title: National suicide rates and mental health system indicators: an ecological study of 191 countries.
abstract: OBJECTIVE
  The relative contributions of psychiatric morbidity and psychosocial stress to suicide, and the efficacy of mental health systems in reducing population suicide rates, are currently unclear. This study, therefore, aimed to investigate whether national suicide rates are associated with their corresponding mental health system indicators.
  
  
  METHODS
  Relevant data were retrieved from the following sources: the World Health Organization, the United Nations Statistics Division and the Central Intelligence Agency World Fact book. Suicide rates of 191 countries were compared with their mental health system indicators using an ecological study design and multivariate non-parametric robust regression models.
  
  
  RESULTS
  Significant positive correlations between suicide rates and mental health system indicators (p<0.001) were documented. After adjusting for the effects of major macroeconomic indices using multivariate analyses, numbers of psychiatrists (p=0.006) and mental health beds (p<0.001) were significantly positively associated with population suicide rates.
  
  
  CONCLUSIONS
  Countries with better psychiatric services experience higher suicide rates. Although these associations should be interpreted with caution, as the issues are complex, we suggest that population-based public health strategies may have greater impact on national suicide rates than curative mental health services for individuals.
authors.affiliation: Department of Biomedicine, Aarhus University, Aarhus - 8000, Denmark. Electronic address: antoprajkumar@yahoo.com.
authors.forename: A P
authors.initials: AP
authors.lastname: Rajkumar
authors.forename: E M
authors.initials: EM
authors.lastname: Brinda
authors.forename: A S
authors.initials: AS
authors.lastname: Duba
authors.forename: P
authors.initials: P
authors.lastname: Thangadurai
authors.forename: K S
authors.initials: KS
authors.lastname: Jacob
mesh_terms: D016208:Databases, Factual; D006297:Health Services Accessibility; D006801:Humans; D038622:Internationality; D008605:Mental Health Services / Q000592:standards*; D019984:Quality Indicators, Health Care; D013405:Suicide / Q000706:statistics & numerical data* / Q000639:trends
keywords: Ecological study; Gini coefficient; Macroeconomic indices; Mental health system indicators; Suicide