AIM: No previous studies investigated the association between psychiatrist density and suicide, accounting for individual- and area-level characteristics. METHODS: All suicide cases in 2007-2017 were identified from the national cause-of-death data files, with each suicide case matched to ten controls by age and sex and each suicide case/control assigned to one of the 355 townships across Taiwan. Our primary outcome was the odds ratios (OR) of suicide estimated via multi-level models, which included both individual-level and area-level characteristics. Townships with no psychiatrists were compared with the quartiles of townships with psychiatrists (density per 100,000 population): Q1 (0.01-3.02); Q2 (3.02-7.20); Q3 (7.20-13.82); and Q4 (>13.82). RESULTS: A total of 40,930 suicide cases and 409,300 age-sex-matched controls were included. We found that increased psychiatrist density was associated with decreased suicide risk (Q1: adjusted OR [aOR] = 0.95 [95% CI 0.90-1.01]; Q2: aOR = 0.90 [95% CI 0.85-0.96]; Q3: aOR = 0.89 [95% CI 0.83-0.94]; Q4: aOR = 0.89 [95% CI 0.83-0.95]) after adjusting for individual characteristics (employment state, monthly income, physical comorbidities, and the diagnosis of psychiatric disorders) and area socioeconomic characteristics. CONCLUSIONS: The psychiatrist density-suicide association suggests an effect of the availability of psychiatric services on preventing suicide. Suicide prevention strategies could usefully focus on enhancing local access to psychiatric services.
Date:
2024-01
Relation:
Psychiatry and Clinical Neurosciences. 2024 Jan;78(1):69-76.
