title: Availability of mental health service providers and suicide rates in Slovenia: a nationwide ecological study.
abstract: OBJECTIVE
  To investigate the influence of socioeconomic factors, mental health service availability, and prevalence of mental disorders on regional differences in the suicide rate in Slovenia.
  
  
  METHODS
  The effects of different socioeconomic factors, mental health service availability, and mental disorders factors on suicide rates from 2000-2009 were analyzed using a general linear mixed model (GLMM). Pearson correlations were used to explore the direction and magnitude of associations.
  
  
  RESULTS
  Among socioeconomic factors, unemployment rate ranked as the most powerful predictor of suicide and an increase of one unit in the unemployment rate increased regional suicide rate by 2.21 (β=2.21, 95% confidence intervals [CI]=1.87-2.54, P<0.001). On the other hand, higher marriage/divorce ratio was negatively related to the suicide rate and an increase of one unit in marriage/divorce ratio reduced regional suicide rate by 1.16 (β=-1.16, 95% CI=-2.20 to -0.13, P<0.031). The most influential mental health service availability parameter was higher psychiatrist availability (4 psychiatrists and more working at outpatient clinics per 100 000 inhabitants), which was negatively correlated with the suicide rate and reduced regional suicide rate by 2.95 (β=-2.95, 95% CI=-4.60 to -1.31, P=0.002). Another negatively correlated factor was the antidepressant/anxiolytic ratio higher than 0.5, which reduced the regional suicide rate by 2.32 (β=-2.32, 95% CI=-3.75 to -0.89, P=0.003). Among mental health disorders, only the prevalence of alcohol use disorders was significantly related to the regional suicide rates and an increase of one unit in the prevalence of alcohol use disorders per 1000 inhabitants increased the regional suicide rate by 0.02 (β=0.02, 95% CI=0.01- 0.03, P=0.008).
  
  
  CONCLUSIONS
  Besides unemployment, which was a very strong predictor of suicide rates, unequal availability of mental health services and quality of depressive disorder treatment may contribute to variations in suicide rates in different regions.
authors.affiliation: Peter Pregelj, University of Ljubljana, Faculty of Medicine, Department of psychiatry, Vrazov trg 2, 1104 Ljubljana, Slovenia, peter.pregelj@psih-klinika.si.
authors.forename: Helena
authors.initials: H
authors.lastname: Korosec Jagodic
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rokavec
authors.forename: Mark
authors.initials: M
authors.lastname: Agius
authors.forename: Peter
authors.initials: P
authors.lastname: Pregelj
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D004243:Divorce / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008605:Mental Health Services; D008875:Middle Aged; D015995:Prevalence; D011570:Psychiatry / Q000706:statistics & numerical data; D017524:Slovenia / Q000453:epidemiology; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014478:Unemployment / Q000523:psychology; D000092864:Suicide Prevention