Suicide in Brazil, 2004-2010: the importance of small counties.

OBJECTIVE To describe suicide rates by county size in the five geopolitical areas of Brazil. METHODS This was an ecological, descriptive study of suicide deaths in Brazil that occurred among the population 10 years of age and older in 2004-2010. Data were obtained from the National Mortality Information System of Brazil. Counties were defined by size as: very large (200,000+), large (< 200,000-100,000), medium (< 100,000-50,000), small (< 50,000-20,000), very small (< 20,000-10,000, and micro (< 10,000). Age-adjusted suicide rates were calculated for all counties and for population-size groups in each geopolitical area. Rate ratio and 95% confidence interval were used to compare suicide risk between groups and the reference. RESULTS The national, average suicide mortality rate was 5.7 deaths/100,000 inhabitants. Except in the North and North-East, suicide mortality rates increased from the very large (> 200,000) to the micro counties (< 10,000 population). Very high rates were scattered in the North and Mid-West among the indigenous peoples (> 30 deaths per 100,000). At highest risk were micro counties in the South (13.6 deaths per 100,000), with elderly males (60+ years, 31.4) and males 40-59 years (31.3) being the sex/age group with the highest rates. CONCLUSIONS To reduce suicide mortality in Brazil, public health authorities must support mental health training in small cities and multi-professional interventions among the indigenous peoples. In addition, the causes behind underreporting of suicide deaths must be resolved in several areas.