Spatiotemporal Patterns and Determinants of Suicide in a Brazilian State: An Eleven-Year Ecological Study.
OBJECTIVE Investigate spatial and temporal distribution of suicide mortality across the Regional Health Care Networks of São Paulo State, Brazil, from 2012 to 2022, evaluating associations with mental health service availability, psychiatric workforce density, and socioeconomic indicators. METHODS Longitudinal retrospective ecological study using annual data from 19 Regional Health Care Networks. Suicide mortality (ICD-10 X60-X84) rates per 100,000 inhabitants were analyzed using descriptive epidemiology, exploratory spatial data analysis, and fixed-effects panel regression models with spatial error specifications and one-year lagged independent variables. RESULTS Suicide rates increased from 4.8 to 6.3 per 100,000 (32%). Female aged 10-14 years experienced a 332% increase. Spatial clustering revealed persistent high-risk areas in inland regions. In panel regression models (within-R² = 0.53), psychiatrist density in the public health system demonstrated a protective association (β = -0.20, p < 0.05), as did psychiatric bed rates in lagged models (β = -0.01, p < 0.05). Psychosocial Care Centers coverage showed no significant association. GDP per capita was positively associated with suicide rates. CONCLUSIONS Psychiatric workforce availability and acute care capacity emerge as key modifiable factors. Increase among female adolescents and persistent geographic disparities warrant targeted prevention strategies. Findings provide actionable evidence for suicide prevention resource allocation in middle-income settings.