@article{ref1,
title="Suicide Rates in Relation to Health Care Access in the United States: An Ecological Study",
journal="Journal of clinical psychiatry",
year="2006",
author="Tondo, L. and Albert, Matthew J. and Baldessarini, Ross J.",
volume="67",
number="4",
pages="517-523",
abstract="</= suicide.<p of prevention the in element crucial a is intervention  clinical that view support findings The care. health to access indicators  proposed with rates suicide state-based correlations strong yielded also They  suicide. associations well-established factors several detected employed methods  Nevertheless, persons. individual for indices risk specify cannot analyses  aggregate Such DISCUSSION: density. population by and physicians psychiatrists  density persons uninsured rate followed indicator, strongest was mental aid  federal state care, between models multivariate In directions. expected  associated were All Americans. African proportion higher health, physicians,  psychiatrists, income, capita per annual density, follows: as ranked are  =&quot;.002)&quot; < p (all bivariate Negative residents. ethnicity, American Native sex,  male .005) /> <p>OBJECTIVE: We tested the hypothesis that suicide rates  in the United States are associated with indicators of access to health care  services. METHOD: With an ecological study design, we compared age-adjusted  suicide rates for men and women with demographic, socioeconomic, and other  indices of access to health care, by state (N= 51, including the District of  Columbia). The most recently available information from the National Statistics  Reports at the U.S. Census Bureau, the U.S. Centers for Disease Control and  Prevention National Center for Health Statistics, and the American Board of  Medical Specialties was used. Data on suicide are from 2001; other measures were  matched for the closest available year, except that state-based data on  psychiatrists and physicians are from 2004. RESULTS: Positive bivariate  associations with state suicide rates (all p &lt;/= .005) are ranked as follows:  male sex, Native American ethnicity, and higher proportion of uninsured  residents. Negative bivariate associations (all p &lt;/= .002) are ranked as  follows: higher population density, higher annual per capita income, higher  population density of psychiatrists, higher population density of physicians,  higher federal aid for mental health, and higher proportion of African  Americans. All factors were associated with state suicide rates in expected  directions. In multivariate models of associations between suicide rates and  indices of access to health care, the state rate of federal aid for mental  health was the strongest indicator, followed by the rate of uninsured persons  and population density of psychiatrists and physicians and by population  density. DISCUSSION: Such aggregate analyses cannot specify risk indices for  individual persons. Nevertheless, the methods employed detected several factors  with well-established associations with suicide. They also yielded strong  correlations of state-based suicide rates with proposed indicators of access to  health care. The findings support the view that clinical intervention is a  crucial element in the prevention of suicide.<BR> </p> <p>Language: en</p>",
language="en",
issn="0160-6689",
doi="",
url="http://dx.doi.org/"
}