Association between the Density of Physicians and Suicide Rates in Japan: Nationwide Ecological Study Using a Spatial Bayesian Model
Association between the Density of Physicians and Suicide Rates in Japan: Nationwide Ecological Study Using a Spatial Bayesian Model
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DOI：
10.1371/journal.pone.0148288
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发表时间：
2016-02-03
期刊：
影响因子：
3.7
通讯作者：
Koike, Soichi
中科院分区：
文献类型：
--
作者：
Kawaguchi, Hideaki;Koike, Soichi
背景自杀率的地区差异是一个严重的世界性问题。一个可能的原因是卫生工作人员，特别是精神科医生的分配不均。因此，关于地区医生数量和自杀率之间关系的研究很重要，但研究很少。这项研究的目的是评估医生数量与日本自杀率之间的联系。方法研究包括日本所有市政当局(n=1896)。我们估计了每个城市自杀率的平滑标准化死亡率，并使用考虑空间相关随机影响的分层贝叶斯模型(条件自回归模型)评估了卫生人力和自杀率之间的关联。我们假设观察到的自杀人数服从泊松分布，并将预期自杀人数设为偏移量。解释变量为医生人数、精神病学家人数的二元变量和社会协变量。结果在调整社会经济因素后，至少有一名精神病学家的城市的自杀率低于其他城市。然而，医生数量与自杀率之间存在显著的正相关。结论至少有一名精神科医生的城市的自杀率低于其他城市，但医生数量与自杀率呈显著正相关。为了改善自杀率的地区差异，政府应该鼓励精神病学家参与社区自杀预防计划，并在目前没有精神病学家的市政当局定居。政府和其他利益相关者还应该在精神科医生和非精神科医生之间建立更好的网络，以支持为预防自杀而共享信息。
BackgroundRegional disparity in suicide rates is a serious problem worldwide. One possible cause is unequal distribution of the health workforce, especially psychiatrists. Research about the association between regional physician numbers and suicide rates is therefore important but studies are rare. The objective of this study was to evaluate the association between physician numbers and suicide rates in Japan, by municipality.MethodsThe study included all the municipalities in Japan (n = 1,896). We estimated smoothed standardized mortality ratios of suicide rates for each municipality and evaluated the association between health workforce and suicide rates using a hierarchical Bayesian model accounting for spatially correlated random effects, a conditional autoregressive model. We assumed a Poisson distribution for the observed number of suicides and set the expected number of suicides as the offset variable. The explanatory variables were numbers of physicians, a binary variable for the presence of psychiatrists, and social covariates.ResultsAfter adjustment for socioeconomic factors, suicide rates in municipalities that had at least one psychiatrist were lower than those in the other municipalities. There was, however, a positive and statistically significant association between the number of physicians and suicide rates.ConclusionsSuicide rates in municipalities that had at least one psychiatrist were lower than those in other municipalities, but the number of physicians was positively and significantly related with suicide rates. To improve the regional disparity in suicide rates, the government should encourage psychiatrists to participate in community-based suicide prevention programs and to settle in municipalities that currently have no psychiatrists. The government and other stakeholders should also construct better networks between psychiatrists and non-psychiatrists to support sharing of information for suicide prevention.