title: Association between the Density of Physicians and Suicide Rates in Japan: Nationwide Ecological Study Using a Spatial Bayesian Model.
abstract: BACKGROUND
  Regional disparity in suicide rates is a serious problem worldwide. One possible cause is unequal distribution of the health workforce, especially psychiatrists. Research about the association between regional physician numbers and suicide rates is therefore important but studies are rare. The objective of this study was to evaluate the association between physician numbers and suicide rates in Japan, by municipality.
  
  
  METHODS
  The study included all the municipalities in Japan (n = 1,896). We estimated smoothed standardized mortality ratios of suicide rates for each municipality and evaluated the association between health workforce and suicide rates using a hierarchical Bayesian model accounting for spatially correlated random effects, a conditional autoregressive model. We assumed a Poisson distribution for the observed number of suicides and set the expected number of suicides as the offset variable. The explanatory variables were numbers of physicians, a binary variable for the presence of psychiatrists, and social covariates.
  
  
  RESULTS
  After adjustment for socioeconomic factors, suicide rates in municipalities that had at least one psychiatrist were lower than those in the other municipalities. There was, however, a positive and statistically significant association between the number of physicians and suicide rates.
  
  
  CONCLUSIONS
  Suicide rates in municipalities that had at least one psychiatrist were lower than those in other municipalities, but the number of physicians was positively and significantly related with suicide rates. To improve the regional disparity in suicide rates, the government should encourage psychiatrists to participate in community-based suicide prevention programs and to settle in municipalities that currently have no psychiatrists. The government and other stakeholders should also construct better networks between psychiatrists and non-psychiatrists to support sharing of information for suicide prevention.
authors: Department of Medical Informatics and Economics, The University of Tokyo, Tokyo, Japan.
authors: Hideaki
authors: H
authors: Kawaguchi
authors: Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.|Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors: Soichi
authors: S
authors: Koike
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010820:Physicians; D013405:Suicide