Geographical clusters and social risk factors for suicide in the city of São Paulo, 2006-2015: An ecologic study.

Abstract

To identify geographical clusters of suicide in São Paulo, Brazil (2006-2015) and to verify the associations of suicide with sociocultural characteristics of its 96 districts. Spatial scan test was used to detect the geographical clusters. Correlation and multiple regression techniques were used to estimate the association of socioeconomic and cultural variables with suicide. The mean suicide rate was 4.8/100,000. Three clusters were identified which are as follows: one of increased risk in downtown and two of decreased risk in the South and in the Southeast. The mean suicide rate of the high-risk clustered districts (7.99/100,000) presented significantly higher average incomes per household, higher proportion of formally educated, of no religious affiliation, of recent migrants, of all-times migrants and lower proportion of married. The multiple model selected two independent risk factors - people with no religious affiliation (β = 0.182) and of recent migrants (β = 0.278) - and two protective factors - the proportion of married (β = -0.185) and of total migrants (β = -0.075), which jointly explained 58.4% of the variance. Durkheimian social and cultural risk factors for suicide were confirmed. Compared to a previous study period (1996-2005), suicide rates and geographical clusters remained relatively stable in the subsequent decade (2006-2015).