relationship between the bolsa famlia national cash transfer programme and suicide CORD-Papers-2022-06-02 (Version 1)

Title: Relationship between the Bolsa Famlia national cash transfer programme and suicide incidence in Brazil: A quasi-experimental study.
Abstract: BACKGROUND Socioeconomic factors have been consistently associated with suicide and economic recessions are linked to rising suicide rates. However evidence on the impact of socioeconomic interventions to reduce suicide rates is limited. This study investigates the association of the world's largest conditional cash transfer programme with suicide rates in a cohort of half of the Brazilian population. METHODS AND FINDINGS We used data from the 100 Million Brazilian Cohort covering a 12-year period (2004 to 2015). It comprises socioeconomic and demographic information on 114008317 individuals linked to the Bolsa Famlia programme (BFP) payroll database and nationwide death registration data. BFP was implemented by the Brazilian government in 2004. We estimated the association of BFP using inverse probability of treatment weighting estimating the weights for BFP beneficiaries (weight = 1) and nonbeneficiaries by the inverse probability of receiving treatment (weight = E(ps)/(1-E(ps))). We used an average treatment effect on the treated (ATT) estimator and fitted Poisson models to estimate the incidence rate ratios (IRRs) for suicide associated with BFP experience. At the cohort baseline BFP beneficiaries were younger (median age 27.4 versus 35.4) had higher unemployment rates (56% versus 32%) a lower level of education resided in rural areas and experienced worse household conditions. There were 36742 suicide cases among the 76532158 individuals aged 10 years or older followed for 489500000 person-years at risk. Suicide rates among beneficiaries and nonbeneficiaries were 5.4 (95% CI = 5.32 5.47 p < 0.001) and 10.7 (95% CI = 10.51 10.87 p < 0.001) per 100000 individuals respectively. BFP beneficiaries had a lower suicide rate than nonbeneficiaries (IRR = 0.44 95% CI = 0.42 0.45 p < 0.001). This association was stronger among women (IRR = 0.36 95% CI = 0.33 0.38 p < 0.001) and individuals aged between 25 and 59 (IRR = 0.41 95% CI = 0.40 0.43 p < 0.001). Study limitations include a lack of control for previous mental disorders and access to means of suicide and the possible under-registration of suicide cases due to stigma. CONCLUSIONS We observed that BFP was associated with lower suicide rates with similar results in all sensitivity analyses. These findings should help to inform policymakers and health authorities to better design suicide prevention strategies. Targeting social determinants using cash transfer programmes could be important in limiting suicide which is predicted to rise with the economic recession consequent to the Coronavirus Disease 2019 (COVID-19) pandemic.
Published: 2022-05-18
Journal: PLoS medicine
DOI: 10.1371/journal.pmed.1004000
Author Name: Machado Daiane Borges
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Author Name: Williamson Elizabeth
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Author Name: Pescarini Julia M
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Author Name: Alves Flavia J O
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Author Name: Castro de Araujo Lus F S
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Author Name: Ichihara Maria Yury
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Author Name: Rodrigues Laura C
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Author Name: Araya Ricardo
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Author Name: Patel Vikram
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Author Name: Barreto Maurcio L
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license: unk
license_url: [unknown license]
source_x: Medline
pubmed_id: 35584178
has_full_text: FALSE
G_ID: relationship_between_the_bolsa_famlia_national_cash_transfer_programme_and_suicide