Relationship between economic development and suicide mortality: a global cross-sectional analysis in an epidemiological transition perspective

doi:10.1016/j.puhe.2003.10.004

Public Health

Volume 118, Issue 5, July 2004, Pages 346-348

https://doi.org/10.1016/j.puhe.2003.10.004 Get rights and content

Abstract

Aim. The aim of this study was to analyse the relationship between suicide rates and economic development within the theoretical framework of epidemiological transition.

Result. A weak positive correlation was found between suicide rates and GNP per capita in both sexes for all ages.

Discussion. According to previous studies, there is a clear decline in deaths due to unintentional injuries with improved economic conditions. This example of a man-made disease that declines during the fourth stage is in agreement with the theory of epidemiological transition. However, our results found the opposite pattern for deaths due to intentional self-inflicted injury.

Conclusion. Mortality rates due to unintentional and intentional self-inflicted injury show deviating patterns from an epidemiological transition perspective.

Introduction

Economic development is one of the main determinants of changing patterns of mortality, disease and injury¹. Lester claimed that economic factors (operationally measured by gross national product (GNP) per capita) are strongly associated with the suicide rates of nations². In his study, he found that industrialized nations had higher suicide rates. Henry and Short³ also predicted that as the quality of life improves, suicidal behaviour may become more common.

To understand the dynamic changes in health status and mortality (including injury-related deaths) in relation to economic development, it is necessary to refer to the theory of epidemiological transition⁴ by Omran. As initially envisaged, epidemiological transition would involve a one-way movement through a sequence of three stages. These start with an ‘age of pestilence and famine’ (stage 1), through an ‘age of receding pandemics’ (stage 2), to an ‘age of degenerative and man-made diseases’ (stage 3). Further changes in the mortality profile have been associated with a proposed fourth stage of transition,⁵ described by Olshansky and Ault, characterized by delayed degenerative diseases and declining mortality rates for man-made diseases, including injury.

Plitponkarnpim et al.⁶ and Ahmed and Andersson⁷ conducted cross-sectional studies in 0–14 and 15–44-years-olds, respectively, of mortality rates due to unintentional injury in relation to various countries' GNP per capita. The present study was inspired by their studies and focuses on deaths due to intentional self-inflicted injury (suicide). The aim of this study was to analyse the relationship between suicide rates and economic development within the theoretical framework of epidemiological transition.

Section snippets

Data sources and study population

The World Health Statistics Annual 1996 was used as the main source of data⁸. All countries reported in the Annual were reviewed, but if data were unavailable, data from the closest preceding year 1994 and 1995 were used. Some countries were excluded due to small population size (less than one million), out-of-date data (earlier than 1994), or lack of information about GNP and population subgroups. The GNP per capita for the same year was obtained from the World Development Indicators 1998⁹.

Statistical methods

Results

Fig. 1 shows the relationship between suicide and GNP per capita for 53 countries (including China) using a linear regression model for each sex. The GNP per capita was positively correlated with the suicide rate in both sexes of the nations (product-moment correlation r=0.115 in males and r=0.235 in females). The slope was steeper in females (β=+0.146) than males (β=+0.068).

Discussion

These results were inconsistent with those found by Plitponkarnpim et al.⁶ and Ahmed and Andersson⁷ in their research on unintentional injury and economic development. They found clear negative correlations between injury mortality rates and GNP per capita in 1–14-year-olds and 15–44-year-olds, respectively. The present study found a weak positive correlation between suicide rates and GNP per capita in both sexes and all ages. In addition, our analysis used data from 53 countries for 1996,

Conclusions

Our findings suggest that the pattern of deaths due to intentional self-inflicted injury (suicide) deviates from epidemiological transition perspectives compared with deaths due to unintentional injury. The clear declining trend shown for deaths due to unintentional injury does not correspond with the pattern for suicide rates. Instead, our results imply a weak increasing trend in suicide rates with economic status.

Acknowledgements

We wish to thank Karen Leander, Department of Public Health Sciences, Karolinska Institutet, for her correction of our English. We also wish to thank the Swedish International Development Co-operation Agency, Sida, for valuable support.

References (10)

N. Ahmed et al.
Unintentional injury mortality and socio-economic development among 15–44 year-olds: in a health transition perspective
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Freedom of the press and personal violence: a cross-national study of suicide and homicide
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A. Henry et al.
Suicide and Homicide
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There are more references available in the full text version of this article.

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Short communicationRelationship between economic development and suicide mortality: a global cross-sectional analysis in an epidemiological transition perspective

Abstract

Introduction

Section snippets

Data sources and study population

Statistical methods

Results

Discussion

Conclusions

Acknowledgements

Public Health

J Safety Res

Injury Control: a Global View

Freedom of the press and personal violence: a cross-national study of suicide and homicide

J Soc Psychol

Suicide and Homicide

Short communication
Relationship between economic development and suicide mortality: a global cross-sectional analysis in an epidemiological transition perspective