An ecological study on suicide and homicide in Brazil

Trend Analysis of Suicide and Homicide Mortality and Years of Life Lost (YLL) in Children Aged 10-19 Years in the South of Iran, 2004-2019

BACKGROUND

This study aimed to investigate mortality and years of life lost (YLL) due to suicide and homicide in children aged 10-19 years in southern Iran from 2004 to 2019. Study Design: A cross-sectional study.

METHODS

The data on all deaths due to suicide and homicide in Fars province were obtained from the population-based electronic death registration system (EDRS). Crude mortality rate and YLL were calculated. The joinpoint regression method was used to examine the trend.

RESULTS

During the study period, 563 cases of suicide and 218 cases of homicide in children aged 10-19 have occurred. The total number of YLL due to suicide was 9766 in men and 6261 in women. According to the joinpoint regression analysis, the trend of YLL due to suicide was increasing in males. In other words, the annual percent change (APC) was 4.8% (95% CI 0.4 to 9.5, P=0.036). Additionally, there was a constant trend in females, and APC was 2.7% (95% CI -2.0 to 7.7, P=0.241). The number of YLL due to homicide was 4890 in males and 1294 in females. The trend of YLL due to homicide was stable in males and females. In other words, APC was -1.6% (95% CI -5.6 to -2.6, P=0.422) in males and -2.7% (95% CI -10.0 to 5.2, P=0.467) in females.

CONCLUSION

Based on the findings of this study, the trend of mortality rate and YLL due to suicide in men has been increasing and it has been stable in women. Moreover, the trend of mortality due to homicide was stable for both males and females. Therefore, it is necessary to take preventive actions.

Epidemiological surveillance: a brief history and the experiences of the United States and the state of São Paulo

OBJECTIVE

The objective of this narrative review was to list some historical aspects of epidemiological surveillance, a technological intervention model initially designed to help control communicable diseases in the last century.

METHODS

This narrative was built based on texts selected to record the development of epidemiological surveillance in the United States and in the state of São Paulo, Brazil.

RESULTS

The origins of some of the actions that constitute epidemiological surveillance activities are presented, as well as a brief history of the establishment of the originally named Center for Disease Control, a United States agency that is held up as an example in relation to the way surveillance has been performed, practically all over the world. Likewise, we outline the paths that led to the establishment of the surveillance system in the state of São Paulo, drawing some parallels with the Brazilian system.

CONCLUSION

The narrative concludes with a conceptual differentiation between epidemiological surveillance, monitoring and health surveillance.

Cultural adaptation of the mental health first aid guidelines for assisting a person at risk of suicide in Brazil: a Delphi expert consensus study

BACKGROUND

Suicide is a major public health concern in Brazil, with nearly 115,000 Brazilians dying by suicide in 2010-2019. As support for individuals at risk of suicide may come from the community, particularly family and friends, it is fundamental that evidence-based programs or resources to improve such support are in place when needed. This study aimed to culturally adapt the mental health first aid guidelines for assisting a person at risk of suicide used in English-speaking countries for Brazil.

METHODS

A Delphi expert consensus study was conducted among a diverse range of Brazilian health professionals and individuals with lived experience of suicide (n = 60). A total of 161 items from the mental health first aid questionnaire used in English-speaking countries were translated and used in the Brazilian questionnaire. Participants were asked to rate the appropriateness of those items to the Brazilian culture and to recommend any new items when appropriate.

RESULTS

Data were collected over two survey rounds. Consensus was achieved on 145 items. While 123 out of 161 items were adopted from the English guidelines, 22 new endorsed items were created from the expert panel comments.

CONCLUSIONS

Even though there were similarities among the Brazilian and English-language guidelines, the adapted guidelines incorporated actions that were specific to the Brazilian culture, such as new items emphasising the role of family and friends. Further research is warranted on dissemination and uptake of the guidelines in Brazil as well as research into incorporation of the guidelines into Mental Health First Aid (MHFA) training for Brazil.

Climate rather than economic variables might have caused increase in US homicide but not suicide rates during the Great Depression

BACKGROUND

It is widely believed that during the Great Depression (1929-1933) there was a rise in suicidal rates which was causally related to the increase in unemployment. There are no studies on the effect the Great Depression had on homicidal rates METHODS: The data concerning suicide, homicide, economic and climatic variables for the years 1900-1940 for the whole of the US were gathered from the US Center for Disease Control, the Maddison Project, the National Bureau of Economic Research and the National Climatic Data Center. Time Series Analysis was performed.

RESULTS

The results are inconclusive on the role of economic factors but preclude any role of climate on suicidal rates during the years 1900-1940 in the US. Suicidal rates might have a 24-years periodicity, however much longer time series are needed to confirm this. On the contrary they strongly suggest an effect of higher temperatures on homicidal rates after 1922.

CONCLUSIONS

The results of the current study suggest a direct and clear effect of climate (higher temperatures) on the increasing homicidal rates in the US after 1922 but failed to establish a causal relationship between suicide rates and economic or climate variables. These should be considered together with increasing concerns on the possible effect of climate change on mental health.

Violence and social determinants of health in Brazil: association between homicides, urbanization, population, inequality, and development

The aim was to analyze the relations between homicidal violence, human development, inequality, population size, and urbanization rates in Brazilian municipalities. This is a retrospective ecological study of 5,570 Brazilian municipalities which analyzes the relations between the average rate of homicides registered in the Brazilian Mortality Information System (from 2005 to 2015) and selected indicators: municipal human development indices (HDI-M), Gini index, urbanization rates, and quantitative population. Analysis of the relative effect (%) of the variables on the risk for homicidal violence showed a greater association with more populous municipalities (log 10) (80.8%, 95%CI: 73.0; 88.8), more urbanized ones (8%, 95%CI: 6.7; 9.2), with higher Gini index (6%, 95%CI: 2.6; 9.5); whereas the relation with HDI-M is inverse (-17.1%, 95%CI: -21.4; -12.6). National policies which aim to limit population growth and the urbanization of the most populous Brazilian cities could reduce homicide rates across the country. Reducing inequalities and investing in municipal social education, health, and income policies could also reduce the number of homicides. We estimated that improving the HDI-M of the municipalities by 0.1 would cause a national reduction between 7,560 and 12,834 annual homicides, whereas decreasing income inequality (Gini index) by 0.1 would mean saving between 1,569 to 5,448 lives per year.

Unemployment and suicide among the Brazilian population in the crisis of capitalism

The current crisis of capitalism has multiple economic, financial, social, environmental, cultural and political facets. In Brazil, the severity of the crisis is no different, resulting from the exhaustion of the neo-developmentalist model and its inability to resist global crisis. This study compares suicide mortality rates (MR) among employed and unemployed persons in Brazil prior to and during the economic crisis using death records from the period 2011 to 2016. The findings show that in the period 2011 to 2016 the suicide MR fell from 2.66/100,000 to 2.46 among unemployed persons and increased from 5.52/100,000 to 6.89/100,000 in employed persons. Suicide is a complex, multi-causal phenomenon determined by a diverse range of social factors, including strategies that increase worker exploitation. Indeed, being employed can have a greater negative impact on the mental health of workers than being unemployed.

Wealth Inequalities in Different Types of Violence Among Brazilian Adolescents: National Survey of School Health 2015

Studies have assessed inequalities in violence by economic status, but few studies have been done with adolescents from middle-income countries. Our objective was to analyze inequalities in verbal bullying, family physical violence, sexual violence, and fights with weapons among Brazilian adolescents in school according to wealth and stratified by sex and skin color. We used data from the Brazilian National Survey of School Health (Pesquisa Nacional de Saúde do Escolar [PeNSE]), carried out in 2015, with a representative sample of Brazilian adolescents attending ninth grade in public and private schools. We created a wealth index based on questions about access to goods and services through principal component analysis; this index was later divided into quintiles. We calculated the slope index of inequality (SII), the concentration index (CIX), and simple measures of inequality, such as ratio and difference. To identify statistically significant differences in sex and skin color inequality, we used the t test. We found high prevalence values of verbal bullying and family physical violence, 23.9% and 14.5%, respectively. In general, when comparing the types of violence according to SII and CIX, we observed a higher prevalence of violence among adolescents in the lower income quintiles, for both sexes and skin colors. We observed higher wealth inequality in sexual violence among girls (CIX = -14.89) when compared with boys (CIX = -4.63) (p = .001). We also observed higher wealth inequality in sexual violence among Whites (CIX = -15.55) when compared with Brown (CIX = -6.23) (p = .009). Wealth inequality aggravates the occurrence of violence among poorer Brazilian adolescents. Also, the identification of vulnerable groups may contribute to target public policies for fighting violence.

Compulsorily notifiable diseases and health problems and socio-environmental conditions: an ecological study, Espírito Santo, Brazil, 2011-2015

OBJECTIVE

To analyze association between climatic-environmental conditions and occurrence of compulsorily notifiable diseases and health problems, in the state of Espírito Santo, Brazil, 2011-2015.

METHODS

This was an ecological study of municipality clusters calculated based on cases confirmed on the Notifiable Health Conditions Information System for the period 2011-2015.

RESULTS

Notifications were more frequent among females (51.1%); people of brown race/skin color (31.7%); in the 20-49 year age group (48.1%) and in the Metropolitan Health Region (60.3%). The factors associated with health problems were ambulatory care sensitive conditions (p-value<0.001); education development index (p-value<0.001); temperature (p-value=0.019) and degree of urbanization (p-value=0.004). Diseases were associated with population density (p-value<0.001); temperature (p-value<0.001), humidity (p-value<0.001) and altitude (p-value=0.005).

CONCLUSION

Health problems were positively associated with ambulatory care sensitive conditions, the education development index and temperature; but negatively associated with degree of urbanization. Diseases were positively associated with the factors mentioned.

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

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.

Mortality by suicide in the State of Pernambuco, Brazil (1996-2015)

ABSTRACT Objective: To describe the epidemiological characteristics of suicide mortality in the state of Pernambuco, from 1996 to 2015. Method: Study with data from the Sistema de Informações sobre Mortalidade. The simple linear regression model was used to verify the trend in the period analyzed. Results: There were 6,229 suicides, of which 3,390 (54.4%) occurred in the second decade of study. The mortality rate was 4.7 per 100,000 inhabitants. The temporal trend presented a decrease of 23.5% (p=0.031). For the male sex and the age range between 20 and 39 years, there was a decline in self-inflicted death of 23.8% (p=0.018) and 26.1% (p=0.046), respectively. Conclusion: The temporal analysis revealed a reduction in suicide mortality coefficients. This observation may contribute to better targeting of health interventions, optimizing resources and efforts, especially in suicide prevention.

[Factors associated with aggression perpetrated by unknown assailants among young males treated by the emergency services: a case-control study]

This study aims to analyze the factors associated with aggression perpetrated by unknown assailants among young males treated by the emergency services. It is a case-control study with data from the Violence and Accident Surveillance System conducted in 2014 by 86 emergency services located in Brazilian State capitals. Young males between 15 and 29 years of age were included. All victims of assault perpetrated by unknown assailants were included as cases. Controls were randomly selected among those who had suffered accidental injuries in the ratio of 2:1. Unconditional logistic regression was used to estimate crude and adjusted odds ratios (OR), and 787 cases and 1,574 controls were included. Risk factors according to the adjusted analysis were: lack of paid work (OR 2.09; 95% CI; 1.66; 2.64), alcohol consumption (OR 3.14; 95% CI; 2.36; 4.17), occurrence at night (OR 3.39; 95% CI; 2.50; 4.61) or early morning (OR 5.31; 95% CI; 3.63; 7.75). Higher age (25-29 years) and schooling (5-8 years of study) were factors of protection. The results revealed the need for more effective and multisectoral actions to prevent violence among young males, which consider the factors associated with such aggression, including alcohol consumption, and investments in qualified education and paid employment.

Epidemiological and toxicological profile of homicide victims in a legal medicine unit in Brazil

OBJECTIVES

The use of illicit drugs is considered a risk factor for victimization by lethal violence and is frequently found in necropsies of homicide victims. This study aimed to evaluate the profile of these victims.

METHODS AND MATERIAL

A cross-sectional retrospective study was performed on homicide victims in 2014 with a sample composed of all homicide cases in 2014 for which toxicology had been performed in an Official Forensic Laboratory (Minas Gerais- Brazil).

RESULTS

1382 homicide victims composed the sample. The group with a positive toxicology test (N = 943) presented higher proportions of men (p = 0.003), black/brown skin (p < 0.001), firearm history (p = 0.007) and a lower mean age (p < 0.001). In 72.2% of the positive tests, cocaine and benzoylecgonine were found; in 67.7%, THC and/or its metabolite was found; and in 43.1%, both illicit drugs were found.

CONCLUSIONS

The role of illicit drugs in early death goes far beyond intoxication as they are directly associated with age, skin color and gender. Young black/mixed men have an increased risk of homicide. Our findings point to the importance of investing in social actions, public safety and efforts to reduce drug use in this at-risk population.

Homicides and socio-environmental determinants of health in Brazil: a systematic literature review

Brazil currently has the highest absolute number of homicides in the world, which results from a complex range of factors. This study aimed at understanding the associations between socio-environmental determinants of health (SDH) and homicides in Brazil through a systematic literature review. The review followed PRISMA guidelines, selecting quantitative and qualitative studies published in Portuguese, English, and Spanish carried out between 2002 and 2017, available in the PubMed, MEDLINE, LILACS, SciELO and BVS-BIREME databases. Two trilingual reviewers tracked studies independently by basing on the eligibility criteria. We critically assessed the selected studies with the Critical Appraisal Skills Programme (CASP) or the Checklist for Analytical Cross-Sectional Studies, depending on the study design. We considered 60 studies and grouped their SDH into categories to develop a narrative synthesis about each SDH. These categories were: territory; race/ethnicity; gender; age; social inequalities and economic factors; development; education; work and employment; drugs and trafficking; other SDH. We found some SDH were more associated with homicides, such as being young, black, male, of low education level, and also people who lived in places of high social inequality, such as urban suburbs and agricultural frontiers. Unemployment and drug trafficking, as well as intersections between various SDH were also prominent. Education seems to be a protective factor for homicide. Despite the limited capacity of interpretation due to the high range of methodological approaches, this review shows the importance of considering SDH and their intersections when developing homicide prevention policies.

O efeito do contexto sobre a incidência de homicídios: existem evidências suficientes?

Ao buscar evidências de associações entre óbitos por homicídios e indicadores sociais, os estudos apresentam achados divergentes. O objetivo deste estudo foi realizar uma revisão bibliográfica crítica acerca das associações entre homicídios e indicadores sociais. Métodos: Revisão bibliográfica. Foram efetuadas consultas na BVS, Scielo, Lilacs, Medline e Scopus. Os descritores utilizados foram: “violência”, “homicídios”, “agressões”, acrescidos dos termos “fatores socioeconômicos”, “desigualdade”, “desorganização social”, “fatores epidemiológicos”, somados a “análise estatística”, “análise espacial”, “estudos ecológicos”. Foram utilizados 49 indicadores diferentes. 12 indicadores apresentaram concordância dos achados e nove indicadores apresentaram discordância, ora estando associados diretamente, ora associados inversamente aos desfechos.Devido à complexidade do tema dos homicídios, alguns estudos esbarram em uma série de limitações metodológicas e conceituais e também são prejudicados pela falta de informações de livre acesso disponíveis nas bases de dados secundárias.

Uma abordagem sobre o suicídio de adolescentes e jovens no Brasil

Resumo O artigo analisa de forma ensaística o suicídio entre jovens no Brasil a partir das abordagens clássicas de Durkheim atualizadas pelo debate contemporâneo sobre redes de integração social. Apresenta argumentação sobre a evolução das taxas de mortalidade por suicídio segundo as premissas clássicas da saúde pública sobre as causas sociais no processo saúde-doença. As taxas de mortalidade são atualizadas segundo estatísticas internacionais, revisão de dados em estudos nacionais e séries recentes para o Brasil e que evidenciam a existência de estoques nacionais de suicídio segundo idade, sexo e grupos sociais. O caráter linear e não linear das séries são tratados no contexto das trajetórias em sistemas sociais complexos. Os dados atualizados são pesquisados no Sistema de Informação de Mortalidade do Ministério da Saúde e nas bases da Organização Mundial de Saúde. O estudo utiliza o modelo de análise de políticas onde a base conceitual é construída a partir de teorias clássicas e atualizadas ao contexto atual, da análise dos dados relevantes ao objeto e da observação de grupos alvo de políticas públicas inclusivas e abrangentes. Os resultados desta análise atestam a alta relevância dos adolescentes e jovens brasileiros como vulneráveis ao suicídio de modo crescente, sustentado e de alto impacto.

Ancestry and different rates of suicide and homicide in European countries: A study with population-level data

INTRODUCTION

There are large differences in suicide rates across Europe. The current study investigated the relationship of suicide and homicide rates in different countries of Europe with ancestry as it is defined with the haplotype frequencies of Y-DNA and mtDNA.

MATERIAL AND METHODS

The mortality data were retrieved from the WHO online database. The genetic data were retrieved from http://www.eupedia.com. The statistical analysis included Forward Stepwise Multiple Linear Regression analysis and Pearson Correlation Coefficient (R).

RESULTS

In males, N and R1a Y-DNA haplotypes were positively related to both homicidal and suicidal behaviors while I1 was negatively related. The Q was positively related to the homicidal rate. Overall, 60-75% of the observed variance was explained. L, J and X mtDNA haplogroups were negatively related with suicide in females alone, with 82-85% of the observed variance described.

DISCUSSION

The current study should not be considered as a study of genetic markers but rather a study of human ancestry. Its results could mean that research on suicidality has a strong biological but locally restricted component and could be limited by the study population; generalizability of the results at an international level might not be possible. Further research with patient-level data are needed to verify whether these haplotypes could serve as biological markers to identify persons at risk to commit suicide or homicide and whether biologically-determined ancestry could serve as an intermediate grouping method or even as an endophenotype in suicide research.

[Mortality from assault in young men in Brazil, 2010-2014: an ecological study]

The aim was to analyze the association between risk of death from assault in young males and socio-demographic characteristics in Brazilian municipalities. In this ecological study, the units of analysis were the 1,651 municipalities of Brazil with more than 20,000 inhabitants. Data were obtained from the Brazilian Mortality Information System (SIM) and indicators were obtained from the 2010 Population Census and Human Development Atlas. Mortality rate ratios were estimated by a negative binomial regression model. From 2010 to 2014, a total of 127,137 deaths from assault were reported in young males 15 to 29 years of age. Corrected mortality rate was 133.3/100 thousand inhabitants for the set of municipalities (median 71.5/100 thousand inhabitants). The rate increased with the municipalities' population size. In the adjusted model, higher rates ratios were observed in the more urbanized municipalities (1.95; 95%CI: 1.70-2.23), in intermediate categories of income inequality (1.10; 95%CI: 1.01-1.20) and poverty rate (1.69; 95%CI: 1.51-1.89), with lower proportion of youth attending Secondary School (2.05; 95%CI: 1.83-2.30), with higher proportion of unemployed youth 18 to 24 years of age (1.27; 95%CI: 1.16-1.40), and with more women than men (1.28; 95%CI: 1.05-1.58). Mortality from assault was high in young Brazilian men, especially in larger and more urbanized municipalities and those with a higher proportion of youth looking for work and not attending secondary school. The results show the relevance of social policies for dealing with violence against youth.

Prevalence, clinical correlates and maternal psychopathology of deliberate self-harm in children and early adolescents: results from a large community study

Objectives:

Little is known about the prevalence and correlates of deliberate self-harm (DSH) in children from low- and middle-income countries. We investigated the prevalence of DSH and its clinical and maternal psychopathological associations in Brazilian children (n=2,508, ages 6-14y) in a community-based study.

Methods:

Participants of the High Risk Cohort Study for the Development of Childhood Psychiatric Disorders (HRC) and their mothers were assessed in structured interviews. Current (last month) and lifetime DSH were estimated, including analysis stratified by age groups. Logistic regressions were performed to investigate the role of the children’s clinical diagnoses and maternal psychopathology on DSH prevalence estimates, adjusting for potential confounding factors.

Results:

The prevalence of current DSH was 0.8% (children 0.6%, adolescents 1%) and lifetime DSH was 1.6% (1.8% and 1.5%, respectively). Current and lifetime DSH were more frequent in children with depression, attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), even in multiple models accounting for demographic variables and co-occurring psychiatric disorders. Maternal anxiety disorder was strongly associated with current and lifetime DSH in offspring; whereas current DSH, specifically in young children, was associated with maternal mood disorder.

Conclusion:

Diagnoses of depression, ADHD and ODD were consistently associated with DSH, as was having a mother with anxiety disorder.

Differential correlation of suicide and homicide rates according to geographical areas: A study with population-level data

The current study investigated the relationship of suicide and homicide rates internationally. WHO database mortality data for 82 countries concerning suicide, homicides, and cancer and traffic accidents as controls were used. The analysis included Pearson correlation and multiple linear regression analysis. Worldwide homicidal rates explained 55.42%, 43.86% and 41.7% of male and 22.0%, 22.14% and 13.25% of female suicides for 2000, 2005 and 2010 respectively. In Europe there was a positive correlation between male suicide rates and all homicide rates including homicide rates in both genders, in male victims, and in female victims. In America there is no significant correlation. In Asia there is a significant correlation of male suicidal rates only with homicide rates of female victims. We observed marked and interesting differences in the pattern of association between Europe and the Americas. Overall the current paper suggests that at least in some human populations, suicidality and homicidality share common etiopathogenetic substrates and could be triggered by the same internal or external events or might develop based on common genetic background. Empirically it has been suggested that suicide is related to higher living standards while murder is related to poor quality of life and lower living standards.