This is a pilot cross sectional study using both quantitative and qualitative approach towards tutors teaching large classes in private universities in the Klang Valley (comprising Kuala Lumpur, its suburbs, adjoining towns in the State of Selangor) and the State of Negeri Sembilan, Malaysia. The general aim of this study is to determine the difficulties faced by tutors when teaching large group of students and to outline appropriate recommendations in overcoming them.
Background: The cost-of-living crisis may be contributing to suicide rates, but this has not been adequately tested. Aims: We aimed to determine whether the cost-of-living crisis is associated with suicide rates in multiple countries and areas-within-countries. Method: We sourced country- and area-within-country-level monthly suicide data at a minimum from January 1, 2019, to December 31, 2022 (and at a maximum from January 1, 2016, to June 30, 2023), and population denominator and monthly headline consumer price index (CPI) data. We calculated the yearly change in inflation as the percentage change in CPI for one month versus the equivalent month in the previous year. We estimated associations between yearly change in inflation (lagged by one month) and suicide rates for each country and area-within-country, using autoregressive negative binomial regression. We summarized results using weighted means. Results: We obtained data on 1,372,994 suicides from 54 countries. At the country-level, for every 1.0% increase in yearly inflation in the previous month, there was an average 0.2% increase in suicide rates. The association was strongest in those aged 30-49 and 50-69; for every 1.0% increase in yearly inflation in the previous month, there were 0.3% and 0.6% increases in suicide rates for these age-groups, respectively. This pattern held for males in these age-groups, with increases of the same magnitude, and for females aged 50-69, with a 0.8% increase. At the area-within-country-level, the picture was even starker. Limitations: Study limitations include: the ecological design; the single measure of inflation; potential variations in suicide data quality; lack of representation by low-and-middle-income countries (LMICS); lack of availability of sex, age and sex/age breakdowns for some countries and areas-within-countries; and potential issues with multiple testing. Conclusions: There is an association between the cost-of-living crisis and suicide rates internationally. Public and social policies that improve people's circumstances are critical.