Association between suicide and access to mental health care in Portugal, 2019-2021

Abstract Background Suicide is a major public health issue in Portugal, where mental health disorders often go undertreated or even untreated. This study explores the association between access to mental health care and suicide rates in mainland Portugal from 2019 to 2021, aiming to understand how healthcare accessibility impacts suicide prevention efforts. Methods We conducted an ecological study which analyzed data from 278 municipalities, focusing on the population aged over 19 years. Access to mental health care was assessed using the ratio of psychiatrists per 100,000 inhabitants and the average distance to reference mental health hospitals. The European Deprivation Index (EDI) measured socioeconomic factors. Standardized mortality rates (SMR) for suicide were calculated and analyzed using multiple linear regression models. Results No significant correlation was found between total SMR and psychiatrist ratio (r = 0.02, p = 0.736) or distance to hospitals (r=-0.044, p = 0.463). However, EDI showed a significant positive correlation with female SMR (r = 0.174, p = 0.008). In the regression model, only EDI demonstrated statistical significance for total SMR (β = 0.71, 95% CI: 0.05-1.37, p = 0.0354), demonstrating no statistical significance with the ratio of psychiatrists - β=-0.875 (95% CI: -3.174 to 1.414; p = 0.4544); and distance to the reference hospital - β = 1.34 (95% CI: -0.76 to 3.44; p = 0.211). Conclusions Socioeconomic factors, particularly affecting women, appear to have a stronger association with suicide rates than the measured aspects of mental health care access. These findings suggest that addressing social inequalities may be crucial in suicide prevention efforts in Portugal. Policy recommendations include integrating socioeconomic support strategies with improved accessibility to mental health services, such as telehealth initiatives. Key messages • Socioeconomic factors strongly influence suicide rates, especially for women. • Improving mental health access alone may not effectively reduce suicide mortality.