Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil.
Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil.
J Affect Disord. 2024 Nov 15;365:459-465. doi: 10.1016/j.jad.2024.08.134. Epub 2024 Aug 24.
Suicide is a global health concern whose rates are soaring in many low-and-middle-income countries. Public awareness campaigns have been implemented in Brazil; however, their impact is uncertain.
This was an ecological study using population data from DATA-SUS, a Brazilian official notification system, selecting only deaths that were voluntarily self-inflicted (CID-10 × 60-X84). We analyzed all available data from 2000 to 2019 to assess trends before and after the national Yellow September (YS) campaign started in 2015. Differences in trends were assessed by Joinpoint Analysis (JA) and Regression Discontinuity Analysis (RDD), unadjusted and adjusted for economic factors.
Overall, there was a progressive increase in the rate of relative (per 100,000 inhabitants) number of suicides over time between 2000 and 2019 (57 % increase). The JA detected a change in the slope of the curve representing an acceleration in suicides starting in the year 2015. Adjusted RDD revealed the year that Yellow September started significantly change the slope of the association between time and rates of suicide (p < 0.01), and marginal analysis detected the coefficient increased from 0.07 (95%CI 0.04-0.10) to 0.27 (95%CI -0.07-0.60) suicides/year per 100,000 inhabitants.
The ecological nature of the manuscript compromises causational implications.
We found an increase in suicidal trends in Brazil, against the global trend that coincides with the beginning of a large national awareness campaign. Although we cannot attribute causality, our results reinforce the need of further studies to better understand the role of awareness campaigns in suicide reduction interventions, including potential unintended effects.
自杀是一个全球性的健康问题，在许多中低收入国家，自杀率正在飙升。巴西已经实施了公众意识宣传活动；然而，其效果尚不确定。
这是一项使用巴西官方通报系统 DATA-SUS 的人口数据进行的生态学研究，仅选择自愿自残（ICD-10 X60-X84）的死亡病例。我们分析了 2000 年至 2019 年所有可用数据，以评估 2015 年全国“黄色九月”（YS）运动开始前后的趋势。通过 Joinpoint 分析（JA）和回归不连续性分析（RDD）评估趋势差异，不调整和调整经济因素。
总体而言，2000 年至 2019 年间，自杀率（每 10 万人相对数量）随时间呈渐进式增长（增长 57%）。JA 检测到代表自杀加速的曲线斜率发生变化，始于 2015 年。调整后的 RDD 显示，YS 开始的年份显著改变了时间和自杀率之间关联的斜率（p<0.01），边际分析检测到系数从 0.07（95%CI 0.04-0.10）增加到 0.27（95%CI -0.07-0.60）自杀/年每 10 万居民。
手稿的生态学性质限制了因果关系的推断。
我们发现巴西的自杀趋势呈上升趋势，与全球趋势相反，这与一项大型全国意识宣传活动的开始相吻合。尽管我们不能归因于因果关系，但我们的结果强化了进一步研究的必要性，以更好地理解意识宣传活动在减少自杀干预中的作用，包括潜在的意外影响。
