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Association between the Density of Physicians and Suicide Rates in Japan: Nationwide Ecological Study Using a Spatial Bayesian Model

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  • Hideaki Kawaguchi
  • Soichi Koike

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.

Suggested Citation

  • Hideaki Kawaguchi & Soichi Koike, 2016. "Association between the Density of Physicians and Suicide Rates in Japan: Nationwide Ecological Study Using a Spatial Bayesian Model," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-9, February.
    • Handle: RePEc:plo:pone00:0148288
    DOI: 10.1371/journal.pone.0148288
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    References listed on IDEAS

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    1. Yip, Paul S.F. & Yousuf, Saman & Chan, Chee Hon & Yung, Tiffany & Wu, Kevin C.-C., 2015. "The roles of culture and gender in the relationship between divorce and suicide risk: A meta-analysis," Social Science & Medicine, Elsevier, vol. 128(C), pages 87-94.
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    Cited by:

    1. Takashi Shiroyama & Kouji Fukuyama & Motohiro Okada, 2021. "Effects of Financial Expenditure of Prefectures/Municipalities on Regional Suicide Mortality in Japan," IJERPH, MDPI, vol. 18(16), pages 1-16, August.
    2. Ryo Kato & Motohiro Okada, 2019. "Can Financial Support Reduce Suicide Mortality Rates?," IJERPH, MDPI, vol. 16(23), pages 1-11, November.
    3. Toshiki Hasegawa & Kouji Fukuyama & Motohiro Okada, 2021. "Relationships between Expenditure of Regional Governments and Suicide Mortalities Caused by Six Major Motives in Japan," IJERPH, MDPI, vol. 19(1), pages 1-18, December.
    4. Misaki Nakamoto & Takatoshi Nakagawa & Masahiko Murata & Motohiro Okada, 2021. "Impacts of Dual-Income Household Rate on Suicide Mortalities in Japan," IJERPH, MDPI, vol. 18(11), pages 1-16, May.
    5. Tomosuke Nakano & Toshiki Hasegawa & Motohiro Okada, 2021. "Analysing the Impacts of Financial Support for Regional Suicide Prevention Programmes on Suicide Mortality Caused by Major Suicide Motives in Japan Using Statistical Government Data," IJERPH, MDPI, vol. 18(7), pages 1-20, March.

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