Abstract
BackgroundIn 2012, international statistics showed El Salvador’s suicide rate as 40th in the world and the highest in Latin America. Over the last 15 years, national statistics show the suicide death rate declining as opposed to an increasing rate of homicide. Though completed suicide is an important social and health issue, little is known about its prevalence, incidence, etiology and spatio-temporal behavior. The primary objective of this study was to examine completed suicide and homicide using the stream analogy to lethal violence within a spatio-temporal framework.MethodsA Bayesian model was applied to examine the spatio-temporal evolution of the tendency of completed suicide over homicide in El Salvador. Data on numbers of suicides and homicides at the municipal level were obtained from the Instituto de Medicina Legal (IML) and population counts, from the Dirección General de Estadística y Censos (DIGESTYC), for the period of 2002 to 2012. Data on migration were derived from the 2007 Population Census, and inequality data were obtained from a study by Damianović, Valenzuela and Vera.ResultsThe data reveal a stable standardized rate of total lethal violence (completed suicide plus homicide) across municipalities over time; a decline in suicide; and a standardized suicide rate decreasing with income inequality but increasing with social isolation. Municipalities clustered in terms of both total lethal violence and suicide standardized rates.ConclusionsSpatial effects for suicide were stronger among municipalities located in the north-east and center-south sides of the country. New clusters of municipalities with large suicide standardized rates were detected in the north-west, south-west and center-south regions, all of which are part of time-stable clusters of homicide. Prevention efforts to reduce income inequality and mitigate the negative effects of weak relational systems should focus upon municipalities forming time-persistent clusters with a large rate of death by suicide. In municipalities that are part of newly-formed suicide clusters and also are located in areas with a large rate of homicide, interrupting the expansion of spatial concentrations of suicide over time may require the implementation of both public health and public safety interventions.
Highlights
In 2012, international statistics showed El Salvador’s suicide rate as 40th in the world and the highest in Latin America
This research used a Bayesian model based on the stream analogy of lethal violence to examine the spatiotemporal evolution of suicide for the 262 municipalities of El Salvador
Our findings provide some empirical evidence for this conceptual approach that considers suicide and homicide as different manifestations of the same event, that the rate of death by total violence has remained stable across municipalities over time
Summary
In 2012, international statistics showed El Salvador’s suicide rate as 40th in the world and the highest in Latin America. Over the last 15 years, national statistics show the suicide death rate declining as opposed to an increasing rate of homicide. El Salvador is part of the group of countries with high suicide rates. International data show this nation with an age-standardized rate of 13.6 suicides per 100,000 in 2012, ranking 40th in the world and the highest in Latin America [2]. Our own calculations using official data show a declining trend in the crude suicide rate from 13.5 in 2002 to 7.7 per 100,000 in 2011 (Fig. 1)
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