ISSN: 1981-8963 DOI: 10.5205/reuol.6039-55477-1-ED.

0810201421

Botti NCL, Mesquita IR, Benjamim MLN. Macro-regional differences in mortality…

ORIGINAL ARTICLE
MACRO-REGIONAL DIFFERENCES IN MORTALITY BY SUICIDE: AN
EPIDEMIOLOGICAL
DIFERENÇAS MACRORREGIONAIS DA MORTALIDADE POR SUICÍDIO: ANÁLISE
EPIDEMIOLÓGICA
DIFERENCIAS MACRORREGIONALES EN LA MORTALIDAD POR SUICIDIO: UN ANÁLISIS
EPIDEMIOLÓGICO
Nadja Cristiane Lappann Botti , Isabela Rodrigues Mesquita2, Maria Luísa Nogueira Benjamim3
1

ABSTRACT
Objective: analyzing, through an epidemiological perspective, suicide deaths in the macro-regions of Minas
Gerais in the quadrennium 2006-2009. Method: a descriptive and retrospective epidemiological study based
on secondary data. There were included deaths of residents in Minas Gerais/MG, between 2006 and 2009,
recorded in the Mortality Information System. Results: the State shows an average suicide rate, but its
distribution is not homogeneous among regions. There is a higher incidence of suicide among men and higher
concentration of these rates for both sexes in the West, Northwest and Triângulo do Sul of the State.
Individuals between 20 and 49 years old accounted for 67,42% of total suicides in the State. Hanging is the
most common method of committing suicide in all geographical regions of the State. Conclusion: the
distribution of suicide cases allowed the identification of risk areas in the macro-regions of Minas Gerais.
Descriptors: Suicide; Violence; Epidemiologic Studies; Mortality Rate.
RESUMO
Objetivo: analisar epidemiologicamente as mortes por suicídio nas macrorregiões de Minas Gerais no
quadriênio 2006-2009. Método: estudo epidemiológico descritivo e retrospectivo baseado em dados
secundários. Foram incluídos os óbitos de residentes em Minas Gerais/MG, entre 2006 e 2009, registrados no
Sistema de Informações sobre Mortalidade. Resultados: o Estado apresenta taxa média de suicídio, porém sua
distribuição não é homogênea entre as macrorregiões. Verifica-se maior ocorrência de suicídio entre os
homens e maior concentração dessas taxas, para ambos os sexos, no Oeste, Noroeste e Triângulo do Sul do
Estado. Os indivíduos entre 20 e 49 anos corresponderam a 67,42% do total de suicídios no Estado. O
enforcamento é o método mais utilizado de perpetração do suicídio em todas as macrorregiões do Estado.
Conclusão: a distribuição dos casos de suicídio possibilitou a identificação de áreas de risco nas macrorregiões
de Minas Gerais. Descritores: Suicídio; Violência; Estudos Epidemiológicos; Coeficiente de Mortalidade.
RESUMEN
Objetivo: analizar las muertes por suicidio epidemiologicamente en las macroregiones de Minas Gerais en el
cuatrienio 2006-2009. Método: es un estudio epidemiológico descriptivo y retrospectivo basado en datos
secundarios. Se incluyeron las muertes de residentes en Minas Gerais/MG entre 2006 y 2009, registradas en el
Sistema de Informaciones sobre Mortalidad. Resultados: el Estado tiene una tasa de suicidio, pero su
distribución no es homogénea entre las regiones. Hay una mayor incidencia de suicidio entre los hombres y la
mayor concentración de estas tasas para ambos sexos en el Oeste, Noroeste y Triángulo del Sur del Estado.
Las personas entre 20 y 49 años representaron el 67,42% del total de suicidios en el Estado. Colgante es el
método más común de suicidio en todas las macroregiones del Estado. Conclusión: La distribución de los casos
de suicidio permitió la identificación de zonas de riesgo en las macroregiones de Minas Gerais. Descriptores:
Suicidio; Violencia; Los Estudios Epidemiológicos; Tasa de Mortalidad.
1
Nurse, Psychologist, Professor of Psychiatric Nursing at the School of Nursing, Federal University of São João Del Rei. Divinópolis (MG),
Brazil. Email: nadjaclb@terra.com.br; 2Academic, School of Nursing, Federal University of São João Del Rei. Scientific Initiation
Scholarship. Divinópolis (MG), Brazil. Email: isabela.mesquita_@hotmail.com; 3Academic, School of Nursing, Federal University of São
João Del Rei. Scientific Initiation Scholarship. Divinópolis (MG), Brazil. Email: maria_luisanr@hotmail.com

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Botti NCL, Mesquita IR, Benjamim MLN.
INTRODUCTION
The intention of dying is the key element
that keeps direct reference to violence, so
suicide is categorized as "external cause" in
the International Classification of Diseases
(ICD), item includes forms of violence and
accidents. Suicide is among the top ten causes
of death for all people over 5 years old. In all
countries where there is reliable information
on mortality, this phenomenon is among the
three leading causes of death for people of
both sexes aged 15 to 34. In this sense,
suicide is seen as an important public health
problem in endemic.1
Its impacts to the health sector not only
account for the deaths caused by this self-
inflicted violence, they also converge damage,
injuries and traumas.2
Global epidemiological data indicate that
in 2020, approximately 1.53 million people
will die by suicide, a number being 10-20
times more attempts. This scenario represents
one death by suicide every 20 seconds and one
attempt every 1-2 seconds.3 Deaths resulting
from suicide should be highlighted, especially
when one considers the social and family
impacts. For each death there is, on average,
five or six people nearby who suffer serious
emotional, social and economic consequences,
resulting in 1.4% of the global burden caused
by diseases.1 Behind the suicidal act exists
complex network of interacting factors that
were over the life of the person, of varied and
peculiar forms. This complexity are part
genetic, biological, psychological, social,
historical and cultural factors known to trigger
factors that join the others who apparently
stimulated the outcome.4
Brazil has overall suicide rate considered
low when compared to other countries (71st
place), but occupies the 9th place in the list of
leading countries in terms of absolute deaths
by suicide.1 There is increasing suicide in the
country, reaching 34% in its rates from 1979 to
1997. In 1997, 6,920 people committed
suicide. In 2003, there were 7,861 cases,
while in 2004, there were 8,017 deaths,
representing 0,8% of total deaths in the
country.5 In 2000, suicide accounted for 6,778
deaths, with a mortality rate of 4,0/100.000
inhabitants (inh.). It is noteworthy that,
among men the mortality rate was
5,0/100.000 inhabitants. and for women, 1,6
deaths/100.000 hab.6 The national rates of
death by suicide between 1980 and 2000
indicate average 3-4/100.000 inhabitants.,
being four times higher incidence among men
and increasing rates in younger age groups.7
Several capitals of Brazil indicate suicide as
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DOI: 10.5205/reuol.6039-55477-1-ED.0810201421
Macro-regional differences in mortality…
6th cause of death in young and urban people
(15-24 years old).8
The distribution of suicide in the country
shows that the rates vary widely between
regions. The Southeast concentrates 50% of
the records, while the South has the highest
rates, the North, the fewer.5 Specifically, Rio
Grande do Sul has the highest incidence in the
country (10,2/100.000 inhabitants. During the
period 1980-1999).9 In Minas Gerais, in the
period 1996-2007, occurred 123 986 deaths
due to external causes, and 7,6% by suicide.
The mortality rate for this injury of 4,29
cases/100.000 inhabitants; it is considered
low, as the index WHO.2 In the State, in
absolute numbers, the suicide deaths were
concentrated in the social and economically
productive age range (20 to 59 years old) and
the highest rates in the age group 40 to 59
years old.10
Suicide statistics are unequally distributed
around the world, by country, gender, age
group and mode of perpetration.11 In Minas
Geras there are no descriptive studies on the
epidemiological profile of suicide in the
macro-regions of the State. For these reasons,
this study aims to conducting an
epidemiological analysis of deaths by suicide
in the macro-regions of the State of Minas
Gerais in the quadrennium 2006-2009.
Ultimately, these results may help guiding
future researches in the area, as well as
collaborating in the construction of public
policies to addressing the problem.
METHOD
Descriptive and retrospective
epidemiological study based on secondary
data. There were included deaths of residents
in Minas Gerais, between 2006 and 2009,
recorded in the Mortality Information System
(SIM), which had as an underlying cause
suicide. The State of Minas Gerais, located in
the southeastern region of Brazil, has
586.528,293 km² of territorial extension and
853 municipalities with a population
estimated in 2009 of 20.033,665 inhabitants.
For administrative purposes, the State
Department of Health, through the
Regionalization Plan (RDP) aggregates in
municipalities 13 Hygienic Macro-Regions.12
To calculate the Standardized Mortality
Rate for macro-regions of the State were used
the categories: Specific Mortality Rate (total
number of deaths on the population x 105),
Mortality Rate by Gender (number of deaths
of one sex over the population same sex x 105)
and Mortality Rate by Age (number of deaths
of certain age group on the population of this
group x 105). For these calculations we used
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Botti NCL, Mesquita IR, Benjamim MLN. Macro-regional differences in mortality…

the 10th revision of the International South, which totaled 16,81% of the deaths.
Classification of Diseases (ICD-10), including The West macro-region of Minas was the 3rd in
categories X60 to X84 (intentional self- the absolute number of deaths, representing
harm).13 The age groups were grouped into six 9,77% of total suicides. It was found that
major groups: a) 10 to 19 years old; b) 20 to among the 853 municipalities in Minas Gerais
29; c) 30 to 39; d) 40 to 49; e) 50-59; f) 60 or only 214 (25,09% of all municipalities) have no
older. records of suicide in the period.
Mortality rates were obtained from the The average rate of suicide mortality found
mortality statistics published by the in the State in four years (5,33 cases/100.000
Department of the Unified Health System inhabitants.) is considered average rate,
(DATASUL) of the Ministry of Health.14 The according to WHO.2 When analyzed the
population data were obtained from the average rate on the macro health regions of
Brazilian Institute of Geography and Statistics the State there is low incidence in the Center
(IBGE).15 and medium in the South Centre,
The research was conducted in accordance Jequitinhonha, South East, North East, North
with Resolution No. 196/96 of the National West, Northern Triangle and South. Moreover,
Health Council (CNS); the project has been the East, North, West and Southeast macro-
approved by the Ethics Committee on Human regions showed high rates, and the South, a
Research of the Campus Center West Dona rate considered too high. The average rate of
Lindu (CEPES/CCO) under opinion No. 31969, macro-South was 43,25 deaths/100.000
CAAE 03054812.0.0000.5545, on June 5th, inhabitants, being the largest in the State.
2012. Except for the center, all other macro-regions
had higher rates than found for the state,
RESULTS considered in this work as a base. The average
rate of macro-South was 711,31% higher
In Minas Gerais, in the period 2006-2009,
compared to the State. Other regions that
occurred 450,230 deaths, 10,99% by external
showed significantly higher rates than the
causes. Among the 49,466 deaths from
state were West, Southeast, North, East and
external causes it is found that 8,53% were by
Northwest, being 444,53%; 368,75%; 232,05%;
suicide (4,217 deaths) (Table 1). The macro-
230,91% and 112,26%, respectively (Table 1).
region Centre represented 25,35% of total
suicides (1,069 deaths), followed by the
Table 1. Average rate of general mortality, external causes and suicide per
100,000 inhabitants in macroregions of health of Minas Gerais between 2006 and
2009.
Average Score Δ (Base MG
mortality rate WHO* - %)
for suicide
(2006-2009)
Minas Gerais
General Mortality 569,33
Mortality by external causes 62,55
Mortality by Suicide 5,33 a
Macro-Regions
Center 4,26 a -20,12
South Centre 6,26 b 17,34
Jequitinhonha 5,44 b 1,99
East 17,64 c 230,91
South East 10,81 b 102,85
Northeast 9,37 b 75,82
Northwest 11,32 b 112,26
North 17,70 c 232,05
Oeste 29,03 c 444,53
Southeast 24,99 c 368,75
South 43,25 d 711,31
North Triangle 6,88 b 29,13
South Triangle 9,22 b 72,98
* Score: a) low-less than 5/100,000 HAB.; b) medium-between 5 and
15/100,000 inhab., c) high-between 15 and 30/100,000 HAB.; d) too high-
above 30/100,000 HAB. 2

Men accounted for 78,78% of total suicides
in the State between 2006 and 2009. The ratio
of the rates indicate average ratio of 4:1 for
men and women. The average rate among
men was 8,49/ 100.000 inhabitants and
between women and 2,24/100.000 hab. In the
period in question, there was a gradual
increase in the average rate in both sexes.
The highest rates were found among women in
the macro regions West, Northwest and South
Triangle, and 3,73/100.000 hab, 3,43/
100,000 inhabitants and 3,09/100.000 hab.
respectively. The highest rates were found
among men in geographical regions North

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West, West and South Triangle, being (23,63%), Southeast (8,43%), South East
14,85/100.000 inhabitants, 13,84/100.000 (3,94%), South Central (3,60%) and South
inhabitants. and 12,33/100.000 inhabitants, (1,92%) had higher rates than the average rate
respectively. According to WHO, these rates of women in the State. Regarding males, the
found put suicide among men in the state in North West (74,88%), West (62,93%), South
mid-level, and among women in low level. Triangle (45,14%), South (31,06%), South
Comparing the average rate for males and Central regions (21,31%) Triangle North
females, it is perceived that there were (12,80%) and Jequitinhonha (3,57%) had higher
differences among regions. Regarding rates than the average rate of men for the
females, the West (66,69%), North West state (Table 2).
(53,47%), South Triangle (38,22%) and North
Table 2. Suicide mortality rate by sex per 100,000 inhabitants in macroregions of health of Minas Gerais
between 2006 and 2009.
Average Score Average rate Score Δ (Base MG - %)
rate by WHO* of mortality WHO*
suicide 2006-2009
(2006-
2009)
Women Men Women Men

Minas Gerais 2,24 a 8,49 b

Macro-regions
Centre 1,90 a 6,76 b -15,00 -20,39
South Centre 2,32 a 10,30 b 3,60 21,31
Jequitinhonha 2,08 a 8,80 b -7,17 3,57
East 1,09 a 5,07 b -51,15 -40,32
South East 2,33 a 7,99 b 3,94 -5,90
Northeast 1,95 a 5,38 b -12,67 -36,62
Northwest 3,43 a 14,85 b 53,47 74,88
North 2,15 a 6,78 b -3,76 -20,13
West 3,73 a 13,84 b 66,69 62,93
Southeast 2,43 a 7,57 b 8,43 -10,81
South 2,28 a 11,13 b 1,92 31,06
North Triangle 2,77 a 9,58 b 23,63 12,80
South Triangle 3,09 a 12,33 b 38,22 45,14
* Score: a) low-less than 5/100,000 HAB.; b) medium-between 5 and 15/100,000 inhab., c) high-between
15 and 30/100.000 HAB.; d) too high-above 30/100,000 HAB. 2

In the State in the quadrennium analyzed
occurred, in 2006, a suicide in children under
9 years old in Jequitinhonha macroregion.
According to the age group it is found that
suicides among 10-19 years old, 20-29, 30-39,
40-49, 50-59, 60-69, and over 70 years old
corresponded to 6, 14%, 23,83%, 22,88%,
20,7%, 14,18%, 6,92% and 5,31%, respectively,
of total suicides. In this case, individuals
between 20 and 49 years accounted for
67,42% of total suicides in the state. In Minas
Gerais the average rate found for age
between 10-19 years old (1,83/100.000
inhab.) is considered low, according to WHO.
For those aged 20-29 years old (7,05/100.000
inhab.), 30-39 (8,12/100.000 inhab.), 40-49
(8,60/100.000 inhab.), 50 to 59 (8,41/100.000
inhab.), 60-69 (6,54/100.000 inhab.) and 70
years old (6,03/100.000 inhab.) there is
average levels of suicide. The Northwest
macro-region has the highest rates among the
age groups 10-19, 40-49, 50-59, 60-69 and
over 70 years old (3.97/100.000 inhabitants;
16,53/100.000 inhabitants; 12,85 / 100,000
inhabitants; 13.59 /100.000 inhabitants;
19,56/100.000 inhab.). The Triangle and the
South West have the highest rates among the
age groups 20-29 and 30-39 years old,
respectively (10,63/100.000 inhabitants;
13,86/100.000 inhab.) (Table 3).

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Table 3. Average rate of suicide mortality by age group per 100,000 inhabitants in macroregions of health of Minas
Gerais between 2006 and 2009.
Average rate of suicide (2006-2009)/Score WHO*
Age (years) 10 20 30 40 50 60 >
a a a a a a 70
19 29 39 49 59 69
Minas Gerais 1,83 a 7,05 b 8,12 b 8,60 b 8,41 b 6,54 b 6,03 b
Macro-Regions
Centre 1,09 a 6,02 b 6,29 b 6,58 b 6,86 b 6,15 b 4,16 a
South Centre 1,42 a 8,99 b 10,8 b 9,34 b 6,90 b 8,67 b 6,99 b
Jequitinhonha 2,85 a 6,75 b 7,89 b 11,56 b 6,31 b 11,94 b 7,38 b
East 1,21 a 4,55 a 4,63 a 4,99 a 4,88 a 2,04 a 3,54 a
South Centre 1,98 a 6,14 b 7,94 b 8,86 b 6,83 b 5,60 b 10,25 b
Northeast 1,35 a 6,12 b 7,10 b 5,61 b 6,47 b 3,46 a 2,69 a
Northwest 3,97 a 10,34 b 13,18 b 16,53 b 12,85 b 13,59 b 19,56 b
North 2,13 a 6,81 b 8,36 b 8,10 b 6,33 b 4,36 a 3,27 a
West 3,08 a 9,88 b 13,86 b 13,56 b 14,14 b 8,99 b 11,96 b
Southeast 2,30 a 7,05 b 7,43 b 10,46 b 10,01 b 7,78 b 6,18 b
South 1,84 a 8,52 b 9,99 b 11,20 b 12,36 b 6,95 b 6,29 b
North Triangle 2,65 a 8,08 b 9,96 b 8,14 b 7,22 b 7,92 b 8,04 b
South Triangle 3,70 a 10,63 b 9,89 b 10,59 b 11,28 b 10,96 b 7,43 b
* Score: a) low-less than 5/100,000 HAB.; b) medium-between 5 and 15/100,000 inhab., c) high-between 15 and
30/100,000 HAB.; d) too high-above 30/100,000 HAB. 2
and South Triangle macro regions had higher
Comparing the average rate among age rates than the average rate among all age
groups, we find that there were differences groups for the State (Table 4).
among regions. The Northwest, West, South
Table 4. Variation of suicide mortality rate by sex per 100,000 inhabitants in macroregions of
health of Minas Gerais between 2006 and 2009.
Δ (Base MG - %)
Age (years) 10 20 30 40 50 60 >
a a a a a a 70
19 29 39 49 59 69
Minas Gerais
Macro-Regions
Centre -40,24 -14,62 -22,57 -23,57 -18,36 -5,98 -30,99
South Centre -22,44 27,52 32,95 8,54 -17,95 32,71 15,95
Jequitinhonha 56,35 -4,29 -2,83 34,40 -25,00 82,69 22,52
East -33,74 -35,45 -43,04 -41,96 -41,93 -68,78 -41,32
South East 8,44 -12,89 -2,22 2,98 -18,82 -14,36 70,19
Northeast -25,92 -13,17 -12,56 -34,80 -23,05 -47,00 -55,36
Northwest 117,69 46,70 62,30 92,18 52,87 107,98 224,67
North 16,65 -3,40 2,98 -5,84 -24,75 -33,35 -45,65
West 68,47 40,25 70,64 57,65 68,14 37,49 98,53
Southeast 26,10 0,03 -8,57 21,56 19,04 19,00 2,63
South 0,73 20,86 23,05 30,23 46,98 6,30 4,39
North Triangle 45,10 14,58 22,59 -5,35 -14,10 21,15 33,51
South Triangle 102,82 50,80 21,75 23,08 34,18 67,64 23,23

As to the means employed is observed that sedatives, hypnotics, antiparkinsonian and

58,27% of deaths by suicide occurred were
classified as hanging, strangulation and
suffocation (X70), 7,60% as intentional
exposure to pesticides (X68) and 7,34% as
firing another firearm and firearm not
specified (X74). These were the categories
with the highest occurrence in the state and
which together make up 73,21% of the
occurrences. It appears that intentional
autointoxication with anticonvulsant drugs,
psychotropic substances (X61); with other
drugs, medicaments and biological substances
(X64); with pesticides (X68); with other
chemicals and harmful substances not
specified (X69); hanging, strangulation and
suffocation (X70); firing of a firearm in hand
(X72); another firearm and firearm not
specified (X74) and smoke, fire and flames
(X76) were the means used in suicide found in
all geographical regions of the state (Table 5).

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Table 5. Percentage distribution of mortality by suicide according to category of ICD-10 in macroregions of health of Minas
Gerais between 2006 and 2009.
Macro-Regions
1 2 3 4 5 6 7 8 9 10 11 12 13
Category
CID 10 (%)
X60 0,10 0 0 0 0 0 0 1,05 0 0,96 0 0 0
X61 2,78 3,33 6,35 1,65 1,22 1,54 0,40 0,70 0,48 3,51 2,43 3,51 0,49
X62 0,58 0 0 0 1,22 0 0 0 0 0 0,14 0,35 0
X63 0,29 0,56 0 0 0 0 0 0 0,24 0,32 0 0 0
X64 1,34 2,22 1,59 6,04 1,22 3,08 2,82 0,70 1,69 4,15 1,29 0,70 0,98
X65 0,29 0 1,59 0 0 0 0 0 0,24 0,32 0,57 0 0
X66 0,10 0 1,59 0 0 0 0,40 0 0 0 0,14 0 0
X67 0,29 0 0 0 0 0,77 0 0 0,48 0,32 0,29 0,35 0
X68 10,27 3,89 14,29 3,85 9,76 10,77 8,47 8,77 6,76 9,27 3,72 8,07 3,90
X69 3,17 2,22 12,70 1,65 3,05 6,92 7,26 12,98 1,21 3,19 3,58 3,51 6,83
X70 50,67 60,00 31,75 59,89 57,32 47,69 63,31 49,47 72,95 47,60 66,81 64,91 63,90
X71 1,15 2,22 0 2,75 4,88 0,77 3,63 0,35 0,48 2,56 2,86 0,70 0,98
X72 2,59 0,56 1,59 0,55 4,27 3,08 3,63 3,86 0,97 1,60 3,00 0,70 1,95
X73 0 0 0 0 0 1,54 1,21 0,35 0,24 0 0 0 0
X74 8,06 7,78 20,63 7,69 6,10 13,08 2,42 8,42 5,56 9,58 5,44 7,02 7,80
X75 0,10 0,56 0 0 0 0 0 0 0,48 0 0,14 0 0
X76 4,03 2,78 1,59 1,65 5,49 2,31 1,21 1,75 3,14 3,51 3,00 2,46 3,90
X77 0,10 0 0 0 0 0,77 0 0 0 0 0 0 0,49
X78 1,82 2,22 3,17 1,10 0 1,54 0,40 2,46 1,21 0,96 1,14 2,46 0,49
X79 0 1,67 1,59 1,10 1,22 0,77 1,61 1,05 0 0 1,29 0,35 0
X80 8,06 2,22 0 4,95 2,44 1,54 1,21 0,70 1,69 5,75 0,57 2,81 2,93
X81 0,38 2,78 0 0 0,61 0 0 0,35 0,48 0 0 0 0
X82 0,58 1,11 0 0,55 0 0,77 0 0 0,97 0,32 0,57 0,35 0,49
X83 0,29 0 1,59 0 0 0,77 0,40 0 0,24 0 0,86 0 1,46
X84 2,98 3,89 0 6,59 1,22 2,31 1,61 7,02 0,48 6,07 2,15 1,75 3,41

Intentional autointoxication: X60 -

analgesics, antipyretics and antirheumatics,
not opiates; X61 - anticonvulsant drugs,
sedatives, hypnotics, antiparkinsonian and
psychotropic substances; X62 - average for the total population in the state
psychodysleptics and narcotics;
X63 - other drugs acting on the autonomic
nervous system; X64 - other drugs,
medicaments and biological substances; X65-
alcohol; X66 - organic solvents and
halogenated hydrocarbons and their vapors;
X67 - other gases and vapors; pesticides; X69 -
chemicals and other harmful substances not
specified
Intentional self-harm: X70 - hanging,
strangulation and suffocation; X71 - drowning
and submersion; X72 - shooting firearm hand;
X73 - shooting shotgun, rifle, or firearm of
greater caliber; X74 - shooting another
firearm and firearm not specified; X75 -
explosive devices; X76 - smoke, fire and
flames; X77 - water vapor, gases or hot
objects; X78 - sharp object; X79 - blunt
object; X80 - jumping from a high place; X81 -
jumping or lying before a moving object; X82 -
impact of a motor vehicle; X83 - other
specified means; X84 - unspecified means.13
Macro-regions: Central (1); South Central
(2); Jequitinhonha (3); E (4); South East (5);
Northeast (6); Northwest (7); North (8); W (9);
Southeast (10); South (11); Triangle North (12)
and South Triangle (13).12
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DISCUSSION
According to the criteria of WHO2 suicide
mortality in Minas Gerais can be considered
(5,33 deaths/100.000 inhab.) In 2006-2009 and
increasing trend when compared with study of
historical series 1996 to 2007 where he found
the suicide rate of 4,29 deaths per 100.000
inhabitants .10 In this case there seems to be
increasing and suicide rate in the state. This
increase comes in agreement with studies that
indicate increased rates of suicide in our
population (4,4 to 5,8 per 100.000
inhabitants. 1980-2006) putting the country on
the threshold of the second level defined by
OMS2 (between five and 15 per 100 000
inhabitants).16 The mortality rate for self-
inflicted violence in major Brazilian cities has
shown growth of 35,3% among youths 15-24
years old. Belo Horizonte, the state capital,
presented in 1979, the mortality rate of 4,3/
100,000 inhabitants, and in 1995, from
6,8/100.000 inhabitants, therefore, growth of
58,1% between 1979 and 1995.8
However, despite the present State
average suicide rate in four years (5,33
deaths/100.000 inhab.), the distribution of
these rates are not homogeneous among the
different geographical regions of the State.
For five macro-regions findings are at high or
very high levels (East, North, West, Southeast
and South). The South holds macro-eight
times larger than average suicide rate of the
state rates. It is known that macro-regions of
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Botti NCL, Mesquita IR, Benjamim MLN.
the state have distinct characteristics in terms
of population distribution, population density
and socioeconomic characteristics. Regional
inequalities have consequences on health,
causing a higher concentration of services,
equipment and skilled manpower. Regions to
the south, the center and the Triangulo
Mineiro stand out for their greater economic
development and greater concentration of
services, equipment and skilled manpower.12
The literature suggests that variables such as
education, socioeconomic level and degree of
investment in health, also seem be correlated
with suicide rates.17
Well-documented aspect of the
epidemiology of suicide is the male/female
ratio. These results also highlight the relation
(4:1) in the state, pointing higher occurrence
of the phenomenon among men. These results
are similar to those found in other national
studies, such as those developed in the
regions and cities in the country (1980 and
2006)18, in the state of Espírito Santo (1980-
2006)19, São Paulo (1976 and 2001)20. This
gender difference may be explained by
several factors such as: the methods chosen
by men are generally more lethal21; greater
sensitivity to economic setbacks such as
unemployment and impoverishment, greater
competitiveness, impulsivity and access to
lethal and firearms among men22; the low
prevalence of alcoholism, religiosity, flexible
attitudes towards social skills and the
performance of roles during life among
women.23
As regards the distribution of suicide cases
in the macro-regions of Minas Gerais by
gender, there is a higher concentration of
these rates for both sexes in the West,
Northwest and South Triangle. Again, these
findings show the need for further
investigation to explain the high rates of
suicide in these geographical regions.
However, these differences may express part
of reality as profound sociocultural changes
and crises in contemporary society, it is
understood the structural nature of violence
in general and suicide in particular.24 Suicide
is an act for the more accomplished man than
for women, while men seek in extreme act
drastic solution to his personal failure, the
woman attempts suicide by means find a way
to reverse any adverse situation experienced
mainly in disequilibrium conditions..25
Epidemiological study in the state in the
period 1996 to 2007 reveals that the age
group 40-59 years chained mortality of 7.0
deaths per 100,000 inhabitants. For the years
of life lost to age of deaths has remained
around 40 years old average, indicating the
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DOI: 10.5205/reuol.6039-55477-1-ED.0810201421
Macro-regional differences in mortality…
loss of social potential of the subject affected
by suicide in Minas Gerais.10 In this study,
individuals between 20 and 49 years old
accounted for 67,42% of all suicides in the
state. According to WHO, in 1998, 55% of
suicides were committed by people between 5
and 44 years old. In 2004, 76,2% of deaths by
suicide in the country focused on the age
group 20 to 59 years old.5 These findings
reflect a worldwide trend growth rates of
suicide in young people, to the point of
passing these to be the main risk group in a
third of countries.21
Regarding age, suicide rates are even
higher, as the age group studied.21 This fact
was not observed in this study is increased,
whereas the highest rates were in the age
groups between 40 and 49 years old. Study
conducted in nine Brazilian capitals,
highlighted the high rates of suicide among
young people and called attention to the fact
that population is dying, increasingly violent
causes. This vulnerability of young Brazilian
population to the risk of suicide may be
explained by the large occupational pressure
and increased competitiveness in the
workmarket.8 Study on morbidity and
mortality by suicide in people aged 10-19
years old living in Minas Gerais, there higher
frequency of hospitalizations among women,
with self-poisoning the most common method
for attempting suicide for both sexes, higher
mortality among men, whose principal means
chosen were hanging and firearms, most
lethal forms than those used by women
(poisoning).26
Among the methods used in all macro-
regions of the State to commit suicide, there
is the prevalence of the hanging, with 58,27%
of cases, appearing to be a simple and easy to
reach, similar to those found in the literature
that points across the nationwide hanging
ranking first.27
CONCLUSION
The present study completed its goal of
conducting epidemiologic analysis of deaths
by suicide in macroregions of the State of
Minas Gerais in the quadrennium 2006-2009.
One should take into consideration that
suicide is a public health problem and it is
necessary to the development of prevention
programs and information with the purpose of
trying to minimize the occurrence of the
same. It is needed to have researches to
determining what extent these differences of
characteristics between the macro-regions of
the State interfere in suicide rates, because a
descriptive study as this does not have the
power to suggest causal relationships, as well
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Botti NCL, Mesquita IR, Benjamim MLN.
as explanations for the high suicide rate in the
southern region of the State are not yet clear.
On this distribution of cases of suicide in
Minas Gerais as macro-regions enabled the
identification of risk areas; a fact that reveals
the necessity of seeking explanations for the
variations in rates in each State macro-region
and points to the need for epidemiological
surveillance and research to better
understand this public health problem and
thus improve the possibilities of prevention. In
this case the main limitation of this study
refers to its characteristic descriptive. A study
of this nature helps in the diagnosis of health
and systematization of the data, but does not
affect the ability to establish associations and
estimating risks.
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