Suicide Mortality in Andalusia, Spain: Geographical Distribution and Relationship with Antidepressants, Altitude and Socioeconomic Inequalities

Background: The suicide mortality rate in Andalusia is higher than the Spanish average, and it shows a different evolution over time. This study analyzes recent changes of suicide mortality in Andalusia, its geographical distribution and its relation with antidepressant use, altitude and socioeconomic inequality. Methods: An ecological study of the Basic Health Zones in Andalusia has been conducted. Age-standarized suicide rates in 2012 and during 20072011 were calculated. The correlation among variables and their association with the geographical differences was assessed with Spearman's coefficient and generalized linear models were also estimated. Results: Andalusia registered 7,58 suicides per 100.000 inhabitants per year from 2007 to 2011, with a range of 0,96 to 27,71 in the different areas. Positive correlation has been observed between altitude and suicide rates in 2012 (r= 0,29; p< 0,001) and during the period 2007-2011 (r= 0,47; p< 0,001). Antidepressant use in 2012 was not correlated with suicide rates in that year (r= 0,03; p= 0,67), but a positive correlation was observed with the precedent five years suicide rates (r= 0,18; p= 0,008). The Deprivation Index had a positive correlation with suicide rates in 2012 (r= 0,29; p< 0,001) and in 2007-2011 (r= 0,33; p< 0,001). Conclusions: There is a clear geographical pattern in the distribution of suicide mortality in Andalusia and it remains stable over time. Central areas and in those with the highest altitude concentrate the highest suicide rates, which are associated with a larger use of antidepressants and also with higher levels of material deprivation.