Spatiotemporal Trends in Suicide: Sociodemographic, Economic, and Environmental Factors

Suicide is one of the world's leading public health problems, with more than 720,000 deaths annually. Suicide has traditionally been studied from an individual perspective. However, research has increasingly highlighted the influence of community-level factors on suicide risk. This study aimed to (1) analyze the spatial distribution of suicide mortality at the provincial level in Spain (2018-2022); (2) perform stratified analyses by sex and age group; and (3) compare suicide risk across different phases of the COVID-19 pandemic. We used data from the Spanish National Institute of Statistics on 17,809 suicide deaths in 47 peninsular provinces between 2018 and 2022. Covariates included sociodemographic (e.g., aging rate, population density), economic (e.g., unemployment, GDP), and environmental (e.g., temperature) indicators. Bayesian hierarchical spatial Poisson regression models were fitted to estimate suicide risk and identify relevant contextual variables. The general spatial model revealed a higher risk of suicide in provinces with lower population density, higher aging rates, and lower health expenditure. Other covariates such as gross domestic product, unemployment, or temperature were associated with specific sex or age groups. Suicide risk was highest in the northwestern provinces and lowest in the central regions. Stratified analyses showed similar patterns across gender and age groups, and between time periods, with some variations in spatial distribution. This study reveals significant spatial heterogeneity in suicide risk across Spanish regions, influenced by sociodemographic, economic, and environmental factors. These findings underline the importance of regionally tailored suicide prevention policies, especially in aging and low-density areas with low health investment.