Abstract
Despite comprehensive prevention programs in Germany, suicide has been on the rise again since 2007. The underlying reasons and spatiotemporal risk patterns are poorly understood. We assessed the spatiotemporal risk of suicide per district attributable to multiple risk and protective factors longitudinally for the period 2007–11. Bayesian space–time regression models were fitted. The nationwide temporal trend showed an increase in relative risk (RR) of dying from suicide (RR 1.008, 95% credibility intervals (CI) 1.001–1.016), whereas district-specific deviations from the grand trend occurred. Striking patterns of amplified risk emerged in southern Germany. While the number of general practitioners was positively related (RR 1.003, 95% CI 1.000–1.006), income was negatively and non-linearly related with suicide risk, as was population density. Unemployment was associated and showed a marked nonlinearity. Neither depression prevalence nor mental health service supply were related. The findings are vital for the implementation of future suicide prevention programs. Concentrating preventive efforts on vulnerable areas of excess risk is recommended.
Highlights
IntroductionNo ecological study had dealt with suicide risk in Germany
Taken together, no ecological study had dealt with suicide risk in Germany
As we confirmed for Germany, striking spatial disparities in suicide risk are found[13,14,15,16, 36]
Summary
No ecological study had dealt with suicide risk in Germany. Failure to do so might result in a poorer understanding of suicide etiologies and less effective suicide prevention strategies that do not target areas that have a high spatiotemporal risk. This study addressed these pressing research gaps and answered the following research questions:. While a nation-wide increasing suicide risk over time was hypothesized, some districts were expected to have a higher risk than the nation-wide trend. It was hypothesized that areas with high unemployment, low income, low population density, and high depression prevalence increase suicide risk while mental health infrastructure supply diminish risk. The research outcomes are of importance for policy makers who wish to complement individual prevention strategies with place-based strategies over time
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