[Suicide Mortality in Andalusia, Spain: geographical Distribution and Relationship with Antidepressants, Altitude and Socioeconomic Inequalities]. / Mortalidad por suicidio en Andalucía: distribución geográfica y relación con el uso de antidepresivos, la altitud y desigualdades socioeconómicas.

BACKGROUND: The suicide mortality rate in Andalusia is higher than the Spanish average, and it shows a different evolution over time. This study analyzes recent changes of suicide mortality in Andalusia, its geographical distribution and its relation with antidepressant use, altitude and socioeconomic inequality. METHODS: An ecological study of the Basic Health Zones in Andalusia has been conducted. Age-standarized suicide rates in 2012 and during 2007-2011 were calculated. The correlation among variables and their association with the geographical differences was assessed with Spearman's coefficient and generalized linear models were also estimated. RESULTS: Andalusia registered 7,58 suicides per 100.000 inhabitants per year from 2007 to 2011, with a range of 0,96 to 27,71 in the different areas. Positive correlation has been observed between altitude and suicide rates in 2012 (r=0,29; p<0,001) and during the period 2007-2011 (r=0,47; p<0,001). Antidepressant use in 2012 was not correlated with suicide rates in that year (r=0,03; p=0,67), but a positive correlation was observed with the precedent five years suicide rates (r=0,18; p=0,008). The Deprivation Index had a positive correlation with suicide rates in 2012 (r=0,29; p<0,001) and in 2007-2011 (r=0,33; p<0,001). CONCLUSIONS: There is a clear geographical pattern in the distribution of suicide mortality in Andalusia and it remains stable over time. Central areas and in those with the highest altitude concentrate the highest suicide rates, which are associated with a larger use of antidepressants and also with higher levels of material deprivation.

Mortalidad por suicidio en Andalucía: distribución geográfica y relación con el uso de antidepresivos, la altitud y desigualdades socioeconómicas / Suicide Mortality in Andalusia, Spain: Geographical Distribution and Relationship with Antidepressants, Altitude and Socioeconomic Inequalities

Fundamentos: Andalucía tiene una mortalidad por suicidio superior a la media española y una evolución temporal discordante con el conjunto del país. El objetivo fue analizar la evolución reciente de la mortalidad por suicidio en Andalucía, su distribución geográfica y la relación con el uso de antidepresivos, la altitud y las desigualdades socioeconómicas. Métodos: Estudio ecológico cuya unidad de análisis fueron las Zonas Básicas de Salud de Andalucía. Se calcularon las tasas de suicidio ajustadas por edad del periodo 2007-2011 y de 2012. Para analizar las variables asociadas a las diferencias geográficas se midió la correlación mediante el coeficiente de Spearman y se estimaron modelos lineales generalizados. Resultados: Andalucía tuvo una tasa de mortalidad por suicidio de 7,58/100.000 habitantes/año entre 2007 y 2011, con un intervalo de 0,96 a 27,71. Hubo correlación positiva entre altitud y tasas de suicidio en 2012 (r=0,29; p<0,001) y en el periodo 2007-2011 (r=0,47; p<0,001). En 2012 el uso de antidepresivos no se correlacionó con las tasas de suicidio (r=0,03; p=0,67) pero sí durante los cinco años anteriores (r=0,18; p=0,008). El Índice de Privación Material tuvo una correlación positiva con las tasas en 2012 (r=0,29; p<0,001) y de 2007-2011 (r=0,33; p<0,001). Conclusiones: Existe un claro patrón geográfico en la distribución de la mortalidad por suicidio en Andalucía que permanece estable en el período estudiado. La zona central y las de mayor altitud concentran las tasas de suicidio más altas y se asocian con utilización de antidepresivos y mayor privación material (AU)

Background: The suicide mortality rate in Andalusia is higher than the Spanish average, and it shows a different evolution over time. This study analyzes recent changes of suicide mortality in Andalusia, its geographical distribution and its relation with antidepressant use, altitude and socioeconomic inequality. Methods: An ecological study of the Basic Health Zones in Andalusia has been conducted. Age-standarized suicide rates in 2012 and during 2007-2011 were calculated. The correlation among variables and their association with the geographical differences was assessed with Spearman’s coefficient and generalized linear models were also estimated. Results: Andalusia registered 7,58 suicides per 100.000 inhabitants per year from 2007 to 2011, with a range of 0,96 to 27,71 in the different areas. Positive correlation has been observed between altitude and suicide rates in 2012 (r=0,29; p<0,001) and during the period 2007-2011 (r=0,47; p<0,001). Antidepressant use in 2012 was not correlated with suicide rates in that year (r=0,03; p=0,67), but a positive correlation was observed with the precedent five years suicide rates (r=0,18; p=0,008). The Deprivation Index had a positive correlation with suicide rates in 2012 (r=0,29; p<0,001) and in 2007-2011 (r=0,33; p<0,001). Conclusions: There is a clear geographical pattern in the distribution of suicide mortality in Andalusia and it remains stable over time. Central areas and in those with the highest altitude concentrate the highest suicide rates, which are associated with a larger use of antidepressants and also with higher levels of material deprivation (AU)

Suicidio, prescripción de antidepresivos y desempleo en Andalucía / Suicide, antidepressant prescription and unemployment in Andalusia (Spain)

Objetivos: Analizar la evolución temporal de la mortalidad por suicidio en Andalucía entre 1975 y 2012, y su relación con el uso de antidepresivos y el desempleo. Métodos: Para estimar los cambios de tendencia se utilizaron modelos segmentados de regresión de Poisson. La correlación se midió mediante el coeficiente de Spearman. Resultados: La tendencia de la mortalidad por suicidio es ascendente, y son las personas de 15 a 44 años de edad las que presentan aumentos más acusados, con un porcentaje de cambio anual de 1,21 (intervalo de confianza del 95% [IC95%]: 0,7-1,7) para los hombres y de 0,93 (IC95%: 0,4-1,4) para las mujeres. Conclusiones: La mortalidad por suicidio ha aumentado desde 1975 en todos los grupos de edad y sexo, salvo en las mujeres ancianas. En las últimas décadas se aprecian tendencias ascendentes en los jóvenes, y estables o descendentes en el resto, que no están asociadas con el desempleo ni con el uso de antidepresivos (AU)

Objectives: To analyze the trend in suicide mortality in Andalusia from 1975 to 2012 and its relationship with unemployment and the use of antidepressants. Methods: Poisson's segmented regression models were used to estimate changes over time. The association between suicide and the factors examined was measured using Spearman's correlation coefficient. Results: Suicide mortality patterns in men and women are rising. The largest increase was found in people aged from 15 to 44 years, with an annual percentage rate change of 1.21 (95%CI: 0.7-1.7) for men and 0.93 (95%CI: 0.4-1.4) for women. Conclusions: Mortality by suicide has increased in Andalusia since 1975 in all age and gender groups except for women aged 65 years or above. During the last few decades, an upward trend has been observed in young people and a stable or falling trend in the remaining population. Temporary variations in suicide rates are not associated with unemployment rates or with changes in antidepressant prescription (AU)

[Suicide, antidepressant prescription and unemployment in Andalusia (Spain)]. / Suicidio, prescripción de antidepresivos y desempleo en Andalucía.

OBJECTIVES: To analyze the trend in suicide mortality in Andalusia from 1975 to 2012 and its relationship with unemployment and the use of antidepressants. METHODS: Poisson's segmented regression models were used to estimate changes over time. The association between suicide and the factors examined was measured using Spearman's correlation coefficient. RESULTS: Suicide mortality patterns in men and women are rising. The largest increase was found in people aged from 15 to 44 years, with an annual percentage rate change of 1.21 (95%CI: 0.7-1.7) for men and 0.93 (95%CI: 0.4-1.4) for women. CONCLUSIONS: Mortality by suicide has increased in Andalusia since 1975 in all age and gender groups except for women aged 65 years or above. During the last few decades, an upward trend has been observed in young people and a stable or falling trend in the remaining population. Temporary variations in suicide rates are not associated with unemployment rates or with changes in antidepressant prescription.