Epidemiological Risk Stratification of Suicide Attempt in Cuba

Abstract

Introduction: Epidemiological risk stratification is an integrated process of diagnosis, intervention and evaluation, used for decision-making. The risk of dying by suicide in those who make attempts is a hundred times higher than in the general population.

Objective: To stratify suicide attempt epidemiologically, according to province of residence.

Methods: A mixed ecological study was carried out. The universe was made up of the records of suicide attempts, accessed through the files of reportable diseases from the Medical Registries and Statistics of the Ministry of Public Health from 1990 to 2014. The variables were sex, age and provinces of residence. Cumulative gross, adjusted and specific morbidity rates per 100 000 inhabitants were calculated. The stratification was carried out taking the percentiles as cut-off point, leaving very high risk above the 75^th percentile, high risk between the 50^th and the 74^th percentiles, moderate risk between the 25^th and the 49^th percentiles, and low risk below the 25^th percentile. The relative change percentage of the series and the percentages were calculated, according to variables.

Results: From 1990 to 2014, there were 291 524 suicide attempts (20 823 attempts per year), of which 71.5% corresponded to women. The provinces with very high risk in the period 1990-2014 were Cienfuegos, Holguín, Santiago de Cuba and Granma, accounting, respectively, for rates of 151.9, 135.2, 126.9 and 125.2 per 100 000 inhabitants; and during 2011-2014, Matanzas, Las Tunas, Cienfuegos and Holguín, accounting, respectively, for rates of 154.4, 154.3, 148.3 and 147.3 per 100 000 inhabitants.

Conclusions: Risk stratification at the provincial level varied in the periods studied. The female sex and adolescents were the most at risk of suicide attempt.