lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

­­The Impact of a National Cash Transfer Programme on Reducing Suicide: A Study Using the 100 Million Brazilian Cohort

29 Pages Posted: 14 Jan 2021

See all articles by Daiane Machado

Daiane Machado

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Elizabeth Williamson

London School of Hygiene and Tropical Medicine - Department of Medical Statistics and Infectious Disease Epidemiology

Julia Pescarini

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Laura Rodrigues

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Flavia J. O. Alves

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Luis Araújo

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Maria Yury Travassos Ichihara

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Ricardo Araya

King's College London - Department of Health Service and Population Research

Vikram Patel

Harvard Medical School - The Pershing Square Professor of Global Health

Mauricio L. Barreto

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

More...

Abstract

Background: Socio-economic factors have been consistently associated with suicide, and economic recessions are linked to rising suicide rates. This study investigates the effect of the world`s largest conditional cash transfer (CCT) programme on suicide rates in a cohort of half the Brazilian population.

Methods: We used data from the 100 Million Brazilian Cohort, covering a 12-year period (2004 to 2015). It comprises socio-economic and demographic information on 114,008,317 individuals, linked to the “Bolsa Família” programme (BFP) payroll database, and nationwide death registration data. We fitted Poisson models to estimate the incidence rate ratios for suicide, associated with exposure to the BFP and Propensity Score (PS) to group BFP beneficiaries and non-beneficiaries. We estimated the PS through multiple logistic regression using baseline socio-demographic and economic characteristics and year of registration, and ran Kernel matching analysis and several sensitivity tests.

Results: In the main analysis, 33,281 suicide cases occurred among the 69,707,312 individuals followed for 305,229,883 person-years at risk. Suicide rates among beneficiaries and non-beneficiaries were 5.5 (95%CI=5.44, 5.61) and 11.1 (95%CI=10.41, 11.81) in the matched cohort and 5.4 (95%CI=5.32, 5.47) and 10.7 (95%CI=10.51, 10.87) per 100,000 individuals, in the original cohorts. BFP beneficiaries had a 61% lower suicide rate than non-beneficiaries (IRR=0.39, 95%CI=0.37,0.41) in the main analysis and similar results in all sensitivity analyses. This effect was higher among women (IRR=0.35, 95%IC=0.31,0.39), and younger individuals (IRR=0.40, 95%IC=0.37,0.44).

Interpretation: CCT programs play an important role in poverty reduction and well-being improvement for beneficiaries. We have also demonstrated that it contributes towards reduced suicide rates. Targeting social determinants, using cash transfer programmes, could be important tools to limit suicide, predicted to rise in the aftermath of the economic recession, consequent to the Covid-19 pandemic.

Funding Statement: The authors received no direct financial support for this article. During the study DBM held a research associate scholarship from Wellcome Trust (202912/Z/16/Z) and CIDACS has received support from the Department of Science and Technology, from the Brazilian Ministry of Health; National Research Council (CNPq), Brazil; Bill and Melinda Gates Foundation (CHAMADA MCTI/CNPq/MS/SCTIE/Decit/Fundação Bill e Melinda Gates N o 47/2014); Health Surveillance Secretariat, Ministry of Health, Brazil; Fundação de Apoio a Pesquisa do Estado da Bahia (FAPESB); Financiadora de Estudos e Projetos (FINEP); Secretaria de Ciência e Tecnologia do Estado da Bahia (SECTI), and Wellcome Trust.

Declaration of Interests: All authors have no competing interests.

Ethics Approval Statement: This study was approved by the two research ethics committees of the: (i) Federal University of Bahia (application number: 1023107) and (ii) London School of Hygiene & Tropical Medicine (application number: 11581).

Keywords: [comma separated]Suicide; cash transfer; social determination; 100 Million Cohort; COVID19 recession.

Suggested Citation

Machado, Daiane and Williamson, Elizabeth and Pescarini, Julia and Rodrigues, Laura and Alves, Flavia J. O. and Araújo, Luis and Ichihara, Maria Yury Travassos and Araya, Ricardo and Patel, Vikram and Barreto, Mauricio L., ­­The Impact of a National Cash Transfer Programme on Reducing Suicide: A Study Using the 100 Million Brazilian Cohort. Available at SSRN: https://ssrn.com/abstract=3766234 or http://dx.doi.org/10.2139/ssrn.3766234

Daiane Machado (Contact Author)

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

Bahia
Brazil

Elizabeth Williamson

London School of Hygiene and Tropical Medicine - Department of Medical Statistics and Infectious Disease Epidemiology

Keppel Street
London, WC1E 7HT
United Kingdom

Julia Pescarini

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

Bahia
Brazil

Laura Rodrigues

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Bahia
Brazil

Flavia J. O. Alves

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Bahia
Brazil

Luis Araújo

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

Bahia
Brazil

Maria Yury Travassos Ichihara

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Bahia
Brazil

Ricardo Araya

King's College London - Department of Health Service and Population Research

London
United Kingdom

Vikram Patel

Harvard Medical School - The Pershing Square Professor of Global Health

Boston, MA
United States

Mauricio L. Barreto

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

Rio de Janeiro
Brazil

Click here to go to TheLancet.com

Paper statistics

Abstract Views
1,838
Downloads
226
PlumX Metrics