Abstract

Suicide is a major public health problem worldwide with far-reaching effects on families, communities, and societies. Influencing factors range from macro-level interventions like alcohol control policies and suicide prevention programs to individual contributors such as alcohol abuse and domestic violence. This study aimed to examine the relationship between Chile’s suicide rate changes from 2002 to 2015 and the Alcohol Act of 2004, a national suicide prevention program implemented in 2007, alcohol abuse, and domestic violence. Assembling a unique longitudinal dataset from Chilean public institutions, the study employed an instrumental variable time-series cross-regional design. Results indicated that the Alcohol Act was not associated with suicide rates, domestic violence exhibited a significant association with increased suicide rates, and the national suicide prevention program was linked to reductions in suicide rates, especially among males. These findings align with research from neighbouring countries, showcasing the efficacy of suicide prevention programs in decreasing suicide rates in Chile. Results highlight the importance of integrating protocols to early-detect domestic violence in suicide prevention programs, as well as the need to further improving alcohol control policies to complement suicide prevention programs.

Introduction

Suicide is a major public health problem worldwide with effects on families, communities, and society. Globally, there are 703,000 annual deaths by suicide (World Health Organization, 2021). The global age-standardized suicide rate in males (12.6 per 100,000) is more than double that in females (5.4 per 100,000) (World Health Organization, 2021). Suicide prevention is a priority for the WHO and is included as an indicator in the United Nations Sustainable Development Goals (World Health Organization, 2021).

Alcohol use is a substantive risk factor for both deaths by suicide and suicide attempts (Amiri and Behnezhad, 2020; Isaacs et al., 2022; Perez et al., 2022). Furthermore, acute high-dose alcohol use increases the risk of suicide (Borges et al., 2017; Conner and Bagge, 2019; Razvodovsky, 2009) and contributes to the adoption of more violent suicide means (Choi et al., 2018; Yeskendir et al., 2022). Studies have consistently found that alcohol abuse and intoxication are prevalent in suicidal behavior (Norström and Rossow, 2016). Hence, strategies to control alcohol abuse and intoxication could impact suicides attributable to alcohol use (Anderson et al., 2009; Babor et al., 2010; Ilhan and Yapar, 2020).

Conclusion

The reduction in suicide mortality following the implementation of Chile’s Suicide Prevention Program leads us to the conclusion that, despite using a crude operationalization, this policy incorporates changes that help anticipate triggers of suicidal behavior in targeted populations. Future research as well improvements in Chile’s Suicide Prevention Program should aim to better understand the mechanisms linking alcohol abuse, domestic violence, and suicide. From a research perspective, better relevant variables, including policy implementation and design, and other measurements of alcohol abuse and domestic violence should be explored further. From a suicide prevention policy perspective, it is advisable to consider a more explicit integration of at-risk groups, such as victims of domestic violence and/or individuals with alcohol related risks, into the early warning systems of Chile’s Suicide Prevention Program.