Spatiotemporal clustering of suicides in the US from 1999 to 2016: a spatial epidemiological approach

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="title" id="d129679e160">Purpose</h5> <p id="P1">This study aims to describe and characterize the spatial and temporal clustering patterns of suicide in the ten states with the greatest suicide burden in the United States from 1999 to 2016. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="title" id="d129679e165">Methods</h5> <p id="P2">All suicide deaths from January 1, 1999 to December 31, 2016 in the United States were identified using data from the Wide-ranging Online Data for Epidemiologic Research (WONDER) dataset. The ten states with the highest age-adjusted suicide rates were Montana, Alaska, Wyoming, New Mexico, Nevada, Utah, Idaho, Colorado, Arizona, and Oklahoma. A spatiotemporal scan statistic using a discrete Poisson model was employed to retrospectively detect spatiotemporal suicide clusters. </p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="title" id="d129679e170">Results</h5> <p id="P3">From 1999 to 2016, a total of 649,843 suicides were recorded in the United States. Nineteen statistically significant spatiotemporal suicide mortality clusters were identified in the states with the greatest suicide rates, and 13.53% of the suicide cases within these states clustered spatiotemporally. The risk ratio of the clusters ranged from 1.45 to 3.64 ( <i>p</i> < 0.001). All states had at least one cluster, with three clusters spanning multiple states, and four clusters were found in Arizona. While there was no clear secular trend in the average size of suicide clusters, the number of clusters increased from 1999 to 2016. </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="title" id="d129679e178">Conclusions</h5> <p id="P4">Hot spots for suicidal behavior in the United States warrant public health intervention and continued surveillance. As suicide rates in the US continue to increase annually, public health efforts could be maximized by focusing on regions with substantial clustering. </p> </div>

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Suicide and suicidal behavior.

M. Nock, G. Borges, E. J. Bromet … (2008)

Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.

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Suicide and the media.

Madelyn S Gould (2001)

Evidence continues to amass on the significant impact of media coverage on suicide. The research literature on the impact of news reports of nonfictional suicides as well as fictional suicide stories is reviewed in order to determine the nature and scope of the influence of the mass media on suicide. The current review, building upon earlier reviews, is limited to English language publications or English translations of articles and/or abstracts. The interactive factors that may moderate the impact of media stories are also reviewed. Such interactive factors include characteristics of the stories (agent), individuals' attributes (host), and social context of the stories (environment). Recommendations are presented for the reporting of suicide stories, which may minimize the risk of imitative suicides. The media's positive role in educating the public about risks for suicide and shaping attitudes about suicide is emphasized. In summary, the existence of suicide contagion no longer needs to be questioned. We should refocus our research efforts on identifying which particular story components promote contagion under which circumstances and which components are useful for preventive programming.

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The Great Recession, unemployment and suicide

Thor Norström, Hans Grönqvist (2014)

Background How have suicide rates responded to the marked increase in unemployment spurred by the Great Recession? Our paper puts this issue into a wider perspective by assessing (1) whether the unemployment-suicide link is modified by the degree of unemployment protection, and (2) whether the effect on suicide of the present crisis differs from the effects of previous economic downturns. Methods We analysed the unemployment-suicide link using time-series data for 30 countries spanning the period 1960–2012. Separate fixed-effects models were estimated for each of five welfare state regimes with different levels of unemployment protection (Eastern, Southern, Anglo-Saxon, Bismarckian and Scandinavian). We included an interaction term to capture the possible excess effect of unemployment during the Great Recession. Results The largest unemployment increases occurred in the welfare state regimes with the least generous unemployment protection. The unemployment effect on male suicides was statistically significant in all welfare regimes, except the Scandinavian one. The effect on female suicides was significant only in the eastern European country group. There was a significant gradient in the effects, being stronger the less generous the unemployment protection. The interaction term capturing the possible excess effect of unemployment during the financial crisis was not significant. Conclusions Our findings suggest that the more generous the unemployment protection the weaker the detrimental impact on suicide of the increasing unemployment during the Great Recession.