Lange Shannon, Kim Kawon V, Jiang Huan, Shield Kevin D, Rehm Jürgen, Hennis Anselm J M, Oliveira E Souza Renato
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.
Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.
Lancet Reg Health Am. 2024 Jul 16;36:100831. doi: 10.1016/j.lana.2024.100831. eCollection 2024 Aug.
The suicide mortality rate has been increasing in Region of the Americas, despite decreasing in all other World Health Organization (WHO) regions. Means restriction is an effective evidence-based intervention for suicide prevention. The objective of the current study was to estimate the impact of implementing national-level means restriction policies (i.e., firearm and pesticide restrictions) on the suicide mortality rate in the Region of the Americas.
In this ecological modeling study, two counterfactual scenarios were investigated using sex-specific suicide mortality data from the WHO Global Health Estimates database for 2000 to 2019. Forecasted sex-specific age-standardized suicide mortality rates were then estimated for each country for 2020 to 2030. Counterfactual scenario 1 involved modeling the impact of a firearm or pesticide restriction implemented in 2020 for those countries where the respective means accounted for 40% or more of all suicides for at least one sex in 2019, while in counterfactual scenario 2 this threshold was reduced to 20% or more.
It was estimated that if a firearm or pesticide restriction had been implemented in 2020 in those countries where the respective means accounted for 40% or more of all suicides for at least one sex in 2019, by 2030 the male and female suicide mortality rate in the Region of the Americas would be 20.5% (from 14.5 [95% Confidence Interval [CI]: 14.1, 15.0] per 100,000 males to 11.5 [95% CI: 11.1, 12.0] per 100,000 males) and 11.1% (from 4.5 [95% CI: 4.4, 4.7] per 100,000 females to 4.0 [95% CI: 3.9, 4.2] per 100,000 females) lower than the rate if no such restrictions were implemented, respectively. When the threshold was reduced to 20% or more, minimal additional gains in terms of number of suicides avoided and suicide mortality rate reduction would be achieved.
The implementation of a firearm or pesticide restriction policy in countries where the respective means account for a large proportion of suicides (e.g., at least 40%) could aid the Region of the Americas in achieving the WHO target of a one third reduction in the suicide mortality rate by 2030.
This work received no funding.
尽管世界卫生组织（WHO）其他所有区域的自杀死亡率都在下降，但美洲区域的自杀死亡率却一直在上升。手段限制是一种基于证据的有效自杀预防干预措施。本研究的目的是评估实施国家级手段限制政策（即枪支和农药限制）对美洲区域自杀死亡率的影响。
在这项生态模型研究中，利用WHO全球卫生估计数据库中2000年至2019年按性别分类的自杀死亡率数据，研究了两种反事实情景。然后估计了每个国家2020年至2030年按性别和年龄标准化的预测自杀死亡率。反事实情景1涉及对2020年实施枪支或农药限制的影响进行建模，这些国家中各自手段在2019年至少对某一性别的所有自杀事件占40%或更多，而在反事实情景2中，这一阈值降低到20%或更多。
据估计，如果2020年在那些各自手段在2019年至少对某一性别的所有自杀事件占40%或更多的国家实施枪支或农药限制，到2030年，美洲区域男性和女性自杀死亡率将分别比不实施此类限制的情况低20.5%（从每10万男性14.5例[95%置信区间（CI）：14.1，15.0]降至每10万男性11.5例[95%CI：11.1，12.0]）和11.1%（从每10万女性4.5例[95%CI：4.4，4.7]降至每10万女性4.0例[95%CI：3.9，4.2]）。当阈值降低到20%或更多时，在避免自杀人数和降低自杀死亡率方面将获得最小的额外收益。
在各自手段在自杀事件中占很大比例（例如至少40%）的国家实施枪支或农药限制政策，可能有助于美洲区域实现WHO到2030年将自杀死亡率降低三分之一的目标。
本研究未获得资金支持。
