The impact of suicide rates on admissions to emergency medical services and the role of education and employment

Year 2025, Volume: 11 Issue: 4, 762 - 768, 04.07.2025

Erkan Boğa

https://doi.org/10.18621/eurj.1618277

Abstract

Objectives: In this research, it was aimed to evaluate the impact of suicide rates on admissions to emergency medical services (EMS) and the role of education and employment.

Methods: In the research, the Ministry of Health of the Republic of Turkey parameter of cases per EMS between 2002 and 2022, deaths due to suicide, education and employment data from the World Bank Turkey Report were used.

Results: Mean cases per EMS in Türkiye for 2002-2022 time period had 1,512.30±560.82 (range: 653-2,428). Mean suicide mortality range was 2.51±0.32 (range: 2.20-3.20). Mean school enrollment rates were 95.45±2.70 ranged from 87.90 to 98.52. Mean employment rate was 44.08±2.12 (range: 41.15-47.37). Cases per EMS was significantly correlated with suicide mortality (r=-0.777; P<0.01), school enrollment (r=-0.832; P<0.01) and employment rate (r=0.704; P<0.01). Year controlled partial correlation analysis results showed that there was a significant correlation between cases per EMS and employment rate (r=0.653; P<0.01). School enrollment and employment on cases per EMS, effect of suicide mortality on cases per EMS was statistically significant (B=-2121.23; P<0.01). Effects of school enrollment and employment on cases per EMS were insignificant (P>0.05).

Conclusions: EMS units are very effective in reducing suicide mortality rates at both the correlation and regression levels. This effectiveness is similar across different education and employment groups. To reduce suicide mortality, it is necessary to focus on EMS access rather than EMS effectiveness.

Keywords

Emergency medical services , suicide , education , employment

Ethical Statement

The primary reason for not obtaining ethical approval in this study is that the data used were entirely sourced from publicly available and reliable sources. The data used in the study were obtained from the Ministry of Health of the Republic of Turkey and the World Bank Turkey Report. These sources provide publicly accessible statistical data available to everyone. Additionally, the study did not use individual patient data or personal information, nor did it involve experimental applications requiring direct contact or intervention with individuals. All statistical data analyzed in the study are anonymized, and it is impossible to identify any individual's identity. According to national and international ethical guidelines, ethical approval is mandatory only for studies involving the processing of personal data, biomedical interventions, or direct human participants. Since only public databases were used in this study, ethical approval was not required. Furthermore, scientific neutrality and ethical standards were strictly adhered to during the research process, and there were no commercial, financial, or personal conflicts of interest that could influence the outcomes of the research.

References

• 1. Lane DJ, Blanchard IE, Buick JE, Shaw M, McRae AD. Changes in presentation, presenting severity and disposition among patients accessing emergency services during the first months of the COVID-19 pandemic in Calgary, Alberta: a descriptive study. CMAJ Open. 2021;9(2):E592-601. doi: 10.9778/cmajo.20200313.
• 2. Barth J, Greene JA, Goldstein J, Sibley A. Adverse Health Effects Related to Shift Work Patterns and Work Schedule Tolerance in Emergency Medical Services Personnel: A Scoping Review. Cureus. 2022;14(4):e23730. doi: 10.7759/cureus.23730.
• 3. Modi PD, Solanki R, Nagdev TS, et al. Public Awareness of the Emergency Medical Services in Maharashtra, India: A Questionnaire-based Survey. Cureus. 2018;10(9):e3309. doi: 10.7759/cureus.3309.
• 4. Steeps RJ, Wilfong DA, Hubble MW, Bercher DL. Emergency Medical Services Professionals' Attitudes About Community Paramedic Programs. West J Emerg Med. 2017;18(4):630-639. doi: 10.5811/westjem.2017.3.32591.5.
• 5. Le AB, Buehler SA, Maniscalco PM, et al. Determining training and education needs pertaining to highly infectious disease preparedness and response: A gap analysis survey of US emergency medical services practitioners. Am J Infect Control. 2018;46(3):246-252. doi: 10.1016/j.ajic.2017.09.024.
• 6. Millar MM, Hewes HA, Genovesi AL, et al. The Effect of the Familiarity of a Survey Sender on Response Outcomes in a Large-Scale Survey of Emergency Medical Services Agencies. Eval Health Prof. 2021;44(3):260-267. doi: 10.1177/01632787211030635.
• 7. McCann-Pineo M, Li T, Barbara P, Levinsky B, Berkowitz J. Factors Influencing Use of Personal Protective Equipment Among Emergency Medical Services Responders During the COVID-19 Pandemic: A Retrospective Chart Review. West J Emerg Med. 2022;23(3):396-407. doi: 10.5811/westjem.2022.2.55217.
• 8. Ningwa A, Muni K, Oporia F, et al. The state of emergency medical services and acute health facility care in Uganda: findings from a National Cross-Sectional Survey. BMC Health Serv Res. 2020;20(1):634. doi: 10.1186/s12913-020-05508-8.
• 9. Hansen PM, Mikkelsen S, Alstrøm H, Damm-Hejmdal A, Rehn M, Berlac PA. The Field's mass shooting: emergency medical services response. Scand J Trauma Resusc Emerg Med. 2023;31(1):71. doi: 10.1186/s13049-023-01140-7.
• 10. Pitman A, McDonald K, Logeswaran Y, Lewis G, Cerel J, Erlangsen A. Proportion of suicides in Denmark attributable to bereavement by the suicide of a first-degree relative or partner: Nested case-control study. Acta Psychiatr Scand. 2022;146(6):529-539. doi: 10.1111/acps.13493.
• 11. Chu C, Buchman-Schmitt JM, Stanley IH, et al. The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychol Bull. 2017;143(12):1313-1345. doi: 10.1037/bul0000123.
• 12. De Leo D, Giannotti AV. Suicide in late life: A viewpoint. Prev Med. 2021;152(Pt1):106735. doi: 10.1016/j.ypmed.2021.106735.
• 13. Benson R, Rigby J, Brunsdon C, Cully G, Too LS, Arensman E. Quantitative Methods to Detect Suicide and Self-Harm Clusters: A Systematic Review. Int J Environ Res Public Health. 2022;19(9):5313. doi: 10.3390/ijerph19095313.
• 14. Kirchner S, Niederkrotenthaler T. Experiences of suicide survivors of sharing their stories about suicidality and overcoming a crisis in media and public talks: a qualitative study. BMC Public Health. 2024;24(1):142. doi: 10.1186/s12889-024-17661-4.
• 15. Pitman A, Logeswaran Y, McDonald K, Cerel J, Lewis G, Erlangsen A. Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study. Epidemiol Psychiatr Sci. 2023;32:e53. doi: 10.1017/S2045796023000653.
• 16. Hawgood J, Spafford SG, Evans A, Webster A, Koo YW. Suicide risk assessment fears, attitudes and behaviours of lifeline crisis supporters. Health Soc Care Community. 2022;30(6):e5083-e5094. doi: 10.1111/hsc.13923.
• 17. Wu KC, Cai Z, Chang Q, Chang SS, Yip PSF, Chen YY. Criminalisation of suicide and suicide rates: an ecological study of 171 countries in the world. BMJ Open. 2022;12(2):e049425. doi: 10.1136/bmjopen-2021-049425.
• 18. McDonnell S, Flynn S, Shaw J, Smith S, McGale B, Hunt IM. Suicide bereavement in the UK: Descriptive findings from a national survey. Suicide Life Threat Behav. 2022;52(5):887-897. doi: 10.1111/sltb.12874.
• 19. Yılmaz K, Turanlı M. A Multi-disciplinary Investigation of Linearization Deviations in Different Regression Models. Asian J Probab Stat. 2023;22(3):15-19. doi: 10.9734/ajpas/2023/v22i3484.
• 20. Yilmaz K, Turanlı M. A multi-disciplinary investigation on minimizing linearization deviations in different regression models. In: Change & Shaping The Future, IV. ASC 2022/Fall Congress; 2022.
• 21. Alrazeeni DM, Sheikh SA, Mobrad A, et al. Epidemiology of non-transported emergency Medical services calls in Saudi Arabia. Saudi Med J. 2016;37(5):575-578. doi: 10.15537/smj.2016.5.13872.
• 22. Xie F, Yan J, Agarwal G, Ferron R. Economic Analysis of Mobile Integrated Health Care Delivered by Emergency Medical Services Paramedic Teams. JAMA Netw Open. 2021;4(2):e210055. doi: 10.1001/jamanetworkopen.2021.0055.
• 23. Newgard CD, Fu R, Bulger E, et al. Evaluation of Rural vs Urban Trauma Patients Served by 9-1-1 Emergency Medical Services. JAMA Surg. 2017;152(1):11-18. doi: 10.1001/jamasurg.2016.3329.
• 24. Salminen T, Kaartinen K, Roos M, et al. Differences between the dispatch priority assessments of emergency medical dispatchers and emergency medical services: a prospective register-based study in Finland. Scand J Trauma Resusc Emerg Med. 2023;31(1):8. doi: 10.1186/s13049-023-01072-2.
• 25. Song J, Hong SH, Kim J, Chang S, Yook KH, Hong HJ. Comparison of Suicide Attempts and Suicide Deaths by Jumping from a High Place in Korean Children and Adolescents. Int J Environ Res Public Health. 2021;18(18):9513. doi: 10.3390/ijerph18189513.
• 26. Ringer FB, Soberay KA, Rogers ML, et al. Initial validation of brief measures of suicide risk factors: Common data elements used by the Military Suicide Research Consortium. Psychol Assess. 2018;30(6):767-778. doi: 10.1037/pas0000519.
• 27. Sinyor M, Schaffer A, Nishikawa Y, et al. The association between suicide deaths and putatively harmful and protective factors in media reports. CMAJ. 2018;190(30):E900-7. doi: 10.1503/cmaj.170698.