rate and poverty are negatively related to suicide mortality. In addition to individual risk factors for suicide, socioeconomic conditions in the environment should be considered risk factors for suicide in Colombia.

Resumo O objetivo foi analisar a tendência, o impacto e os fatores socioeconómicos associados a mortalidade por suicídio na Colômbia entre 2000 e 2013, por sexo, camadas de idade e nível de rendas do índice de necessidades básicas insatisfeitas (INB). Calcularam-se taxas padronizadas de mortalidade, anos de vida perdidos (AVP) e análise de regressão múltipla binomial negativa. A mortalidade por suicídio diminuiu na Colômbia entre 2000 e 2013. O nível meio de rendas INB teve a maior mortalidade por suicídio; o nível de rendas muito baixas apresentou a maior diminuição; e o nível de muito altas rendas teve a menor mortalidade. A desigualdade do ingresso foi associada positivamente com o risco de falecer por suicídio, igual que a taxa de desemprego e a pobreza têm relação negativa com a mortalidade de suicídios. Além dos fatores de risco individuais do suicídio, as condições socioeconómicas do entorno devem se considerar fatores de risco de suicídio na Colômbia.

Medical Care Expenditure in Suicides From Non-illness-related Causes / 예방의학회지

OBJECTIVES: Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated. METHODS: Suicides motivated by non-illness-related factors were identified using the investigator's note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status. RESULTS: Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women. CONCLUSIONS: Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.

Medical Care Utilization During 1 Year Prior to Death in Suicides Motivated by Physical Illnesses / 예방의학회지

OBJECTIVES: Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. METHODS: Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. RESULTS: Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p=0.021) after adjustment for residence, socioeconomic status, and morbidity. CONCLUSIONS: Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.

Costs of injuries due to interpersonal and self-directed violence in Thailand, 2005.

Violence, a serious public health problem in Thailand, remains largely unknown for its economic costs. This study is a national-level economic cost-estimates of injury from interpersonal and self-directed violence for Thailand during 2005 using the World Health Organization-US Centers for Disease Control and Prevention's guidelines. Direct medical costs from self-directed violence totaled 569 million Baht (THB) while the cost of interpersonal violence was THB 1.3 billion. Productivity losses for injuries due to self-directed violence were estimated at THB 12.2 billion and those for interpersonal violence were THB 14.4 billion. The total direct medical cost, thus, accounted for about 4% of Thailand's total health budget while the productivity losses accounted for approximately 0.4% of Thailand s GDP In summary, interpersonal and self-directed violence caused a total loss of 33.8 billion baht for Thailand in 2005. More than 90% of the economic loss was incurred from productivity loss and about four-fifths came from men.