Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
J Affect Disord. 2018 Oct 15;239:66-71. doi: 10.1016/j.jad.2018.06.042. Epub 2018 Jun 28.
Previous research suggests significant increases in suicide mortality rates in European countries following the economic crisis of 2008. However, the relationship between national differences in availability and use of mental health services and suicide rates has not been extensively examined yet.
Data on mental health services and socioeconomic variables were derived from Eurostat for the years 2000-2013 for ten European countries. The national health care variables consisted of suicide mortality rate (SMR), average length of hospital stay and number of hospitalizations due to affective disorder or any psychiatric disorder, number of psychiatric beds and number of prescribed antidepressants. Economic variables included the gross domestic product (GDP), the gross domestic product per 1000 inhabitants (Real GDP), the rate of unemployment and the GINI-coefficient as a measurement for the equality of wealth distribution. Mixed models were used to investigate the potential influence of the onset of the economic crisis in 2008 on each of the psychiatric variables. Multivariable regression analyses were used to assess the influence on suicide mortality rates.
In this study, a significant change in slope starting from 2008 was revealed for the number of psychiatric beds, hospitalizations due to affective disorder or any psychiatric disorder and for prescribed antidepressants. Furthermore, a significant step change for hospitalizations due to affective disorder was observed in 2008. SMR exhibited a significant step change in 2008 for males and females as well as a significant change in slope from 2008 onwards for males only. Contrary to our hypothesis, most variables showed no statistically significant influence on SMR. Only a higher number of available psychiatric beds was significantly associated with higher suicide mortality rates. This effect, however, was only significant for females and did not remain significant after correcting for economic variables. Less than 10% of suicide mortality rate variability could be explained by a model including all variables, further corroborating the multifactorial etiology of suicide.
Since administrative registry data was used, the results should be interpreted with caution. Results might not be applicable to countries not included.
While significant changes in the psychiatric variables, as well as SMR, were observed, no statistically significant influence on SMR remained after correcting for country, time and economic variables. Our study suggests the necessity of a more comprehensive international data gathering effort. Further research is needed to identify populations at risk of suicide.
先前的研究表明，2008 年欧洲经济危机后，一些欧洲国家的自杀死亡率显著上升。然而，精神卫生服务的可及性和使用率方面的国家差异与自杀率之间的关系尚未得到广泛研究。
本研究从 2000 年至 2013 年，从欧盟统计局（Eurostat）获取了十个欧洲国家的精神卫生服务和社会经济变量数据。国家卫生保健变量包括自杀死亡率（SMR）、平均住院时间、因心境障碍或任何精神障碍住院的人数、精神科床位数量和抗抑郁药处方数量。经济变量包括国内生产总值（GDP）、每千居民的国内生产总值（实际 GDP）、失业率和基尼系数，作为衡量财富分配均等程度的指标。采用混合模型研究 2008 年经济危机的发生对每种精神卫生变量的潜在影响。采用多元回归分析评估对自杀死亡率的影响。
本研究发现，精神科床位数量、因心境障碍或任何精神障碍住院的人数和抗抑郁药处方数量的斜率从 2008 年开始发生显著变化。此外，2008 年观察到心境障碍住院人数出现显著阶跃变化。2008 年男性和女性的 SMR 出现显著阶跃变化，仅男性的斜率从 2008 年开始发生显著变化。与我们的假设相反，大多数变量对 SMR 没有统计学意义上的影响。只有更多的精神科床位数量与更高的自杀死亡率显著相关。然而，这种影响仅在女性中显著，且在校正经济变量后不再显著。包括所有变量的模型只能解释不到 10%的自杀死亡率变异性，进一步证实了自杀的多因素病因。
由于使用了行政登记数据，因此应谨慎解释结果。结果可能不适用于未包括的国家。
尽管观察到精神卫生变量和 SMR 发生显著变化，但在校正国家、时间和经济变量后，对 SMR 没有统计学意义上的影响。我们的研究表明，有必要进行更全面的国际数据收集工作。需要进一步研究以确定自杀风险人群。
