title: Spatial-temporal trends and risk of suicide in Central Brazil: an ecological study contrasting indigenous and non-indigenous populations.
abstract: OBJECTIVE
  To examine spatial-temporal distribution and risk of suicide, as well as trends in suicide mortality rates, in the indigenous and non-indigenous population of the state of Mato Grosso do Sul, Brazil.
  
  
  METHODS
  Data were obtained from the Information Department of the Brazilian Unified Health System. Deaths recorded as voluntary self-inflicted injuries (ICD-10 codes X60.0 to X84.9) were considered suicide. Suicide rates were estimated and adjusted by age in the population > 9 years of age. Kernel analysis was used to assess the spatial distribution of suicide cases, while trend analysis was carried out using a non-parametric test (Mann-Kendall).
  
  
  RESULTS
  The suicide risk among the indigenous population was 8.1 (95%CI 7.2-9.0) times higher than in the non-indigenous population. For indigenous residents in the 15-24 age group, the risk was 18.5 (95%CI 17.5-19.6) times higher than in the non-indigenous population. The majority of indigenous cases were concentrated in a few villages in reservation areas, mainly occupied by Guarani-Kaiowá and Guarani-Ñandeva groups. Rate patterns remained stable over time in both groups.
  
  
  CONCLUSIONS
  Suicide is a serious public health problem in Mato Grosso do Sul, and has had an alarming and disproportionate impact on the indigenous population for more than a decade.
authors.affiliation: Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz (FIOCRUZ), Manaus, AM, Brazil.
authors.forename: Jesem D
authors.initials: JD
authors.lastname: Orellana
authors.affiliation: Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz (FIOCRUZ), Manaus, AM, Brazil.
authors.forename: Antônio A
authors.initials: AA
authors.lastname: Balieiro
authors.affiliation: Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz (FIOCRUZ), Manaus, AM, Brazil.
authors.forename: Fernanda R
authors.initials: FR
authors.lastname: Fonseca
authors.affiliation: Escola Nacional de Saúde Pública Sergio Arouca (ENSP), FIOCRUZ, Rio de Janeiro, RJ, Brazil.
authors.forename: Paulo C
authors.initials: PC
authors.lastname: Basta
authors.affiliation: Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz (FIOCRUZ), Manaus, AM, Brazil.
authors.forename: Maximiliano L Ponte de
authors.initials: ML
authors.lastname: Souza
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001938:Brazil / Q000208:ethnology; D002648:Child; D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D007199:Indians, South American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D062211:Spatio-Temporal Analysis; D018709:Statistics, Nonparametric; D013405:Suicide / Q000208:ethnology / Q000706:statistics & numerical data* / Q000639:trends*; D055815:Young Adult