Dr. Enrique Baca GarcíaCRISIS ECONÓMICA Y EL SUICIDIOEl suicidio en las circunstancias actuales
E. Baca-GarcíaPUNTOS CLAVEWhy are some people healthy and others not?It seems a simple question.The answers, however, are ...
E. Baca-GarcíaINDICEIntroducciónEpidemiología y SociologíaSuicidio en EspañaClínicaConclusion
E. Baca-García 163.000 European deaths2nd cause of death in 15-35 years oldMakes up 2,3% of all diseases
E. Baca-GarcíaCOSTE ECONOMICO DEL SUICIDIO USA 1990• 30,906• $5.07 billion (2005 dollars)Irlanda 2001-2002 (1% PIB)• 519...
E. Baca-GarcíaACTUALIDAD Iwww.thelancet.com Published online March 27, 2013http://dx.doi.org/10.1016/S0140-6736(13)60102-6
E. Baca-GarcíaCRISIS ECONOMICA Y SALUD MENTAL Consecuancias de la crisis economica:• Disminución de capacidad adquisitiva...
E. Baca-GarcíaACTUALIDAD IIhttp://wiki.15m.cc/wiki/Lista_de_suicidios_relacionados_con_desahucios
E. Baca-GarcíaANTES DE VALORAR DATOS I“fluctuation between 10.0 per 100,000and 19.0 per 100,000 over the past 100years.”No...
E. Baca-GarcíaANTES DE VALORAR DATOS IIErrores en tasas por paises: infranotificaciónClaassen CA. National Suicide Rates a...
E. Baca-GarcíaANTES DE VALORAR DATOS III
E. Baca-GarcíaANTES DE VALORAR DATOS IV
E. Baca-GarcíaINDICEIntroducciónEpidemiología y SociologíaSuicidio en EspañaClínicaConclusion
E. Baca-GarcíaDURKHEIMEl suicidio (1897)“El único medio de proceder metódicamente consiste enclasificar, según sus propied...
E. Baca-GarcíaDURKHEIMLester BY. Learning from Durkheim and beyond: The economy and suicide.Suicide & Life - Threatening B...
E. Baca-GarcíaSUICIDIO ECONOMIA Relación stress económico y suicidio: pobreza ydesempleo Hombres 15- 29 años más vulnera...
E. Baca-GarcíaAutor, Pais Años Metodo ResultadoThomas K, 2010 UK 1861-2007 Office for National Statistics (ONS)age-standar...
E. Baca-GarcíaStatistically significant correlations between GDP (PPP) percapita and rate of suicide per 100,000 (WHO)Blas...
E. Baca-GarcíaGDP and rate of suicide
E. Baca-GarcíaEFECTOS DE CRISIS EN DISTINTOS PAISES Crisis económica asiática 1997-98• Tailand ia fue el pais más afectad...
E. Baca-GarcíaSUICIDIO CRISIS 26 EU paises entre 1970 and 2007 ( 550 años pais) Efectos a corto plazo (3 años)  de 1% ...
E. Baca-GarcíaSUICIDIO DESEMPLEOStuckler D. The public health eff ect of economic crises and alternative policyresponses i...
E. Baca-GarcíaDURKHEIM“An important question is to what extent today’s findings (ie, a changein unemployment rates is foll...
E. Baca-GarcíaDURKHEIM control depresión y alcoholFernquist RM. Archives of Suicide Research, 11:361–Suicide rates (Belgiu...
E. Baca-GarcíaINDICEIntroducciónEpidemiología y SociologíaSuicidio en EspañaClínicaConclusion
E. Baca-GarcíaCRISIS Y SALUD MENTAL EN ESPAÑAThe mental health risks of economic crisis in Spain: evidence from primary ca...
E. Baca-GarcíaSUICIDIO EN ESPAÑA 1981-2008Alvaro-Meca A. Epidemiology of suicide in Spain, 1981e2008: A spatiotemporalanal...
E. Baca-GarcíaSUICIDIO EN ESPAÑA 1981-2008Alvaro-Meca A. Epidemiology of suicide in Spain, 1981e2008: A spatiotemporalanal...
E. Baca-GarcíaINDICEIntroducciónEpidemiología y SociologíaSuicidio en EspañaClínicaConclusion
E. Baca-GarcíaRISK FACTOR FOR SUICIDEHawton K, van Heeringen K. Suicide. Lancet. 2009 vol. 373 (9672): 1372-81
E. Baca-GarcíaPROTECTORES•RELIGIÓN•SOPORTE SOCIAL•EMBARAZO•PRESENCIA DENIÑOSBIOLÓGICOS•HERENCIA•MONOAMINAS•LÍPIDOSSOCIODEM...
E. Baca-GarcíaWEIGHTING BIOLOGICAL AND CLINICAL FACTORSNeuropsychophram 2001; Psychos Med 2003; JCP 2006; Stress and Healt...
E. Baca-GarcíaINTENTOS DE SUICIDIO vs SUICIDIOPersonality disorders and health problems distinguish attempters fromcomplet...
E. Baca-GarcíaINTENTOS DE SUICIDIO vs SUICIDIOPersonality disorders and health problems distinguish attempters fromcomplet...
E. Baca-GarcíaINDICEIntroducciónEpidemiología y SociologíaSuicidio en EspañaClínicaConclusion
E. Baca-GarcíaFaltan estudios etiológicos para establecer larelación entre situación económica y suicidioFalacia ecológi...
E. Baca-GarcíaEQUIPO Enrique Baca García Hilario Blasco Fontecilla Juan José Carballo Belloso Pablo Fernández Navarro...
E. Baca-GarcíaMuchas gracias
E. Baca-GarcíaPREDICTORES SUICIDIO TRAS HOSPITALIZACIÓNMorrel S et al. Suicide and unemployment in Australia 1907-1990. Sm...
E. Baca-GarcíaMODELOSThis research examines empirically the determinants of suicidesinDenmarkover the period1970–2006. To ...
E. Baca-GarcíaSUICIDIO DESEMPLEO Age-adjusted, gender-specific suicide trends for selected Western and Eastern Europe.c...
E. Baca-GarcíaPREDICTORES SUICIDIO TRAS HOSPITALIZACIÓNTroister T eta al. Review of Predictors of Suicide Within 1 Year of...
E. Baca-GarcíaHampton T. Depression Care Effort Brings Dramatic Drop in Large HMOPopulation’s Suicide Rate. JAMA, 2010; 10...
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Enrique Baca. Crisis Económica y Suicidio

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IV Encuentros en Psiquiatría. Sevilla, año 2013. Ponencia "Crisis Económica y Suicidio", por Enrique Baca. Jefe Asociado Servicio Psiquiatría Fundación Jiménez Díaz. Profesor Asociado Universidad Autónoma. Madrid. Adjunct Associate Professor. Columbia University. NY. USA

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  • Durkheimargued that egoism and anomie (e.g., lowsocial integration and low social regulation,respectively) explain significant variation innational suicide rates.
  • As in most ecological studies, conclusions may beprone to ecological fallacy: characteristics may have beenascribed to group members that they do not in fact possessas individuals.
  • Empezare presentando al equipo que ha desarrollado este complejo proyecto  multidisciplinar que  requiere la paticipacion de varios hospitales, CSM, universidades, ayuntamiento y CAMEn los próximo minutos les hablare de 
  • Enrique Baca. Crisis Económica y Suicidio

    1. 1. Dr. Enrique Baca GarcíaCRISIS ECONÓMICA Y EL SUICIDIOEl suicidio en las circunstancias actuales
    2. 2. E. Baca-GarcíaPUNTOS CLAVEWhy are some people healthy and others not?It seems a simple question.The answers, however, are complex and have to donot only with disease and illness, but also with whowe are, where we live and work, and the social andeconomic policies of our government, all of whichplay a role in determining our health.Institute of Medicine. The Future of the Public’s Health in the 21st Century, 2003PARA EL CLÍNICO• Integrar datos y metodologías diferentes• Causas del Suicidio vs causa del suicidio en unpaciente• Debate ideologizado
    3. 3. E. Baca-GarcíaINDICEIntroducciónEpidemiología y SociologíaSuicidio en EspañaClínicaConclusion
    4. 4. E. Baca-García 163.000 European deaths2nd cause of death in 15-35 years oldMakes up 2,3% of all diseases
    5. 5. E. Baca-GarcíaCOSTE ECONOMICO DEL SUICIDIO USA 1990• 30,906• $5.07 billion (2005 dollars)Irlanda 2001-2002 (1% PIB)• 519-478• € 906 millon 2001• €835 millon 2002 ( 2001 €).Suiza• 15 000 - 25 000 intentos• Costes directos 191 million CHFDeath Stud. 2007 Apr;31(4):351-61Crisis. 2007;28(2):89-94.
    6. 6. E. Baca-GarcíaACTUALIDAD Iwww.thelancet.com Published online March 27, 2013http://dx.doi.org/10.1016/S0140-6736(13)60102-6
    7. 7. E. Baca-GarcíaCRISIS ECONOMICA Y SALUD MENTAL Consecuancias de la crisis economica:• Disminución de capacidad adquisitivas ( pobreza)• Paro• Disminucion presupsueto publico El despempleo afecta a al bienestar y autostima, serelaciona con depresión, ansiedad, sintomaspsicosomaticos. Las personas desempleadas tienen un 34% deproblemas psicologicos frente al 16% de losempleados. El efecto sobre la salus mental es mayor.• Cuanto más largo es el desempleo• En paises en desarollo , con inequidades• Sistemas de protección socal escasosUutela A. Economic crisis and mental health. Current Opinion in Psychiatry 2010,23:127–130
    8. 8. E. Baca-GarcíaACTUALIDAD IIhttp://wiki.15m.cc/wiki/Lista_de_suicidios_relacionados_con_desahucios
    9. 9. E. Baca-GarcíaANTES DE VALORAR DATOS I“fluctuation between 10.0 per 100,000and 19.0 per 100,000 over the past 100years.”Nock MK et al. Suicide and Suicidal Behavior. Epidemiol Rev. 2008 ; 30(1): 133–154.NATURAL FLUCTUATION 50%
    10. 10. E. Baca-GarcíaANTES DE VALORAR DATOS IIErrores en tasas por paises: infranotificaciónClaassen CA. National Suicide Rates a Century after Durkheim: Do We KnowEnough to Estimate Error? Suicide and Life-Threatening Behavior 40(3) 2010
    11. 11. E. Baca-GarcíaANTES DE VALORAR DATOS III
    12. 12. E. Baca-GarcíaANTES DE VALORAR DATOS IV
    13. 13. E. Baca-GarcíaINDICEIntroducciónEpidemiología y SociologíaSuicidio en EspañaClínicaConclusion
    14. 14. E. Baca-GarcíaDURKHEIMEl suicidio (1897)“El único medio de proceder metódicamente consiste enclasificar, según sus propiedades esenciales, los suicidioscometidos por los locos, constituyendo así el tipo principal delos suicidios vesánicos e investigar después si todos los casos demuerte voluntaria caben en estos cuadros nosológicos. En otrostérminos, para saber si el suicidio es un acto especial de losalienados, es preciso determinar las formas que afecta en laenajenación mental y ver a continuación si estas son las únicasque toma.Los alienistas se han preocupado poco de clasificar lossuicidios de alienados”“No existe ningún estado psicopático que sostenga con elsuicidio una relación regular e incontestable. Porque unasociedad contenga más o menos neurópatas o alcohólicos no sedarán en ella más o menos suicidios”
    15. 15. E. Baca-GarcíaDURKHEIMLester BY. Learning from Durkheim and beyond: The economy and suicide.Suicide & Life - Threatening Behavior; 2001; 31 (1):15-31“Singularmente hay dos factores del suicidio que tienen el uno conel otro una afinidad especial, y son el egoísmo y la anomia”• EGOISMO: falta de integración social (religión, educación, vidafamiliar y política)• ANOMIA: falta de regulación o control por la sociedad (cambioseconómicos, desempleo, divorcio)U DrurkheimContraciclicaProciclica
    16. 16. E. Baca-GarcíaSUICIDIO ECONOMIA Relación stress económico y suicidio: pobreza ydesempleo Hombres 15- 29 años más vulnerables Variables de confusión alcohol y depresión 4 tipos de métodos• Estudios trasversales individuales (3b):Casos control - > hombres en UK,(Platt, 1984)• Estudios agregados (2c):Mortalidad poblacional - > Resultados controvertidos• Estudios longitudinales (2b):Cohortes -> Problemas laborales vs no 25 años RR 2.5 (Rorsman, 1980)• Estudios agregados de tendencias temporales (2c):Mortalidad poblacional periodo - >resultados contradictorios, indiciosen hombres jóvenesAdemas series de casos (4)y opiniones de expertos (5)Niveles de evidencia (1-5) según http://www.cebm.net/?o=1025Stack S.Suicide: A 15-Year Review of the Sociological Literature - Part I: Culturaland Economic Factors , Suicide and Life-Threatening Behavior, 2000; 30:2.145
    17. 17. E. Baca-GarcíaAutor, Pais Años Metodo ResultadoThomas K, 2010 UK 1861-2007 Office for National Statistics (ONS)age-standardized suicide rates (European Standard)Suicide rates increased in all age groups in the 1930s, coincidingwith the Great Depression.Kwon JW, 2009 Korea 1986-2005 Korean National Statistical Office (NSO)age-standardized using the standard populationin 2005.the Asian economic downturn in 1997evoked an increase in suicide rates with a ripple effectoccurring even after economic recovery in KoreaRedanie, 2011 Philipines 1974-2005 PhilippineHealth Statistics (PHS) producedAge-standardized rates were computed using theWHO world standard populationThe increasing rates of suicide and accidental deaths andcorresponding decrease in undetermined deaths aresuggestive of some underreporting and misclassification.Andres AR, 2010 Denamark 1970-2006 Dynamic econometric model of suicides on the basisof time series dataRise in real per capita income and fertility rate decreasessuicides for males and females. Divorce is positively associatedwith suicides and this effect seems to be stronger for men. A fallin unemployment rates seems to lower significantly suicidesin males and femalesBarr B, 2012 UK 2008-10 Time trend analysis comparing the actual number ofsuicides with those that would be expected ifprerecession trends had continued.Multivariate regression models quantified theassociation between changes in unemployment(based on claimant data) and suicides (based on datafrom the National Clinical Health OutcomesDatabase).We estimated 846 more suicides among men (818 to 877) and155 more suicides among women (121 to 189) than would havebeen expected if these trends had continued in the period 2008-10.Kolves K, 2013 EasternEuropeancountries1990-2008 WorldHealth Organization (WHO)In both models, unemployment (P < 0.05) was positivelyassociated with male mortality rates, while GDP per capita (P <0.001 for suicide and P < 0.05 for suicide ⁄ UD), GPs per100,000 (P < 0.05) and birth rates (P < 0.001) were negativelyassociated with mortality rates. Both models 1a and 1b showedthat the 5-year indicator variables were associated with adecrease in male mortality rates (using 1990–1994 as areference category).Unemployment was positively associated with female suicide (P< 0.05) and GDP per capita negatively associated with femalesuicide (P < 0.001). However, they did not have an effect on thesuicide or UD rate. Alcohol consumption per capita wasnegatively associated with the female suicide rate (P < 0.05).SUICIDIO CRISIS
    18. 18. E. Baca-GarcíaStatistically significant correlations between GDP (PPP) percapita and rate of suicide per 100,000 (WHO)Blasco-Fontecilla H. Worldwide impact of economic cycles on suicide trends over 3decades: Differences according to level of development. BMJ Open 2012 (2 (3):000785
    19. 19. E. Baca-GarcíaGDP and rate of suicide
    20. 20. E. Baca-GarcíaEFECTOS DE CRISIS EN DISTINTOS PAISES Crisis económica asiática 1997-98• Tailand ia fue el pais más afectado por la crisi y la tasa desuicidio aumento en 199 y cayó despues de la crisis (5.9 in 1977,8.6 in 1999 and 7.8 in 2002)• Japón, Hong Kong y Koreaa tubieron un exceso de 10,400suicidios (8800–11,300) en 1998 . Afectando más a hombres enedad activa• La crisi no afectos a las tendencias en Taiwan and Singaporedonde la crisis afecto menos a GDP y desempleo. Rusia:• Aumento en 1998 y descenso despues Finlandia• Aumento desmpleo durante la crisi de 1990 no tuvo efecto sobrela tasa de suicidioBMC Public Health 2009, 9:72. doi:10.1186/1471-2458-9-72Social Science & Medicine 68 (2009) 1322–1331
    21. 21. E. Baca-GarcíaSUICIDIO CRISIS 26 EU paises entre 1970 and 2007 ( 550 años pais) Efectos a corto plazo (3 años)  de 1% de la tasa de desempleo supone: de a 0.79% suicidio de <65 años (95% CI 0.16–1.42; 60–550exceso de muerte potencial EU)de a 0.79% en la tasa de homicideios (0.06–1.52; 3–80 exceso demuerte potencial EU). muertes de trafico en 1.39% (0.64–2.14; 290–980 menosmuertes potenciales [mean 630] EU-wide). No se detecta efecto de género en la relaciónmortalidad- desempleo Hay una relación entre las muertes debidas a abusode alcohol en mujeres y el desempleo (χ.=5.41,p=0.0194),Stuckler D. The public health eff ect of economic crises and alternative policyresponses in Europe: an empirical analysis. Thelancet 2009; 379; 315-6
    22. 22. E. Baca-GarcíaSUICIDIO DESEMPLEOStuckler D. The public health eff ect of economic crises and alternative policyresponses in Europe: an empirical analysis. Thelancet 2009; 379; 315-6
    23. 23. E. Baca-GarcíaDURKHEIM“An important question is to what extent today’s findings (ie, a changein unemployment rates is followed by a change in suicide rates) areconsistent with findings from individual-level studies on theassociation between unemployment and suicide (ie, individuals exposedto unemployment are at increased risk of suicide).Lundin A. Unemployment and suicide. Lancet 2013.“The association between suicide and unemployment for 15-24 year oldmales was comparatively high for the recent period, 1966-1990. Theincreasingly youthful contribution to male suicide was demonstrated bya rise in the loss of life years during 1973- 1984. Despite the inabilityof any investigation based on aggregate data to establish anunequivocable causal relationship”Morrell S. Suicide and unemployment in australia 1907-1990. Soc. Sci. Med.Vol.3 6,N o. 6.p p.7 49.-7561,9 93
    24. 24. E. Baca-GarcíaDURKHEIM control depresión y alcoholFernquist RM. Archives of Suicide Research, 11:361–Suicide rates (Belgium,Denmark,England=Wales, France,Germany, Ireland, Italy, and theNetherlands) from 1973–1997
    25. 25. E. Baca-GarcíaINDICEIntroducciónEpidemiología y SociologíaSuicidio en EspañaClínicaConclusion
    26. 26. E. Baca-GarcíaCRISIS Y SALUD MENTAL EN ESPAÑAThe mental health risks of economic crisis in Spain: evidence from primary carecentres, 2006 and 2010. European Journal of Public Health, 2013; 23 (1):103–108
    27. 27. E. Baca-GarcíaSUICIDIO EN ESPAÑA 1981-2008Alvaro-Meca A. Epidemiology of suicide in Spain, 1981e2008: A spatiotemporalanalysis. Public Health. http://dx.doi.org/10.1016/j.puhe.2012.12.007“The spatiotemporal analysis for total suicide mortality. A cleargeographic pattern was found. The southern areas in Spain(AndalucIa, Murcia, Extremadura) have the lowest gross domesticproduct in Spain and have the highest suicide mortality rate.Furthermore, Asturias and Galicia (rural areas) were hadincreasing levels of suicide. The capitals of the provinces, includingMadrid, Barcelona, and Valencia (urban centres with highpopulation density), had high suicide rates. In contrast, CastillaLeón, Castilla la Mancha and Aragón (unpopulated geographicareas of Spain) had low suicide rate”
    28. 28. E. Baca-GarcíaSUICIDIO EN ESPAÑA 1981-2008Alvaro-Meca A. Epidemiology of suicide in Spain, 1981e2008: A spatiotemporalanalysis. Public Health. http://dx.doi.org/10.1016/j.puhe.2012.12.007“The pattern of mortality was slightly different among mencompared with the total population. In this comparison, the onlyareas with higher rates of suicide were Andalucia and Extremadura,on one side, and Galicia and Asturias, on the other. No regionaltrends were found among women”
    29. 29. E. Baca-GarcíaINDICEIntroducciónEpidemiología y SociologíaSuicidio en EspañaClínicaConclusion
    30. 30. E. Baca-GarcíaRISK FACTOR FOR SUICIDEHawton K, van Heeringen K. Suicide. Lancet. 2009 vol. 373 (9672): 1372-81
    31. 31. E. Baca-GarcíaPROTECTORES•RELIGIÓN•SOPORTE SOCIAL•EMBARAZO•PRESENCIA DENIÑOSBIOLÓGICOS•HERENCIA•MONOAMINAS•LÍPIDOSSOCIODEMO.•HOMBRES•EDADESEXTREMAS•DESVENTAJASSOCIALESCLINICOS•INTENTOS PREVIOS•DEPRESIÓN•PSICOSIS•DROGAS•PERSONALIDADEVENTOSVITALES•CONFILCTOINTERPERSONAL•MALTRATO•AISLAMIENTOPSICOLÓGICOS•IMPULSIVIDAD•AGRESIVIDAD•DESESPERANZA•ANHEDONIA•REACTIVIDADEMOCIONALOTROS•ACCESO A MEDIOSLETALES•CONTAGIO•ENFERMEDADCRÓNICARIESGO Y PRONOSTICO CONDUCTA SUICIDANock MK et al. Suicide and Suicidal Behavior. Epidemiol Rev 2008;30:133–154
    32. 32. E. Baca-GarcíaWEIGHTING BIOLOGICAL AND CLINICAL FACTORSNeuropsychophram 2001; Psychos Med 2003; JCP 2006; Stress and Health, 2007;AM J Med Gen 2008; JCP 2008; AM J Med Gen 201005101520253035MensesCholesterol<160mg/dl5-Ht2aT1002C5-HTPRLHTR1E~GABRP~ACTN2AggresivityImpulsivityClusterBAdultphysicalabuseInterpersonalconcfictsPartnerconflictsTheorical distributionBlood donorsPsychiatric patientsOR BIOLOGICAL GENE PSYCHOLOGICAL-CLINICAL LIFE EXPERIENCEAm J Psychiatry 2005; 162:1243–1252
    33. 33. E. Baca-GarcíaINTENTOS DE SUICIDIO vs SUICIDIOPersonality disorders and health problems distinguish attempters fromcompleters in a direct comparison, submitted.
    34. 34. E. Baca-GarcíaINTENTOS DE SUICIDIO vs SUICIDIOPersonality disorders and health problems distinguish attempters fromcompleters in a direct comparison, submitted.
    35. 35. E. Baca-GarcíaINDICEIntroducciónEpidemiología y SociologíaSuicidio en EspañaClínicaConclusion
    36. 36. E. Baca-GarcíaFaltan estudios etiológicos para establecer larelación entre situación económica y suicidioFalacia ecológica: datos poblacionales noson extrapolables a individuosDepresión y alcholismo factores de confusiónpara intepretar la relación entre suicidio ysituación económicaFactores de riesgo individualesCoste individual, social y económicoCONCLUSIONES
    37. 37. E. Baca-GarcíaEQUIPO Enrique Baca García Hilario Blasco Fontecilla Juan José Carballo Belloso Pablo Fernández Navarro Rebeca García Nieto Jorge López Castroman Concepción Vaquero Asesores y colaboradores• Antonio Artés Rodríguez• José de León• María Oquendo• Jerónimo Saiz Ruiz
    38. 38. E. Baca-GarcíaMuchas gracias
    39. 39. E. Baca-GarcíaPREDICTORES SUICIDIO TRAS HOSPITALIZACIÓNMorrel S et al. Suicide and unemployment in Australia 1907-1990. Sm. Sri. Med. Vol.36,N o. 6.p p.7 49.-7561,9 93While the aggregate data show that thesuicide/unemployment relationship is not a simpleyear-by-year correlation, the present study stronglysupports the hypothesis that unemployment is significantas a predisposing factor for increasing the riskof suicide, especially in malesFemale suicide rates were generally stable throughout theperiod, whereas those formales demonstrated sharp fluctuations with the peaks coincidingwith times of high unemployment.The association between suicide and unemployment for 15524year old males was comparatively high forthe recent period, 1966-1990. The increasingly youthfulcontribution to male suicide was demonstratedby a rise in the loss of life years during 1973- 1984. Despite theinability of any investigation based onaggregate data to establish an unequivocable causalrelationship, no evidence was detected to suggest thatrelatively high population levels of unemployment were notrelated to the occurrence of suicide.
    40. 40. E. Baca-GarcíaMODELOSThis research examines empirically the determinants of suicidesinDenmarkover the period1970–2006. To our knowledge, there exist no previous study that estimatesa dynamiceconometric model of suicides on the basis of time series data andcointegration frameworkat disaggregate level. Our results indicate that suicide is associated with arange ofsocio-economic factors but the strength of the association can differ bygender. In particular,we find that a rise in real per capita income and fertility rate decreasessuicides formales and females. Divorce is positively associated with suicides and thiseffect seems tobe stronger for men. A fall in unemployment rates seems to lowersignificantly suicidesin males and females. Policy implications of suicides are discussed withsome appropriateAndrésa AR, Halicioglub F. Determinants of suicides in Denmark: Evidence from timeseries data. Health Policy 98 (2010) 263–269BryanCharnley
    41. 41. E. Baca-GarcíaSUICIDIO DESEMPLEO Age-adjusted, gender-specific suicide trends for selected Western and Eastern Europe.countries in 1980–2008 were obtained from the World Health Organization (WHO) European Mortality Database, updated in January 2010 (http://data.euro.who.int/hfamdb). Several gaps in the WHO mortality data were filled using the Eurostat database (http://epp.eurostat.ec.europa.eu). Absolute numbers of employed people and population data for 1980–2008 were obtained from the Total Economy Database, developed by the Groningen Growth and Development Centre (http://www.conference-board.org) In line with Durkheim’s classic theory, work may be understood as one of the important ties that integrates individuals into the community and regulates their everyday life, providing them with realistic means of fulfilling some of their basic needs. Accordingly, merely having a position in the labour market would in itself appear very important (Wasserman and Mäkinen, 2009). Both the country level (represented by employment rates) and the individual level (represented by people’s attitudes towards employment problems) were considered. Overall, the results of the study generally support the hypothesis that suicidal behaviour is dependent to a certain extent on the situation on the labour market, and is characterized by an inverse relationship with employment in the majority of countries studied. It is worth bearing in mind that the Eastern European countries covered in the study underwent fundamental socioeconomic changes during the 1990s, after the USSR collapsed. This transition period was accompanied by critical disruption of economic activity, resulting in high unemployment and marked labour-market insecurity. A rapid rise in suicide mortality was reported at the time (Mäkinen, 2000; Varnik et al., 2010). Suicidal behaviour is more strongly related to attitudesYur’yev A. Employment status influences suicide mortality in Europe. InternationalJournal of Social Psychiatry 2010; 58(1) 62–68
    42. 42. E. Baca-GarcíaPREDICTORES SUICIDIO TRAS HOSPITALIZACIÓNTroister T eta al. Review of Predictors of Suicide Within 1 Year of Discharge from aPsychiatric Hospital. Current Psychiatry Reports 2008, 10:60–65Conducta suicida ORIntentos previos 3,1- 13,8Ideación / intentos previa al ingreso 1,9- 3.4Autolesiones/intentos durante le ingreso 2,6- 10,5Atención sanitaria ORCumplimiento del tratamiento 8,0Alta sin planificar 4,0Continuidad de cuidado 16,8We found that nearly half of suicide cases occurring within thefirst month had taken place before their first out-patientappointment.Psychological Medicine (2009), 39, 443–449
    43. 43. E. Baca-GarcíaHampton T. Depression Care Effort Brings Dramatic Drop in Large HMOPopulation’s Suicide Rate. JAMA, 2010; 103 (19): 1903-5PREVENIR SIN PREDECIRRedesign depression care delivery:• Seguridad• Efectividad: evitar infrautilizacion ysobreutilización• Centrado en el paciente: considerar suspreferencias, necesidades y valores queguían todas las decisiones• Tiempo: Reducción de esperaas y retrasos• Eficiente: evitar derroche• Equidad

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