Inequalities in suicide mortality rates and the economic recession in the municipalities of Catalonia, Spain.
BACKGROUND
While previous research already exists on the impact of the current economic crisis and whether it leads to an increase in mortality by suicide, our objective in this paper is to determine if the increase in the suicide rate in Catalonia, Spain from 2010 onwards has been statistically significant and whether it is associated with rising unemployment.


METHODS
We used hierarchical mixed models, separately considering the crude death rate of suicides for municipalities with more than and less than 10,000 inhabitants as dependent variables both unstratified and stratified according to gender and/or age group.


RESULTS
In municipalities with 10,000 or more inhabitants there was an increase in the relative risk of suicide from 2009 onwards. This increase was only statistically significant for working-aged women (16-64 years). In municipalities with less than 10,000 inhabitants the relative risk showed a decreasing trend even after 2009. In no case did we find the unemployment rate to be associated (statistically significant) with the suicide rate.


CONCLUSIONS
The increase in the suicide rate from 2010 in Catalonia was not statistically significant as a whole, with the exception of working-aged women (16-64 years) living in municipalities with 10,000 or more inhabitants. We have not found this increase to be associated with rising unemployment in any of the cases. Future research into the effects of economic recessions on suicide mortality should take into account inequalities by age, sex and size of municipalities.
Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain. carme.saurina@udg.edu.|CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. carme.saurina@udg.edu.
Carme
C
Saurina
Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.
Manel
M
Marzo
Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.|CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Marc
M
Saez
D000293:Adolescent; D000328:Adult; D000368:Aged; D002947:Cities; D057172:Economic Recession; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D013030:Spain / Q000453:epidemiology; D013405:Suicide / Q000639:trends*; D014478:Unemployment / Q000706:statistics & numerical data; D055815:Young Adult