Effect of Maximum Average Temperature on Suicide Rates in California, 2008-2017: Public Health Implications of Climate Change

Abstract BackgroundSuicide prevention is a salient public health responsibility, as it is one of the top ten leading causes of premature mortality in the United States. Risk factors of suicide transcend the individual and societal level as risk can increase based on climatic variables. Previous studies have been country-based. Currently, studies focused solely on regions, provinces, or states, such as California, are limited. The present study holds two purposes: i) to assess the effect of maximum temperature on suicides, and ii) to evaluate the effect of number of monthly heat events on suicide rates, in California from 2008-2017.MethodsThe exposure was measured as the average Californian daily maximum temperature within each month, and the number of monthly heat events, which was calculated as a count of the days exhibiting a >15% increase from the historical monthly temperature. The outcome was measured as California’s monthly suicide rate. Negative binomial regression models assessed the relationship between maximum temperature and suicides, and heat events and suicide. A seasonal decomposition of a time series and auto-correlogram further analyzed the seasonality of suicide and the trend from 2008-2017. ResultsThere were 40,315 deaths by suicide in California between 2008-2017. Negative binomial regression indicated a 6.1% increase in suicide incidence rate ratio (IRR) per 10°F increase in maximum temperature (IRR=1.00590 per 1°F, 95% CI: 1.00387, 1.00793, p<0.0001) and a positive, non-significant association between suicide rates and number of heat events adjusted for month of occurrence (IRR 1.00148 per heat event, 95% CI: 0.99636, 1.00661, p=0.572). The time series analysis and auto-correlogram suggested seasonality of deaths by suicide.ConclusionThe present study provided preliminary evidence that will generate future directions for research. We must seek to further illuminate the relationship of interest and apply our findings to public health interventions that will lower the rates of death by suicide as we are confronted with the effects of climate change.