## 4 Discussion
### Mental Health-Related Variables  
Focusing now on the mental health-related variables, it is known from many studies that organic and non-organic mental disorders are associated with high rates of suicide [11; 12], especially in patients who previously underwent inpatient treatment [12; 13]. Schizophrenia and organic mental disorders in inpatients [12; 13; 33], and depression [13; 33; 34], and substance-related disorders [33] in outpatients have been determined as highly significant risk factors for suicide. However, in our study, no association was found with the SDR of overall mental disorders, organic and non-organic psychoses, and alcohol dependence syndrome. The lack of association may be due to the low levels of mortality of these conditions [21], as shown in Supplementary Materials S2. In some regions and years, the number of events may be zero or very small, and therefore, there may be corresponding observations that are misleading and inappropriate to produce statistically significant results in correlation and regression analyses. However, looking at the numbers in Table 3 and Supplementary Materials S2, we found that after 2012, a sharp increase in mental disorder mortality was recorded. This increase may be related to the rise in suicide mortality, but it cannot be statistically supported. The observation of a greater impact on suicidality than on mental morbidity might be related to the phenomenon of \"deaths of despair\", which has attracted attention during the recent years [35]. Attempting to further explore the possible effect of mental morbidity on suicide variation, by exploring the association of suicide rates with the average per capita consumption of total psychotropic drugs, antipsychotics and antidepressants, taking them as indirect measures of the prevalence of overall mental morbidity, psychoses, and depression disorders, respectively. However, we did not find any correlation of suicide mortality with any of them. A reasonable explanation could be that crude psychotropic consumption is probably not a reliable measure of the prevalence of mental disorders because it is affected by the mix of drugs, treatment patterns, potential abuse, etc. Furthermore, several studies from Greece [36; 37] and other countries [38; 39; 40] found that mental morbidity increased significantly after economic crisis, and that is expected to have an impact on suicides [11; 12; 13]. The present study adds certain new elements in the suicide literature. It explores for the first time the differences in suicide rates among Greek regions, which were found to be significant, but did not widen during crisis. In addition, apart from traditional indicators (e.g., unemployment and GDP) we used new indicators like \"Change in per capita GDP\", \"per capita disposable household income (DHI)\", and \"long-term unemployment\", which seems to be more sensitive in describing the socio-economic impact and provide some additional tools in exploring determinants of suicide mortality. It is likely that the two former indicators could better measure the living standards than the per capita GDP. Finally, it is the first study to our knowledge to explore the correlation of suicidality with mental disorder mortality rates, providing evidence that financial crises may affect suicidality independently and more severely than mental morbidity. Our study has several limitations. First, the ecologic design based on aggregate data poses the risk of the ecological fallacy. Nevertheless, despite the shortcoming of ecological studies, it has been suggested that they are a suitable and practical choice for the investigation of the impact of economic crisis on health. Similarly, the associations with socio-economic and mental health-related factors are based on statistical correlations, which do not allow directly attributing a suicide to a particular cause. Regarding the quality of data, these were based on death certificates. However, there are no indications for unreported suicide cases in Greece.