Spatiotemporal Suicide Risk in Germany: A Longitudinal Study 2007-11
Spatiotemporal Suicide Risk in Germany: A Longitudinal Study 2007-11
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DOI：
10.1038/s41598-017-08117-4
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发表时间：
2017-08-09
影响因子：
4.6
通讯作者：
Blueml, Victor
中科院分区：
文献类型：
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作者：
Helbich, Marco;Plener, Paul L.;Blueml, Victor
尽管德国实施了全面的预防计划，但自2007年以来，自杀人数再次上升。人们对潜在原因和时空风险模式知之甚少。我们纵向评估了2007-11年间每个地区由多种危险和保护因素引起的自杀的时空风险。拟合出贝叶斯时空回归模型。全国范围内的时间趋势显示死于自杀的相对风险(RR)增加(RR 1.008，95%可信区间(CI)1.001-1.016)，而特定地区的趋势发生偏离大趋势。德国南部出现了风险放大的显著模式。全科医生人数与自杀风险呈正相关(RR 1.003，95%CI 1.000-1.006)，收入与自杀风险呈负相关，与人口密度呈非线性负相关。失业是相关的，并表现出明显的非线性。抑郁患病率与心理卫生服务供给均无相关性。这一发现对未来自杀预防计划的实施至关重要。建议将预防工作集中在风险过高的脆弱领域。
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 nonlinearly 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.