Availability of mental health service providers and suicide rates in Austria: a nationwide study.
OBJECTIVE
Evidence shows that access to mental health services may have an impact on mental health outcomes such as suicide rates. This small-area analysis examined whether the availability of professionals providing mental health treatment in Austria had an effect on regional suicide rates.


METHODS
A hierarchical Bayesian model accounting for spatially correlated random effects using an intrinsic conditional autoregressive prior that incorporated the neighborhood structure of districts and that assumed a Poisson distribution for the observed number of suicides was used to estimate the effects of access to mental health care (population density of general practitioners, psychiatrists, and psychotherapists) in Austria.


RESULTS
Regional socioeconomic factors were correlated with the density of psychiatrists and psychotherapists. Only the number of psychotherapists per 10,000 population had a significant effect on suicide rates (relative risk [RR]=.97, 95% confidence interval [CI]=.94-.997, and absolute risk reduction [ARR]=-.62, CI=-1.20 to -.11); however, after adjustment for socioeconomic factors (in particular urbanicity as indicated by population density, average income, and proportion of non-Catholics), the observed effects were no longer significant. In the final model, only the socioeconomic component remained significant (RR=.94, CI=.88-.99), and ARR=-1.17, CI=-2.34 to -.05).


CONCLUSIONS
The availability of specialized mental health service providers was associated with regional socioeconomic factors, and these factors appeared to be stronger predictors of suicide rates than the availability of providers. Therefore, suicide prevention efforts need to acknowledge that availability of services is only one aspect of access to care; a more influential factor is whether availability satisfies local demand.
Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria. nestor.kapusta@meduniwien.ac.at
Nestor D
ND
Kapusta
Martin
M
Posch
Thomas
T
Niederkrotenthaler
Melitta
M
Fischer-Kern
Elmar
E
Etzersdorfer
Gernot
G
Sonneck
D001317:Austria; D001499:Bayes Theorem; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility; D006280:Health Workforce / Q000639:trends; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000600:supply & distribution*; D013405:Suicide / Q000639:trends*