<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2 20190208//EN" "http://jats.nlm.nih.gov/publishing/1.2/JATS-journalpublishing1.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="research-article" dtd-version="1.2" xml:lang="en">
    <front>
        <journal-meta>
            <journal-id journal-id-type="pmc">F1000Research</journal-id>
            <journal-title-group>
                <journal-title>F1000Research</journal-title>
            </journal-title-group>
            <issn pub-type="epub">2046-1402</issn>
            <publisher>
                <publisher-name>F1000 Research Limited</publisher-name>
                <publisher-loc>London, UK</publisher-loc>
            </publisher>
        </journal-meta>
        <article-meta>
            <article-id pub-id-type="doi">10.12688/f1000research.158285.1</article-id>
            <article-categories>
                <subj-group subj-group-type="heading">
                    <subject>Research Article</subject>
                </subj-group>
                <subj-group>
                    <subject>Articles</subject>
                </subj-group>
            </article-categories>
            <title-group>
                <article-title>The Hidden Toll: Investigating the influence of Corruption on Persistent Suicide in the Americas</article-title>
                <fn-group content-type="pub-status">
                    <fn>
                        <p>[version 1; peer review: 2 approved with reservations]</p>
                    </fn>
                </fn-group>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Kularathne</surname>
                        <given-names>Sherin</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Data Curation</role>
                    <role content-type="http://credit.niso.org/">Formal Analysis</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Software</role>
                    <role content-type="http://credit.niso.org/">Validation</role>
                    <role content-type="http://credit.niso.org/">Visualization</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Original Draft Preparation</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Review &amp; Editing</role>
                    <uri content-type="orcid">https://orcid.org/0009-0000-7124-6276</uri>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="yes">
                    <name>
                        <surname>Jayathilaka</surname>
                        <given-names>Ruwan</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Supervision</role>
                    <role content-type="http://credit.niso.org/">Validation</role>
                    <role content-type="http://credit.niso.org/">Visualization</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Original Draft Preparation</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Review &amp; Editing</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-7679-4164</uri>
                    <xref ref-type="corresp" rid="c1">a</xref>
                    <xref ref-type="aff" rid="a2">2</xref>
                </contrib>
                <aff id="a1">
                    <label>1</label>SLIIT Faculty of Graduate Studies, Sri Lanka Institute of Information Technology, Malabe, 10115, Sri Lanka</aff>
                <aff id="a2">
                    <label>2</label>SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, 10115, Sri Lanka</aff>
            </contrib-group>
            <author-notes>
                <corresp id="c1">
                    <label>a</label>
                    <email xlink:href="mailto:ruwan.j@sliit.lk">ruwan.j@sliit.lk</email>
                </corresp>
                <fn fn-type="conflict">
                    <p>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>26</day>
                <month>11</month>
                <year>2024</year>
            </pub-date>
            <pub-date pub-type="collection">
                <year>2024</year>
            </pub-date>
            <volume>13</volume>
            <elocation-id>1427</elocation-id>
            <history>
                <date date-type="accepted">
                    <day>15</day>
                    <month>11</month>
                    <year>2024</year>
                </date>
            </history>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2024 Kularathne S and Jayathilaka R</copyright-statement>
                <copyright-year>2024</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <self-uri content-type="pdf" xlink:href="https://f1000research.com/articles/13-1427/pdf"/>
            <abstract>
                <sec>
                    <title>Background</title>
                    <p>Corruption, a multifaceted governance issue, impacts public well-being globally. The recent trends reveal a rise in suicide rates across the Americas, while all other regions show declines over twenty years of time. This study investigates corruption&#x2019;s effect on suicide in 26 American countries, considering moderating factors of unemployment, inflation, and economic growth.</p>
                </sec>
                <sec>
                    <title>Methods</title>
                    <p>This study analysed latest two decades of available data, using stepwise panel regression method to investigate the effects of corruption and economic variables on suicide across income levels. Data were sourced from Transparency International, World Bank and the World Health Organization. Initially, unit root tests and CUSUM plots were used to ensure the stability and stationarity of the dataset, and model specification were validated through F test, LM test and Hausman test to select the ideal econometric model - POLS, REM, or FEM for the study.</p>
                </sec>
                <sec>
                    <title>Results</title>
                    <p>A strong suicide rate persistence revealed, particularly in high-income countries, where the lagged suicide variable showed a coefficient of 0.8063 (p &lt; 0.001). Corruption significantly impacted suicide rates in upper-middle-income countries (coefficient = -0.0268, p &lt; 0.05), with higher corruption perceptions scores correlating with lower suicide rates. Additionally, unemployment acted as a significant moderator, intensifying the corruption&#x2019;s adverse impact on suicide with a coefficient of 0.0022 (p &lt; 0.001) in upper-middle income nations. Economic growth demonstrated a minor protective effect, particularly in high-income regions, with an interaction coefficient of -0.0005 (p &lt; 0.1), suggesting slight suicide reduction linked to economic stability.</p>
                </sec>
                <sec>
                    <title>Conclusion</title>
                    <p>This study found that corruption, unemployment, and economic growth significantly influence suicide rates across the Americas. Corruption exacerbates suicide risks in upper-middle-income countries, while unemployment amplifies this effect. Economic growth offers a slight protective effect, particularly in high-income regions, suggesting that economic stability may help mitigate suicide rates.</p>
                </sec>
            </abstract>
            <kwd-group kwd-group-type="author">
                <kwd>Corruption</kwd>
                <kwd>Suicide</kwd>
                <kwd>Inflation</kwd>
                <kwd>Unemployment</kwd>
                <kwd>Economic growth</kwd>
                <kwd>Americas</kwd>
                <kwd>Corruption</kwd>
                <kwd>Inflation</kwd>
                <kwd>Economic growth</kwd>
                <kwd>Latin America</kwd>
                <kwd>North America</kwd>
                <kwd>South America</kwd>
            </kwd-group>
            <funding-group>
                <funding-statement>The author(s) declared that no grants were involved in supporting this work.</funding-statement>
            </funding-group>
        </article-meta>
    </front>
    <body>
        <sec id="sec5" sec-type="intro">
            <title>Introduction</title>
            <p>Corruption is more than a mere failure of governance; it erodes the individual&#x2019;s mental and emotional well-being, resulting in negative consequences, such as growing suicide rates. Previous research has shown that corruption and inadequate institutions such as weak legal systems, insufficient healthcare, and ineffective social services create despair severe enough to lead to suicide (
                <xref ref-type="bibr" rid="ref17">Glaeser &amp; Saks, 2006</xref>; 
                <xref ref-type="bibr" rid="ref24">Johnston, 1983</xref>; 
                <xref ref-type="bibr" rid="ref65">Stockman, 2013</xref>). Weak government, characterised by corruption and a lack of transparency, fosters a climate conducive to mental health crises, greatly influencing suicide rates (
                <xref ref-type="bibr" rid="ref14">Desjarlais, 1995</xref>; 
                <xref ref-type="bibr" rid="ref55">Saad, 2022</xref>). These findings reveal a darker, often neglected element of corruption: it not only suppresses economic development but also compromises lives by creating a climate of despondency within the nation.</p>
            <p>Any government&#x2019;s motive is to foster better living conditions and promote sustainable development, yet this ideal is often unmet (
                <xref ref-type="bibr" rid="ref71">Yamamura et al., 2012</xref>). Suicide, a complicated worldwide public health issue, differs by gender, age, area, and geopolitical context, and is influenced by a variety of risk factors (
                <xref ref-type="bibr" rid="ref67">Turecki &amp; Brent, 2016</xref>). While some studies have revealed that corruption restricts economic growth (
                <xref ref-type="bibr" rid="ref40">Mauro, 1995</xref>; 
                <xref ref-type="bibr" rid="ref59">Seligson, 2002</xref>), others have investigated its relationship with well-being and governance (
                <xref ref-type="bibr" rid="ref15">Fischer &amp; Andres, 2008</xref>; 
                <xref ref-type="bibr" rid="ref22">Helliwell &amp; Huang, 2008</xref>; 
                <xref ref-type="bibr" rid="ref50">Ott, 2011</xref>). Furthermore, evidence also points to a high link between suicide and subjective well-being (
                <xref ref-type="bibr" rid="ref29">Koivumaa-Honkanen et al., 2004</xref>). Similarly, studies conducted in the United States demonstrate common determinants of suicide rates and well-being (
                <xref ref-type="bibr" rid="ref13">Daly &amp; Wilson, 2009</xref>). However, despite efforts to improve well-being and governance, the persistent link between socio-political factors, economic inequality, and suicide highlights the need for more targeted and effective government interventions.</p>
            <p>While the negative impacts of corruption on mental health are obvious worldwide, regional trends in suicide rates suggest specific patterns that require further investigation, particularly in the Americas, where suicide mortality has increased between 2000 and 2019, despite global declines shown in other regions (
                <xref ref-type="bibr" rid="ref38">M Ilic, 2022</xref>). The following 
                <xref ref-type="fig" rid="f1">
Figure 1</xref> depicts a visual representation of this finding.</p>
            <fig fig-type="figure" id="f1" orientation="portrait" position="float">
                <label>
Figure 1. </label>
                <caption>
                    <title>Regional Suicide Comparison 2000-2019.</title>
                    <p>Source: Authors&#x2019; compilation based on 
                        <xref ref-type="bibr" rid="ref49">World Health Organization data (2024)</xref>.</p>
                </caption>
                <graphic id="gr1" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/173856/c1da134a-2424-41f7-ac25-e4e36e28cf08_figure1.gif"/>
            </fig>
            <p>Suicide, a globally complex issue, is caused by the combination of several elements, including neurobiology, family history, societal settings, and economic pressures (
                <xref ref-type="bibr" rid="ref7">Breault, 1986</xref>; 
                <xref ref-type="bibr" rid="ref9">Bunney et al., 2002</xref>; 
                <xref ref-type="bibr" rid="ref53">Quinlan-Davidson et al., 2014</xref>; 
                <xref ref-type="bibr" rid="ref67">Turecki &amp; Brent, 2016</xref>).</p>
            <p>Current suicide preventative measures seem to be insufficient (especially in the Americas) because they frequently ignore deeper sociopolitical issues such as corruption and instability, which aggravate citizens&#x2019; despair. While worldwide efforts emphasise diagnosis and response, yet many related factors are there for investigation and governments, and policymakers must work persistently to improve suicide prevention (
                <xref ref-type="bibr" rid="ref74">Yossi Levi-Belz et al., 2019</xref>). Thus, it is apparent that suicide prevention initiatives must go beyond immediate treatments to address the underlying socio-political and economic causes.</p>
            <p>The primary goal of this study is to investigate how corruption, paired with economic factors such as unemployment, inflation, and economic growth, affects suicide rates across different income levels in the Americas. By evaluating these variables together, the study expects to uncover the complex, frequently overlooked relationships that influence mental health outcomes. This study contributes to a more holistic picture of how government failures and economic stressors interact to compound public health challenges, including suicide.</p>
            <p>This study makes numerous essential contributions to the body of current literature and policy-making assistance. First, although earlier studies have investigated the relationship between mental health, macroeconomic variables, and corruption in local, national, global and sub-continent areas, there is a lack of investigation executed for the whole American region. The current study concentrates on the American region. In this critical geographic area, suicide rates have shown a unique upward trend over the past 20 years although worldwide decreases of other regions. There is a lack of recent research in the overall arena, which concentrates exclusively on the Americas. Therefore, this region is underexplored. This study seeks to fill the gap in the literature caused by the inadequate or outdated research that is currently available. Additionally, the study also utilises an income category-wise analysis, which provides a more detailed understanding of how these correlations fluctuate among countries among various economic circumstances.</p>
            <p>Second, this study uses the most recent data from 2000 to 2019 that is available at present, making it one of the few that covers such a lengthy period with the most recent data, allowing for a more comprehensive and up-to-date understanding of long-term patterns and fluctuations explaining corruption&#x2019;s impact on suicide. Hence, the study offers a new and contemporary viewpoint on the relationship between governance (corruption) and suicide rates in the American region. income category-wise analysis, with a particular focus on income category.</p>
            <p>Third, this study stands out in terms of its methodological approach. Few studies in current research, utilise Panel regression techniques that include interaction terms, particularly about moderating economic factors such as inflation, unemployment, and economic growth This study provides novel insights by taking a comprehensive approach to understand how corruption interacts with inflation, unemployment, and economic growth to affect suicide rates. The use of time-series visual analyses of factors incorporated in the study enriches the study by presenting trends and patterns in a clear and understandable manner, allowing for a more accurate data interpretation. These efforts in the s survey enhance the contextual understanding of the results, offering additional layers of insight.</p>
            <p>Furthermore, although previous studies have primarily evaluated these variables in isolation or within distinct contexts, this study bridges a gap by studying significant macroeconomic indicators and corruption together within the context of the Americas. The study&#x2019;s findings have important significance for policymakers since they identify the primary causes contributing to growing suicide rates in the region, providing strategic insights for targeted responses. Understanding the macroeconomic and governance-related factors allows governments to develop more effective policies to combat corruption, while mitigating its devastating impact on suicide, which is a critical public health concern.</p>
        </sec>
        <sec id="sec6">
            <title>Literature review</title>
            <p>Corruption is widespread worldwide, and eliminating it is critical for equitable economic growth (
                <xref ref-type="bibr" rid="ref48">Olken &amp; Pande, 2012</xref>). Although its negative impact on nations is widely understood, the precise costs to individuals, notably mental health, are understudied. Suicide is a serious global public health hazard, accounting for about 700,000 deaths annually (2024). Addressing both corruption and suicide is crucial for society&#x2019;s well-being, since they both risk individual mental health and long-term development.</p>
            <sec id="sec7">
                <title>Corruption and suicide</title>
                <p>A victim of corruption can have several negative consequences for one&#x2019;s mental health, including severe depression (
                    <xref ref-type="bibr" rid="ref3">Bai et al., 2019</xref>). Previous researchers have explained that in low-income nations, harassment bribes- defined as bribes frequently demanded by officials for services or rights to which people are already entitled, are a sort of regressive income tax that is typically a significant portion of one&#x2019;s income, particularly for poorer households, and are unpredictable and frequent, causing chronic stress in low-income families (
                    <xref ref-type="bibr" rid="ref1">Adhvaryu et al., 2018</xref>). As a result, such corruption erodes trust in local governance, diminishes social capital, and damages mental health. A leading, study on OECD countries indicated lower suicide rates in nations with less corruption (
                    <xref ref-type="bibr" rid="ref71">Yamamura et al., 2012</xref>). On the other hand, another study revealed that poor governance causes more stress and despair among citizens, raising the likelihood of suicide (
                    <xref ref-type="bibr" rid="ref62">Sharma et al., 2021</xref>). This aligns with results that effective governments and strong social trust contribute to life satisfaction (
                    <xref ref-type="bibr" rid="ref5">Bj&#x00f8;rnskov et al., 2010</xref>). Thus, corruption and poor governance not only weaken economic and social institutions but also have severe consequences for mental health, raising the risk of psychological distress and suicide across a wide range of socioeconomic circumstances.</p>
                <p>Past literature emphasises the undeniable link between corruption and worsening mental health, including higher suicide rates, particularly among poor communities. Corruption weakens economies, destroys institutional trust, and denies access to essential services, instilling hopelessness. Despite its clear public health implications, current research on corruption&#x2019;s role in driving suicide, particularly in the Americas, is insufficient. The lack of contemporary, focused studies on this pressing issue reveals a critical gap in comprehending how deeply corruption impacts mental health, indicating an urgent need for further exploration.</p>
            </sec>
            <sec id="sec8">
                <title>Inflation and suicide</title>
                <p>Understanding mental health and crime rates is made more difficult by macroeconomic issues such as inflation. Although there is conflicting evidence, some argue that decreasing inflation lowers crime, including suicides. For instance, growing food inflation in Turkey disproportionately increased male suicide rates, while rising inflation in the United States is associated with increasing criminality (
                    <xref ref-type="bibr" rid="ref60">&#x015e;ent&#x00fc;rk &amp; Erbay, 2022</xref>). Though their success depends on political and financial support, welfare programs and minimum wage laws have been suggested as suicide prevention techniques (
                    <xref ref-type="bibr" rid="ref64">Stack, 2021</xref>; 
                    <xref ref-type="bibr" rid="ref68">Tuttle, 2018</xref>). Increasing salaries has the potential to decrease suicide, but achieving this will be politically challenging (
                    <xref ref-type="bibr" rid="ref26">Kaufman et al., 2020</xref>).</p>
                <p>Furthermore, economic crises, such as the 2008 Great Recession, which experienced high inflation, intensify these psychological consequences, with repossessions and family breakdowns contributing to mental health toll (
                    <xref ref-type="bibr" rid="ref2">Agrrawal et al., 2017</xref>; 
                    <xref ref-type="bibr" rid="ref12">Coope et al., 2014</xref>; 
                    <xref ref-type="bibr" rid="ref44">Mucci et al., 2016</xref>). The broader socioeconomic implications, such as family breakdowns and lower academic accomplishment for children, compound the mental health concerns (
                    <xref ref-type="bibr" rid="ref45">National Council of La Raza, 2009</xref>). However, the linear assumption that financial crises cause an increase in suicide rates may oversimplify the issue. While financial stress is clearly a factor, it is essential to evaluate how other factors may influence these outcomes. Simply focussing on financial indicators without addressing underlying socioeconomic inequities risks providing an inadequate picture of the suicide-inflation nexus.</p>
                <p>The literature also contains inconsistent knowledge, with some studies disputing the commonly held idea that inflation constantly raises suicide rates. For example, South African research discovered a negative association, with suicides increasing as inflation dropped, though this relationship became statistically insignificant when province adjustments were applied, particularly among women (
                    <xref ref-type="bibr" rid="ref46">Noh, 2009</xref>). Adding to the stated findings, similar studies reveal countercyclical suicide trends (
                    <xref ref-type="bibr" rid="ref19">Granados, 2008</xref>). This contradiction raises serious concerns regarding the universality of the inflation-suicide association. Such findings highlight the need to examine context-specific factors, such as cultural attitudes and thinking patterns of the public towards economic hardship and the availability of government safety nets, rather than assuming equal outcomes across countries.</p>
                <p>Although there is evidence associating inflation with suicide, this relationship is nuanced and complex to generalise. This demands a more concentrated approach that takes socioeconomic, gender, and regional variables into consideration. Understanding such a relationship and creating remedies that address the psychological as well as the economic aspects of inflation require thorough, context-sensitive studies. Without careful examination, policy recommendations have the potential of being detrimental or ineffectual, depending on the local or national contexts.</p>
            </sec>
            <sec id="sec9">
                <title>Unemployment and suicide</title>
                <p>Unemployment, especially during economic downturns, is a well-known cause of suicide (
                    <xref ref-type="bibr" rid="ref25">Jung et al., 2024</xref>; 
                    <xref ref-type="bibr" rid="ref58">Schapiro &amp; Ahlburg, 1982</xref>), And lower unemployment rates often improve mental health and lessen the risk of suicide. This fact underlines how important it is to conduct cross-national replication to assess the validity of the relationships between unemployment and societal outcomes, including suicides (
                    <xref ref-type="bibr" rid="ref18">Goulas &amp; Zervoyianni, 2023</xref>; 
                    <xref ref-type="bibr" rid="ref41">McKee-Ryan et al., 2005</xref>; 
                    <xref ref-type="bibr" rid="ref42">Milner et al., 2012</xref>; 
                    <xref ref-type="bibr" rid="ref51">Park et al., 2003</xref>; 
                    <xref ref-type="bibr" rid="ref52">Paul &amp; Moser, 2009</xref>; 
                    <xref ref-type="bibr" rid="ref72">Yang &amp; Lester, 1995</xref>). The Great Recession demonstrated this fact since growing unemployment was associated with greater suicide rates, especially in areas where supportive measures such as social programs were missing (
                    <xref ref-type="bibr" rid="ref47">Norstr&#x00f6;m &amp; Gr&#x00f6;nqvist, 2015</xref>; 
                    <xref ref-type="bibr" rid="ref61">Shand et al., 2021</xref>). Also, a systematic review found that long-term unemployment increases the risk of suicide while the risk decreases over time, probably due to habituation (
                    <xref ref-type="bibr" rid="ref43">Milner et al., 2013</xref>).</p>
                <p>However, contradicting the majority of the past literature, some studies have revealed a negative association between unemployment and suicide in low-income countries (
                    <xref ref-type="bibr" rid="ref4">Barth et al., 2011</xref>). Unemployment in these regions may not carry the same social stigma or economic challenges, which could explain the lower suicide rates. In contrast, in high-income countries, unemployment tends to increase suicide rates due to increased psychological and societal pressures. This emphasises the significance of income levels in understanding the diverse effects of unemployment on suicide across different socioeconomic circumstances (
                    <xref ref-type="bibr" rid="ref46">Noh, 2009</xref>). This divergence in findings underscores the importance of considering regional economic structures and cultural contexts when studying the unemployment-suicide relationship.</p>
            </sec>
            <sec id="sec10">
                <title>Economic growth and suicide</title>
                <p>Suicide is a complicated issue driven by economic, social, and psychological factors, although the link between economic growth and suicide rates is still debated. Early studies revealed that economic downturns increase suicide risk by lowering prospects, whereas economic prosperity lowers these risks (
                    <xref ref-type="bibr" rid="ref21">Hamermesh &amp; Soss, 1974</xref>). Also, it has found a negative association between GDP growth and suicide rates, supporting this viewpoint (
                    <xref ref-type="bibr" rid="ref39">Mattei &amp; Pistoresi, 2019</xref>; 
                    <xref ref-type="bibr" rid="ref75">Zhang et al., 2010</xref>). However, the drop in suicide was often only temporary during periods of economic prosperity, implying that economic growth alone may not be a long-term answer to lowering suicide rates. This emphasises the importance of rigorously examining the long-term psychological benefits of economic growth, which may be underestimated in standard economic theory.</p>
                <p>More recent research indicated that GDP alone has poor predictive value for changes in suicide rates, calling into doubt the premise that economic prosperity inevitably improves mental health (
                    <xref ref-type="bibr" rid="ref10">Cao, 2024</xref>). In fact, it has also discovered a positive relationship between economic growth and suicide rates, particularly during periods of fast expansion, attributing these trends to increased workplace stress and cultural changes, notably among older populations (
                    <xref ref-type="bibr" rid="ref16">Fountoulakis et al., 2014</xref>; 
                    <xref ref-type="bibr" rid="ref54">Rajagukguk et al., 2020</xref>). These conflicting findings imply that economic expansion might occasionally intensify rather than reduce pressures, challenging the myth that growth is always favourable to mental health.</p>
                <p>The relationship between economic progress and suicide is more nuanced than previous research believed. While expansion may enhance material situations, it can also increase stress, which increases the possibility of suicide. The contradicting findings underscore the need for further research, emphasising the need to include social and mental health factors in economic policies. Focussing primarily on GDP growth risks ignoring significant public health implications, possibly increasing suicide rates. This demonstrates the crucial need for a more comprehensive approach to economic planning.</p>
            </sec>
            <sec id="sec11">
                <title>Suicide-related literature search</title>
                <p>An extensive literature search was done in the Google Scholar database to acquire a basic understanding of the evolution and expansion of the related disciplines. 
                    <xref ref-type="fig" rid="f2">
Figure 2</xref> illustrates the search results over decades.</p>
                <fig fig-type="figure" id="f2" orientation="portrait" position="float">
                    <label>
Figure 2. </label>
                    <caption>
                        <title>Bar chart of related literature over the years.</title>
                        <p>Source: Authors&#x2019; illustrations based on literature search.</p>
                    </caption>
                    <graphic id="gr2" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/173856/c1da134a-2424-41f7-ac25-e4e36e28cf08_figure2.gif"/>
                </fig>
                <p>This bar chart illustrates the distribution of key research publications over time, focussing on the studies included in this analysis. The figure reveals an interesting trend: while research on topics such as unemployment, economic growth, and inflation influencing suicide has risen over the years, studies on the link between corruption and suicide have only recently gained attention. Despite the growing global relevance of both corruption and suicide, these arenas remain unexplored in comparison to other common variables in this study. This study attempted to emphasise more recent key studies, which showed a rising but still limited focus on corruption as a suicide factor, highlighting the need for further research in the domain of corruption&#x2019;s influence on suicide.</p>
                <p>Following 
                    <xref ref-type="fig" rid="f3">
Figure 3</xref> illustrates the geographical distribution of major literature cited in the study, emphasising the global aspect of suicide risk factor research spanning on to various regions and countries.</p>
                <fig fig-type="figure" id="f3" orientation="portrait" position="float">
                    <label>
Figure 3. </label>
                    <caption>
                        <title>Bubble pie charts of key literature.</title>
                        <p>Source: Authors&#x2019; illustrations based on literature search.</p>
                    </caption>
                    <graphic id="gr3" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/173856/c1da134a-2424-41f7-ac25-e4e36e28cf08_figure3.gif"/>
                </fig>
                <p>This map depicts the geographic distribution of relevant literature included in the study, demonstrating that while regions such as Latin America, the Caribbean, and portions of Asia have gotten significant attention, there is a noticeable lack of focus on the broader American region, including North America. Especially, despite the crucial challenges of corruption, and suicide in the American region, research in these areas is still under-explored. The unlabelled icons in this map are country-wise studies. This literature map signals the need for more concentrated research in the American region, where socioeconomic issues and suicide rates are continuously growing. These studies highlight the key literature used in this study, emphasising geographical differences and the need to resolve these gaps in future research.</p>
                <p>The conceptual base for the current study was built based on the literature study and existing knowledge. The independent variables mentioned have revealed a significant impact on suicide rates. 
                    <xref ref-type="table" rid="T1">
Table 1</xref> divides the supporting key literature into four independent variables relevant to the study of suicide: corruption, inflation, unemployment, and economic growth.</p>
                <table-wrap id="T1" orientation="portrait" position="float">
                    <label>
Table 1. </label>
                    <caption>
                        <title>Variables and key supporting studies.</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="1" rowspan="2" valign="top">
Variables</th>
                                <th align="left" colspan="2" rowspan="1" valign="top">Past studies</th>
                            </tr>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">(+)</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">(-)</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>

                                        <italic toggle="yes">CORR &#x2192; SUI</italic>
</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <xref ref-type="bibr" rid="ref62">Sharma et al. (2021)</xref>;
                                    <xref ref-type="bibr" rid="ref5">Bj&#x00f8;rnskov et al. (2010)</xref>;
                                    <xref ref-type="bibr" rid="ref71">Yamamura et al. (2012)</xref>
                                </td>
                                <td colspan="1" rowspan="1"/>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>

                                        <italic toggle="yes">INFL &#x2192; SUI</italic>
</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <xref ref-type="bibr" rid="ref60">&#x015e;ent&#x00fc;rk and Erbay (2022)</xref>;
                                    <xref ref-type="bibr" rid="ref16">Fountoulakis et al. (2014)</xref>;
                                    <xref ref-type="bibr" rid="ref12">Coope et al. (2014)</xref>
                                </td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <xref ref-type="bibr" rid="ref6">Botha (2012)</xref>;
                                    <xref ref-type="bibr" rid="ref19">Granados (2008)</xref>
                                </td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>

                                        <italic toggle="yes">UNEMP &#x2192; SUI</italic>
</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <xref ref-type="bibr" rid="ref25">Jung et al. (2024)</xref>
                                    <break/>
                                    <xref ref-type="bibr" rid="ref61">Shand et al. (2021)</xref>
                                    <break/>
                                    <xref ref-type="bibr" rid="ref42">Milner et al. (2012)</xref>
                                </td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <xref ref-type="bibr" rid="ref4">Barth et al. (2011)</xref>
                                    <break/>
                                    <xref ref-type="bibr" rid="ref46">Noh (2009)</xref>
                                </td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>

                                        <italic toggle="yes">EG &#x2192; SUI</italic>
</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <xref ref-type="bibr" rid="ref54">Rajagukguk et al. (2020)</xref>;
                                    <xref ref-type="bibr" rid="ref16">Fountoulakis et al. (2014)</xref>
                                </td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <xref ref-type="bibr" rid="ref39">Mattei and Pistoresi (2019)</xref>;
                                    <xref ref-type="bibr" rid="ref75">Zhang et al. (2010)</xref>
                                    <break/>
                                    <xref ref-type="bibr" rid="ref51">Park et al. (2003)</xref>
                                </td>
                            </tr>
                        </tbody>
                    </table>
                    <table-wrap-foot>
                        <p>Source: Authors&#x2019; compilations based on past literature.</p>
                    </table-wrap-foot>
                </table-wrap>
                <p>With this conceptual foundation, this study is executed to investigate the impact of corruption on suicide corruption, incorporating moderating macroeconomic indicators and their impact on suicide rates across the American region. This framework aims to provide a comprehensive understanding of how various economic and governance qualities influence the rising suicide rates in the Americas and to reveal the underlying dynamics that contribute to mental health crises in the region.</p>
            </sec>
        </sec>
        <sec id="sec12" sec-type="methods">
            <title>Methods</title>
            <p>The variables used in this study, the data sources used to collect data, and the statistical methods used to compute the results are illustrated in 
                <xref ref-type="fig" rid="f4">
Figure 4</xref>. It begins with data collection and preparation, followed by stability/stationary testing and the execution of stepwise panel regression models to produce the final results.</p>
            <fig fig-type="figure" id="f4" orientation="portrait" position="float">
                <label>
Figure 4. </label>
                <caption>
                    <title>Overview of the workflow of the study.</title>
                    <p>Source: Authors&#x2019; illustrations.</p>
                </caption>
                <graphic id="gr4" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/173856/c1da134a-2424-41f7-ac25-e4e36e28cf08_figure4.gif"/>
            </fig>
            <sec id="sec13">
                <title>Data</title>
                <p>The study used secondary data sources that are presented in 
                    <xref ref-type="table" rid="T2">
Table 2</xref>. The study used a panel dataset of 26 nations, focusing on the American region, across 20 years, starting from 2000. The latest reported data is the latest data available currently.</p>
                <table-wrap id="T2" orientation="portrait" position="float">
                    <label>
Table 2. </label>
                    <caption>
                        <title>Data variable definitions and variables.</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">Variable Code</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Variable</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Measurement Unit</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Source</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>

                                        <italic toggle="yes">CORR</italic>
</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Corruption Score</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Corruption Perception Index (0-100)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Transparency International
                                    <break/>

                                    <ext-link ext-link-type="uri" xlink:href="https://www.transparency.org/en/cpi/2023">https://www.transparency.org/en/cpi/2023</ext-link>
</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>

                                        <italic toggle="yes">SUI</italic>
</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Suicides</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Crude suicide rates (per 100,000 population)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">World Health Organization
                                    <break/>

                                    <ext-link ext-link-type="uri" xlink:href="https://www.who.int/data/gho/data/indicators/indicator-details/GHO/crude-suicide-rates-(per-100-000-population">https://www.who.int/data/gho/data/indicators/indicator-details/GHO/crude-suicide-rates-(per-100-000-population</ext-link>)</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>

                                        <italic toggle="yes">INFL</italic>
</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Inflation</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Inflation, consumer prices (annual %)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">The World Bank
                                    <break/>

                                    <ext-link ext-link-type="uri" xlink:href="https://data.worldbank.org/indicator/FP.CPI.TOTL.ZG">https://data.worldbank.org/indicator/FP.CPI.TOTL.ZG</ext-link>
</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>

                                        <italic toggle="yes">UNEMP</italic>
</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Unemployment</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Unemployment, total (% of total labour force) (modelled ILO estimate)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">The World Bank
                                    <break/>

                                    <ext-link ext-link-type="uri" xlink:href="https://data.worldbank.org/indicator/SL.UEM.TOTL.ZS">https://data.worldbank.org/indicator/SL.UEM.TOTL.ZS</ext-link>
</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>

                                        <italic toggle="yes">EG</italic>
</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Economic Growth</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">GDP growth (annual %)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">The World Bank
                                    <break/>

                                    <ext-link ext-link-type="uri" xlink:href="https://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG">https://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG</ext-link>
</td>
                            </tr>
                        </tbody>
                    </table>
                    <table-wrap-foot>
                        <p>Source: Authors&#x2019; compilation based on the data from the 
                            <xref ref-type="bibr" rid="ref70">World Bank (2024)</xref>, the 
                            <xref ref-type="bibr" rid="ref66">Transparency International (2024)</xref>, and the 
                            <xref ref-type="bibr" rid="ref49">World Health Organization (2024)</xref>.</p>
                    </table-wrap-foot>
                </table-wrap>
                <p>The study utilised stepwise panel regression models as analytical methodology. The analyses were executed for the whole Americas and for the three income level categories that can be primarily noticed within the region - high, upper-middle, and lower-middle income nations. First, the stationarity and the stability of the dataset were tested using the unit root tests: Levi-Lin-Chu (LLC) and Fisher Augmented Dicky Fuller (Fisher ADF), and the CUSUM tests. Ensuring stationarity is critical for maintaining stable relationships between variables throughout time (
                    <xref ref-type="bibr" rid="ref37">Kwiatkowski et al., 1992</xref>). The CUSUM plots are recommended for minimal projected movement to measure process stability (
                    <xref ref-type="bibr" rid="ref56">Saniga et al., 2006</xref>). Then, three specification tests were performed to determine the most suitable model: Pooled Ordinary Least Squares (POLS), Random Effect Model (REM), or Fixed Effect Model (FEM). The F test was used to assess the suitable model from POLS and FEM (
                    <xref ref-type="bibr" rid="ref73">Yang et al., 2007</xref>). The LM (Lagrange Multiplier) test assessed the best model from POLS and REM (
                    <xref ref-type="bibr" rid="ref8">Breusch &amp; Pagan, 1980</xref>). Finally, the Hausman test was used to determine the applicability of the RE and FE models (
                    <xref ref-type="bibr" rid="ref11">Chmelarova, 2006</xref>). Furthermore, the analysis was performed with conventional robust error, which eliminated the issue of heteroscedasticity.</p>
                <p>Next, to analyse how 

                    <italic toggle="yes">CORR,
</italic> with the influence of three selected moderating variables affects 
                    <italic toggle="yes">SUI</italic> with a focus on the American region, below 
                    <xref ref-type="disp-formula" rid="e1">
Equation 1</xref> was developed.
                    <disp-formula id="e1">

                        <mml:math display="block">
                            <mml:mi mathvariant="italic">SU</mml:mi>
                            <mml:msub>
                                <mml:mi>I</mml:mi>
                                <mml:mi mathvariant="italic">it</mml:mi>
                            </mml:msub>
                            <mml:mo>=</mml:mo>
                            <mml:msub>
                                <mml:mi>&#x03b2;</mml:mi>
                                <mml:mn>0</mml:mn>
                            </mml:msub>
                            <mml:mo>+</mml:mo>
                            <mml:msub>
                                <mml:mi>&#x03b2;</mml:mi>
                                <mml:mn>1</mml:mn>
                            </mml:msub>
                            <mml:msub>
                                <mml:mi mathvariant="italic">SUI</mml:mi>
                                <mml:mrow>
                                    <mml:mi mathvariant="italic">it</mml:mi>
                                    <mml:mo>&#x2212;</mml:mo>
                                    <mml:mn>1</mml:mn>
                                </mml:mrow>
                            </mml:msub>
                            <mml:mo>+</mml:mo>
                            <mml:msub>
                                <mml:mi>&#x03b2;</mml:mi>
                                <mml:mn>2</mml:mn>
                            </mml:msub>
                            <mml:mi mathvariant="italic">COR</mml:mi>
                            <mml:msub>
                                <mml:mi>R</mml:mi>
                                <mml:mi mathvariant="italic">it</mml:mi>
                            </mml:msub>
                            <mml:mo>+</mml:mo>
                            <mml:msub>
                                <mml:mi>&#x03b2;</mml:mi>
                                <mml:mn>3</mml:mn>
                            </mml:msub>
                            <mml:msub>
                                <mml:mrow>
                                    <mml:mo stretchy="true">(</mml:mo>
                                    <mml:mtext mathvariant="italic">CORR</mml:mtext>
                                    <mml:mo>&#x00d7;</mml:mo>
                                    <mml:mo>&#x2206;</mml:mo>
                                    <mml:mtext mathvariant="italic">INFL</mml:mtext>
                                    <mml:mo stretchy="true">)</mml:mo>
                                </mml:mrow>
                                <mml:mi mathvariant="italic">it</mml:mi>
                            </mml:msub>
                            <mml:mo>+</mml:mo>
                            <mml:msub>
                                <mml:mi>&#x03b2;</mml:mi>
                                <mml:mn>4</mml:mn>
                            </mml:msub>
                            <mml:msub>
                                <mml:mrow>
                                    <mml:mo stretchy="true">(</mml:mo>
                                    <mml:mtext mathvariant="italic">CORR</mml:mtext>
                                    <mml:mo>&#x00d7;</mml:mo>
                                    <mml:mtext mathvariant="italic">UNEMP</mml:mtext>
                                    <mml:mo stretchy="true">)</mml:mo>
                                </mml:mrow>
                                <mml:mi mathvariant="italic">it</mml:mi>
                            </mml:msub>
                            <mml:mo>+</mml:mo>
                            <mml:msub>
                                <mml:mi>&#x03b2;</mml:mi>
                                <mml:mn>5</mml:mn>
                            </mml:msub>
                            <mml:msub>
                                <mml:mrow>
                                    <mml:mo stretchy="true">(</mml:mo>
                                    <mml:mtext mathvariant="italic">CORR</mml:mtext>
                                    <mml:mo>&#x00d7;</mml:mo>
                                    <mml:mi mathvariant="italic">EG</mml:mi>
                                    <mml:mo stretchy="true">)</mml:mo>
                                </mml:mrow>
                                <mml:mi mathvariant="italic">it</mml:mi>
                            </mml:msub>
                            <mml:mo>+</mml:mo>
                            <mml:msub>
                                <mml:mi>&#x03b5;</mml:mi>
                                <mml:mi mathvariant="italic">it</mml:mi>
                            </mml:msub>
                        </mml:math>

                        <label>(1)</label>
</disp-formula>
                </p>
                <p>The 
                    <italic toggle="yes">SUI
                        <sub>it</sub>
                    </italic> is the suicide rate, with 
                    <sub>

                        <italic toggle="yes">i</italic>
                    </sub> as income category and 
                    <sub>t</sub> as time. 
                    <italic toggle="yes">SUI</italic>
                    <sub>

                        <italic toggle="yes">it</italic>-1</sub> represents the lagged suicide rate. This variable was introduced to eliminate the stationary issue of the dataset.</p>
                <p>

                    <italic toggle="yes">CORR
                        <sub>it</sub>
                    </italic> measures corruption levels, whereas (
                    <italic toggle="yes">CORR &#x00d7; &#x0394;INFL</italic>)
                    <sub>

                        <italic toggle="yes">it</italic>
                    </sub> demonstrates the moderating effect of inflation (first-differenced). This 
                    <italic toggle="yes">&#x0394;INFL</italic> was introduced to fix the stability issue of the 
                    <italic toggle="yes">INFL</italic> variable. The terms (
                    <italic toggle="yes">CORR &#x00d7; UNEMP</italic>)
                    <sub>

                        <italic toggle="yes">it</italic>
                    </sub> and (
                    <italic toggle="yes">CORR &#x00d7; EG</italic>)
                    <sub>

                        <italic toggle="yes">it</italic>
                    </sub> denote the moderating effects of unemployment and economic growth, respectively. The coefficients 
                    <italic toggle="yes">&#x03b2;</italic>
                    <sub>0</sub>, 
                    <italic toggle="yes">&#x03b2;</italic>
                    <sub>1</sub>, 
                    <italic toggle="yes">&#x03b2;</italic>
                    <sub>2</sub>, 
                    <italic toggle="yes">&#x03b2;</italic>
                    <sub>3</sub>, 
                    <italic toggle="yes">
&#x03b2;</italic>
                    <sub>4,</sub> and 
                    <italic toggle="yes">&#x03b2;</italic>
                    <sub>5</sub> represent the intercept and slopes of the regression line, which describe the impact of the independent variables on the dependent variable 

                    <italic toggle="yes">SUI
                        <sub>it</sub>,
</italic> and the error term is denoted by 
                    <italic toggle="yes">&#x03b5;
                        <sub>it</sub>.</italic> Next, the initial stepwise panel regression models were developed to analyse the stepwise effects of 
                    <italic toggle="yes">SUI</italic>
                    <sub>

                        <italic toggle="yes">it</italic>-1</sub>, 
                    <italic toggle="yes">CORR, CORR &#x00d7; &#x0394;INFL, CORR &#x00d7; UNEMP</italic>, and 
                    <italic toggle="yes">CORR &#x00d7; EG</italic> on 
                    <italic toggle="yes">SUI.</italic>
                </p>
                <p>Ultimately, the final model was refined by stepwise panel regression, with variables added or eliminated based on statistical significance or discrepancies with previous studies. The model was rerun to obtain the final findings. Panel regression provides several advantages, including the capability to account for unobserved heterogeneity, improve statistical efficiency, model dynamic relationships, and accommodate both fixed and random variables, resulting in more robust and flexible findings (
                    <xref ref-type="bibr" rid="ref23">Hsiao, 2007</xref>). Furthermore, stepwise regression makes model selection easier by automatically finding relevant predictors, lowering the risk of overfitting, and enhancing model interpretability and generalisability, especially in large datasets. Thus, the technique is suitable for developing socioeconomic models.</p>
                <p>To derive the results of the study, panel regressions and stationary tests were carried out using STATA whereas RStudio and DATAtab were utilised, to generate the CUSUM plots and violin plots respectively.</p>
            </sec>
        </sec>
        <sec id="sec14" sec-type="results">
            <title>Results</title>
            <p>This study contains 520 observations, 160, 280, and 80 across 20 years, which are associated with high-income, upper-middle-income, and lower-middle-income countries in the American region, respectively.</p>
            <p>
                <xref ref-type="fig" rid="f5">
Figure 5</xref> illustrates the descriptive statistics in violin plots for the ease of comparison between different income groups and the Americas, providing a clear visual representation of the distribution of critical variables among different income categories of the Americas. The 5(A) plots show that high-income countries have the greatest mean corruption levels, whereas lower- and middle-income countries have lower mean values with more variability. The SUI variable data distribution is depicted by the 5(B) plots, with high-income countries exhibiting both higher mean suicide rates and more considerable variability than other income categories. The 5(C) plots depict GDP growth, with lower-middle-income countries experiencing a greater variety of growth results. In contrast, upper-middle- and high-income countries demonstrate more consistent economic growth. The 
                <italic toggle="yes">UNEMP</italic> factor is illustrated by the 5(D) plots, with middle-income countries seeing more significant variability than high-income countries, which maintain lower and more constant unemployment levels. Finally, the 5(E) violin plots depict 
                <italic toggle="yes">INFL</italic>, the violin plots are shown in two value scales due to high performance in specific categories. The Americas and upper-middle income" categories have extremely high maximum values due to special conditions faced by upper-middle- income countries (Especially, Venezuela&#x2019;s hyperinflation). The upper lower-middle income countries have a larger range of inflation readings than the more stable high-income
 ones.</p>
            <fig fig-type="figure" id="f5" orientation="portrait" position="float">
                <label>
Figure 5. </label>
                <caption>
                    <title>Descriptive statistics in violin plots.</title>
                    <p>Source: Authors&#x2019; illustrations based on the data from the 
                        <xref ref-type="bibr" rid="ref70">World Bank (2024)</xref>, 
                        <xref ref-type="bibr" rid="ref66">Transparency International (2024)</xref>, and the 
                        <xref ref-type="bibr" rid="ref49">World Health Organization (2024)</xref>.</p>
                </caption>
                <graphic id="gr5" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/173856/c1da134a-2424-41f7-ac25-e4e36e28cf08_figure5.gif"/>
            </fig>
            <p>These observations are supported by the detailed descriptive statistics which provide more information on the mean, standard deviation, and range for each variable (Available in repository - Appendix 1). Together, the visual and statistical summaries establish the path for a more in-depth examination of the linkages between economic conditions, corruption, and suicides in the subsequent sections of this study.</p>
            <sec id="sec15">
                <title>Initial observations</title>
                <p>The observations of suicide rates across the American region from 20 years apart depicted in 
                    <xref ref-type="fig" rid="f6">
Figure 6</xref>, reveal considerable regional variations. Suicide rates in countries such as Guyana increased dramatically, from 31.35 in 2000 to 40.28 in 2019, while in Brazil, the rate nearly doubled, from 3.98 to 6.89. Conversely, specific countries, such as Argentina and Venezuela, saw their rates fall from 9.11 to 8.37 and 5.44 to 2.05, respectively. The United States had a significant increase, from 11.03 to 16.14. Overall, it shows a complex pattern of gains and falls, while overall, in many countries &#x2018;suicides have risen (An illustration of suicide in the countries of the Americas during the same period (2000-2019) is available in repository - Appendix 2). Over two decades, Guyana had the highest suicide rates, showing significant growth. Canada, while the second highest, maintained consistent levels. Suriname and Uruguay had high rates with minor volatility. Canada, the U.S., and Argentina showed steady trends, while Venezuela, Jamaica, Honduras, and Panama consistently had low suicide rates.</p>
                <fig fig-type="figure" id="f6" orientation="portrait" position="float">
                    <label>
Figure 6. </label>
                    <caption>
                        <title>Suicide rates comparison maps 2000 vs 2019.</title>
                        <p>Source: Authors&#x2019; compilation based on the 
                            <xref ref-type="bibr" rid="ref49">World Health Organization data (2024)</xref>.</p>
                    </caption>
                    <graphic id="gr6" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/173856/c1da134a-2424-41f7-ac25-e4e36e28cf08_figure6.gif"/>
                </fig>
                <p>The analysis of corruption index values from 2000 to 2019 in 
                    <xref ref-type="fig" rid="f7">
Figure 7</xref> depicts the Americas and reveals diverse trends across the American area. As key observations, Argentina improved from 35 to 45, indicating a decrease in corruption, whereas Brazil fell from 39 to 35. Canada and the United States both showed reductions, with Canada dropping from 92 to 77 and the United States from 78 to 69, indicating growing corruption. Guyana improved dramatically from 25 to 40, whereas Venezuela&#x2019;s grade fell from 27 to 16, indicating worsening corruption. Overall, the region presents a mixed picture, with some governments making headway in tackling corruption and others falling back.</p>
                <fig fig-type="figure" id="f7" orientation="portrait" position="float">
                    <label>
Figure 7. </label>
                    <caption>
                        <title>Corruption comparison maps 2000 vs 2019.</title>
                        <p>Source: Authors&#x2019; compilation based on the Transparency International data (2024).</p>
                    </caption>
                    <graphic id="gr7" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/173856/c1da134a-2424-41f7-ac25-e4e36e28cf08_figure7.gif"/>
                </fig>
                <p>Furthermore, Venezuela&#x2019;s corruption score has dropped significantly, indicating that corruption is on the rise. In contrast, countries such as Canada, the United States, Guatemala, Nicaragua, and Barbados have all seen increased corruption in recent years. In contrast, Argentina, Guyana, Ecuador, Costa Rica, and Panama all improved, while Brazil and Barbados demonstrated more variable tendencies. Overall, the data show an increasing burden of corruption across the area, with notable differences between governments that manage corruption well and those that are losing control (An illustration of corruption in the countries of the Americas during the same period (2000-2019) is available inrepository - Appendix 3).</p>
                <p>The following 
                    <xref ref-type="fig" rid="f8">
Figure 8</xref> illustrates inflation rates in the Americas between 2000 and 2019. Venezuela encountered an exceptional increase in inflation, rising from 16.29% to 19,906.62%, indicating a period of hyperinflation Argentina similarly experienced a rise in inflation from -0.70% in 2000 to 53.80% in 2019. The fundamental cause of this crisis was the country&#x2019;s reliance on oil exports, which made the economy sensitive to global oil price fluctuations, known as &#x201c;Dutch disease.&#x201d; Additional factors, such as Chavismo&#x2019;s restrictive state-controlled policies, the growth of black markets, and the authoritarian government under Ch&#x00e1;vez and Maduro, intensified economic instability and hyperinflation (
                    <xref ref-type="bibr" rid="ref69">Wang, 2022</xref>). Other countries, including Mexico, Canada, and the United States, kept inflation rates relatively low and consistent during this time. However, the region&#x2019;s inflationary tendencies are varied, with some nations stabilising and others, such as Argentina and Venezuela, experiencing intense inflationary pressures.</p>
                <fig fig-type="figure" id="f8" orientation="portrait" position="float">
                    <label>
Figure 8. </label>
                    <caption>
                        <title>Inflation comparison maps 2000 vs 2019.</title>
                        <p>Source: Authors&#x2019; compilation based on the 
                            <xref ref-type="bibr" rid="ref70">World Bank data (2024)</xref>.</p>
                    </caption>
                    <graphic id="gr8" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/173856/c1da134a-2424-41f7-ac25-e4e36e28cf08_figure8.gif"/>
                </fig>
                <p>The examination of unemployment rates from 2000 to 2019 yields varied results, as depicted in 
                    <xref ref-type="fig" rid="f9">
Figure 9</xref>. Argentina&#x2019;s unemployment rate fell significantly from 15.00 to 9.84, whilst Brazil&#x2019;s grew from 10.53 to 12.05. Colombia improved, going from 20.52 to 9.96, while Suriname decreased from 12.74 to 8.03. The United States saw a modest decline from 3.99 to 3.67. In comparison, Guyana&#x2019;s rate increased marginally, from 11.89 to 13.52. Overall, while some nations made headway in lowering unemployment, others, such as Brazil and Guyana, saw rates rise, reflecting regional labour market patterns.</p>
                <fig fig-type="figure" id="f9" orientation="portrait" position="float">
                    <label>
Figure 9. </label>
                    <caption>
                        <title>Unemployment comparison maps 2000 vs 2019.</title>
                        <p>Source: Authors&#x2019; compilation based on the 
                            <xref ref-type="bibr" rid="ref70">World Bank data (2024)</xref>.</p>
                    </caption>
                    <graphic id="gr9" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/173856/c1da134a-2424-41f7-ac25-e4e36e28cf08_figure9.gif"/>
                </fig>
                <p>The GDP growth comparison maps for the Americas from 2000 to 2019 are depicted in 
                    <xref ref-type="fig" rid="f10">
Figure 10</xref>, and they indicate unfavourable economic growth patterns in most Americas countries. Brazil&#x2019;s growth rate dropped significantly, while Venezuela&#x2019;s decreased dramatically from 3.69% to -27.67%. Argentina and Ecuador also saw near-zero or negative growth rates, indicating experiences of economically troublesome conditions. However, countries like the Dominican Republic, Bolivia, and Guyana performed well, maintaining or improving their growth rates. Overall, the region saw more economic setbacks than growth outcomes.</p>
                <fig fig-type="figure" id="f10" orientation="portrait" position="float">
                    <label>
Figure 10. </label>
                    <caption>
                        <title>Economic growth comparison maps 2000 vs 2019.</title>
                        <p>Source: Authors&#x2019; compilation based on the 
                            <xref ref-type="bibr" rid="ref70">World Bank data (2024)</xref>.</p>
                    </caption>
                    <graphic id="gr10" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/173856/c1da134a-2424-41f7-ac25-e4e36e28cf08_figure10.gif"/>
                </fig>
                <p>These maps and line graphs provide insight into patterns of corruption, suicide rates, and economic indicators such as inflation, unemployment, and GDP growth throughout the Americas from 2000 to 2019. By analysing these trends at the country level, the report identifies significant socioeconomic concerns, setting the foundation for future research and policy interventions.</p>
                <p>The primary analysis of this research is the stepwise panel regression. As the first step, the stationarity and stability of the datasets were tested. This step guarantees that the variables maintain stable associations across time. 
                    <xref ref-type="table" rid="T3">
Table 3</xref> below confirms that the datasets are stationarity, utilizing LLC and Fisher ADF tests.</p>
                <table-wrap id="T3" orientation="portrait" position="float">
                    <label>
Table 3. </label>
                    <caption>
                        <title>Stationary unit root tests.</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">Variables</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">LLC Test</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">
Fisher ADF</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <italic toggle="yes">CORR 
                                        <sub>it</sub>
                                    </italic>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-2.1193**</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-2.9676***</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <italic toggle="yes">SUI
                                        <sub>it-1</sub>
                                    </italic>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-1.1386*</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-1.9039**</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <italic toggle="yes">UNEMP</italic>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-4.6994***</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-0.6318*</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <italic toggle="yes">EG 
                                        <sub>it</sub>
                                    </italic>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-6.5100***</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-9.7929***</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <italic toggle="yes">CORR&#x0394;INFL 
                                        <sub>it</sub>
                                    </italic>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-15.7171***</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-25.2726***</td>
                            </tr>
                        </tbody>
                    </table>
                    <table-wrap-foot>
                        <p>Note: The symbols *, **, and *** represent 10%, 5%, and 1% significance levels, respectively.</p>
                        <p>Source: Authors&#x2019; calculations are based on the data from the 
                            <xref ref-type="bibr" rid="ref70">World Bank (2024)</xref>, 
                            <xref ref-type="bibr" rid="ref66">Transparency International (2024)</xref>, and the 
                            <xref ref-type="bibr" rid="ref49">World Health Organization (2024)</xref>.</p>
                    </table-wrap-foot>
                </table-wrap>
                <p>The structural stability of the study&#x2019;s datasets is confirmed through CUSUM plots, as depicted in 
                    <xref ref-type="fig" rid="f11">
Figure 11</xref> wherein stability is measured under a 95% significance level.</p>
                <fig fig-type="figure" id="f11" orientation="portrait" position="float">
                    <label>
Figure 11. </label>
                    <caption>
                        <title>CUSUM plots as stability test.</title>
                        <p>Source: Authors&#x2019; illustrations using RStudio.</p>
                    </caption>
                    <graphic id="gr11" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/173856/c1da134a-2424-41f7-ac25-e4e36e28cf08_figure11.gif"/>
                </fig>
                <p>The results of the stationarity and stability tests establish the dataset&#x2019;s dependability for panel regression analysis, guaranteeing that the variables maintain stable associations across time and that the model is appropriate for the next stage of statistical research.</p>
                <p>Next, the selection of the best model fit for panel data analysis across all Americas is presented in 
                    <xref ref-type="table" rid="T4">
Table 4</xref>, which includes separate income categories. The F-test shows that the POLS model is ineffective, whereas FEM is preferable. The LM test reveals no significant changes between income levels, indicating that the REM does not outperform POLS. The Hausman Test reveals that FEM is the best fit across all income levels (The stepwise results for each category is available in repository - Appendix 4).</p>
                <table-wrap id="T4" orientation="portrait" position="float">
                    <label>
Table 4. </label>
                    <caption>
                        <title>Specification tests for the final stepwise panel regression model.</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="1" rowspan="4" valign="top">Income Levels</th>
                                <th align="left" colspan="3" rowspan="1" valign="top">Tests</th>
                            </tr>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">F test</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">F test</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">
F test</th>
                            </tr>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">H0: POLS</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">H0: POLS</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">H0: POLS</th>
                            </tr>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">H1: Fixed Effect</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">H1: Fixed Effect</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">H1: Fixed Effect</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Americas</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">5017.66 ***</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.00</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">45.53***</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">High-Income Level</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">2236.32***</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.85</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">10.65***</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Upper-Middle Income Level</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">3688.55***</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.00</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">46.76***</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Lower-Middle Income Level</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">814.22***</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.00</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">21.21***</td>
                            </tr>
                        </tbody>
                    </table>
                    <table-wrap-foot>
                        <p>Note: The symbols *, **, and *** represent 10%, 5%, and 1% significance levels, respectively.</p>
                        <p>Source: Authors&#x2019; calculations are based on the data from the 
                            <xref ref-type="bibr" rid="ref70">World Bank (2024)</xref>, 
                            <xref ref-type="bibr" rid="ref66">Transparency International (2024)</xref>, and the 
                            <xref ref-type="bibr" rid="ref49">World Health Organization (2024).</xref>
                        </p>
                    </table-wrap-foot>
                </table-wrap>
                <p>
                    <xref ref-type="table" rid="T5">
Table 5</xref> shows the results of the final stepwise panel regression models for the Americas and three income categories: high, upper-middle, and lower-middle-income countries (The groundwork of the final stepwise panel regression is available in repository - Appendix 5). In the next step, the base for building the final regression models of the Americas and the different income groups was tested (The fixed and random effect estimates for the final stepwise model is available in repository - Appendix 6). When developing the Americas regression model, the 
                    <italic toggle="yes">CORR</italic> 
                    <inline-formula>

                        <mml:math display="inline">
                            <mml:mo mathvariant="bold-italic">&#x00d7;</mml:mo>
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                    <italic toggle="yes">&#x0394;INFL</italic> variable is dropped due to changing coefficient signs across different stepwise models. All income level category regression models successfully included all the chosen variables since they aligned with the coefficient signs in previous literature and were consistent throughout stepwise models. These tests provided necessary information on the applicability and suitability of the various models, allowing to choose the most effective approach for the analysis.</p>
                <table-wrap id="T5" orientation="portrait" position="float">
                    <label>
Table 5. </label>
                    <caption>
                        <title>Final Regression Models.</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top"/>
                                <th align="left" colspan="1" rowspan="1" valign="top">Americas</th>
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                                <th align="left" colspan="1" rowspan="1" valign="top">Upper middle income</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">
Lower middle income</th>
                            </tr>
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                                <th align="left" colspan="1" rowspan="1" valign="top">Equation</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">

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                                                <mml:mo stretchy="true">)</mml:mo>
                                            </mml:mrow>
                                        </mml:math>
</inline-formula>
</th>
                            </tr>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">Variables</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">

                                    <italic toggle="yes">SUI</italic>
</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">

                                    <italic toggle="yes">SUI</italic>
</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">

                                    <italic toggle="yes">SUI</italic>
</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">

                                    <italic toggle="yes">SUI</italic>
</th>
                            </tr>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top"/>
                                <th align="left" colspan="1" rowspan="1" valign="top">

                                    <italic toggle="yes">FEM</italic>
</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">

                                    <italic toggle="yes">FEM</italic>
</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">

                                    <italic toggle="yes">FEM</italic>
</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">

                                    <italic toggle="yes">FEM</italic>
</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="1" rowspan="2" valign="middle">
                                    <inline-formula>

                                        <mml:math display="inline">
                                            <mml:msub>
                                                <mml:mi mathvariant="bold-italic">SUI</mml:mi>
                                                <mml:mrow>
                                                    <mml:mi mathvariant="bold-italic">it</mml:mi>
                                                    <mml:mo mathvariant="bold-italic">&#x2212;</mml:mo>
                                                    <mml:mn mathvariant="bold">1</mml:mn>
                                                </mml:mrow>
                                            </mml:msub>
                                        </mml:math>
</inline-formula>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.8063***</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.8059***</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.7416***</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.3929***</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0949446)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.029358)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0376741)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.111296)</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="2" valign="middle">
                                    <inline-formula>

                                        <mml:math display="inline">
                                            <mml:mtext mathvariant="bold-italic">CORR</mml:mtext>
                                        </mml:math>
</inline-formula>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-0.0001</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-0.0001</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-0.0268**</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-0.0151</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0115197)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0093758)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0105321)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0184751)</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="2" valign="middle">
                                    <inline-formula>

                                        <mml:math display="inline">
                                            <mml:mtext mathvariant="bold-italic">CORR</mml:mtext>
                                            <mml:mo mathvariant="bold-italic">&#x00d7;</mml:mo>
                                            <mml:mo mathvariant="bold-italic">&#x2206;</mml:mo>
                                            <mml:mtext mathvariant="bold-italic">INFL</mml:mtext>
                                        </mml:math>
</inline-formula>
</td>
                                <td colspan="1" rowspan="1"/>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-2.82e-07</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-2.55e-07</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-0.0002</td>
                            </tr>
                            <tr>
                                <td colspan="1" rowspan="1"/>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(6.40e-07)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(5.09e-07)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.000498)</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="2" valign="middle">
                                    <inline-formula>

                                        <mml:math display="inline">
                                            <mml:mtext mathvariant="bold-italic">CORR</mml:mtext>
                                            <mml:mo mathvariant="bold-italic">&#x00d7;</mml:mo>
                                            <mml:mtext mathvariant="bold-italic">UNEMP</mml:mtext>
                                        </mml:math>
</inline-formula>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.0006</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.0006*</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.0022***</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.0040***</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0009214)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0004467)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0006107)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0015929)</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="2" valign="middle">
                                    <inline-formula>

                                        <mml:math display="inline">
                                            <mml:mtext mathvariant="bold-italic">CORR</mml:mtext>
                                            <mml:mo mathvariant="bold-italic">&#x00d7;</mml:mo>
                                            <mml:mi mathvariant="bold-italic">EG</mml:mi>
                                        </mml:math>
</inline-formula>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-0.0005*</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-0.0005*</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-0.0003</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">-0.0005</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0003641)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0002868)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0003484)</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">(0.0008034)</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>Constant</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">1.557312</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">1.5663</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">2.2007</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">3.3192</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>No of Countries</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">26</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">8</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">14</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">4</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>R</bold>
                                    <sup>

                                        <bold>2</bold>
                                    </sup> 
                                    <bold>Within</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.6490</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.6492</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.6481</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.3916</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>R</bold>
                                    <sup>

                                        <bold>2</bold>
                                    </sup> 
                                    <bold>Between</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.9995</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.9995</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.9971</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.9709</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">
                                    <bold>R</bold>
                                    <sup>

                                        <bold>2</bold>
                                    </sup> 
                                    <bold>Overall</bold>
</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.9893</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.9892</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.9848</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">0.9453</td>
                            </tr>
                        </tbody>
                    </table>
                    <table-wrap-foot>
                        <p>Note: (.) indicates the Robust standard error.</p>
                        <p>The symbols *, **and *** represents 10%, 5% and 1% significance level, respectively.</p>
                    </table-wrap-foot>
                </table-wrap>
                <p>The results of the final stepwise panel regression suggest that suicide rates persist over time, as evidenced by the lagged variable (
                    <italic toggle="yes">SUI
                        <sub>it-1</sub>
                    </italic>), which is highly significant across all income levels, particularly in the whole Americas and the high-income countries. 
                    <italic toggle="yes">CORR</italic> has an insignificant direct influence, except in upper-middle-income nations, where it has a positive and significant coefficient. However, its interactions with economic moderators produce more substantial results. For example, the moderation between corruption and unemployment is positive and significant across all income levels. Yet, it shows the highest significance and impact in only upper-middle-income and lower-middle income nations, implying that corruption combined with increased unemployment rates increases suicide rates in middle-income countries. Economic growth has a minor negative impact across all categories. However, it is only significant in high-income and Americas models, implying that corruption moderated by economic growth may modestly reduce suicide risk.</p>
                <p>The overall R
                    <sup>2</sup> levels across all income categories demonstrate a solid fit for the models. For the entire Americas, the overall R
                    <sup>2</sup> indicates the model explains that 98.93% of the variation in suicide rates. Similarly, in high-income countries, the R
                    <sup>2</sup> states 98.92% reflecting a very close level of explanatory power. Upper-middle-income countries&#x2019; overall R
                    <sup>2</sup> indicates 98.48% model success, while lower-middle-income countries show a slightly lower but still strong R
                    <sup>2</sup> explaining 94.53% of overall explanatory power. These high R
                    <sup>2</sup> values indicate that the models effectively capture the relationships between suicide rates and the included variables across all income categories.</p>
                <p>The findings showed the persistent significance of the lagged suicide rate across all income levels, emphasising its importance as a predictor of future suicide rates. Although 
                    <italic toggle="yes">CORR</italic> has low direct importance, its interaction with other economic variables, particularly 
                    <italic toggle="yes">UNEMP</italic>, has significant moderating effects across income levels. The model accounts for over 94% of the difference in suicide rates across all income levels. These findings suggest that, while previous suicide rates remain a powerful predictor, the impact of corruption, particularly its relationship with unemployment, is an essential element to consider when studying suicide rates in the Americas.</p>
            </sec>
        </sec>
        <sec id="sec16" sec-type="discussion">
            <title>Discussion</title>
            <p>The complex interplay between corruption, economic variables, and mental health is visible in the Americas, where the socioeconomic landscape is marked by significant inequality, different levels of governance, and economic instability. The findings, based on a Panel data regression model, show that corruption, combined with financial stresses, have an influence on suicide rates across income categories of the American region.</p>
            <p>One key finding is that suicide rates in the Americas have remained consistent throughout time across all income levels. The lagged suicide rate is a strong predictor, mainly in high-income countries. Once suicides rise, they tend to stay high, reflecting long-term social and economic challenges. In high-income countries, unmet expectations for personal and financial success can lead to ongoing mental health issues and rising suicide rates, even in stable economies (
                <xref ref-type="bibr" rid="ref22">Helliwell &amp; Huang, 2008</xref>; 
                <xref ref-type="bibr" rid="ref28">HeliKoivumaa-Honkanen et al., 2001</xref>). These findings emphasise the need to take proactive actions to address the underlying social and psychological elements that lead to persistent suicide rates.</p>
            <p>Corruption plays a crucial role in upper-middle-income countries, where it significantly increases suicide rates. Moreover, when corruption acts as a moderating factor, amplifying the effects of unemployment, inflation, and other economic stressors on mental health. Countries where corruption is widespread often see weakened public services, a lack of trust in institutions, and heightened social inequality, all of which contribute to a sense of hopelessness. As a result, the interaction between corruption and economic stressors intensifies the psychological burden on individuals, leading to higher suicide rates. Previous studies confirm that corruption erodes public trust and worsens economic disparities, disproportionately affecting vulnerable populations (
                <xref ref-type="bibr" rid="ref5">Bj&#x00f8;rnskov et al., 2010</xref>). This upper-middle income category&#x2019;s findings stand with the empirical evidence suggesting that corruption worsens economic and social inequality, thereby contributing to emotions of despair and societal dissatisfaction and demonstrating that corruption undermines the effectiveness of public services and disproportionately affects the public (
                <xref ref-type="bibr" rid="ref20">Gupta et al., 2001</xref>; 
                <xref ref-type="bibr" rid="ref27">Kaufmann et al., 2005</xref>). However, in the current study, the impact of corruption is less significant in high-income and lower-middle-income countries. In high-income countries, more robust governance and better social services may buffer the adverse effects of corruption. In contrast, in lower-middle-income countries, more immediate concerns like unemployment appear to take precedence over corruption in driving suicide rates.</p>
            <p>Unemployment has a significant role in explaining suicide rates at all economic levels, particularly in lower-middle-income countries. It functions as a moderating variable for corruption, exacerbating its harmful consequences. High unemployment and financial insecurity produce an environment of economic insecurity in low- and middle-income countries. Individuals who are unemployed for an extended period of time may lose hope in their ability to better their situation, which can lead to worsening psychological issues and, in some instances, suicide (
                <xref ref-type="bibr" rid="ref18">Goulas &amp; Zervoyianni, 2023</xref>; 
                <xref ref-type="bibr" rid="ref63">Skinner et al., 2023</xref>). This aligns with the research demonstrating that unemployment is strongly associated with declining mental health, particularly in countries with weak or non-existent social safety nets (
                <xref ref-type="bibr" rid="ref17">Glaeser &amp; Saks, 2006</xref>). Furthermore, the interplay between unemployment and corruption may worsen the psychological toll, as economic hardship and systemic governance failures compound one another, creating a vicious cycle of despair.</p>
            <p>Despite being statistically insignificant in all the final regression models, inflation is still confirmed to be a crucial variable as there is sufficient literature base to support the finding. Earlier research has shown that it might have a direct or indirect impact on mental health. While many of the studies argue that there is a positive association with inflation&#x2019;s influence on suicide, the current study reflects more of the minority who suggested that inflation has a negative influence on suicide (
                <xref ref-type="bibr" rid="ref46">Noh, 2009</xref>). The current finding suggests that unemployment in some countries may not carry the same social stigma or economic hardships; hence, in some countries and instances, inflation lowers suicide rates The absence of statistical significance in this study implies that inflation may not affect highly on suicide, specifically in the American region but rather a contributing factor when combined with other economic and governance failures.</p>
            <p>In contrast, economic growth serves as a protective factor, lowering the suicide rate, especially in high-income nations. When economic growth is inclusive, it can raise living standards, lessen poverty, and eventually reduce the suicide rate (
                <xref ref-type="bibr" rid="ref57">Sannapureddy et al., 2024</xref>). Even so, the moderating effect of economic growth is not simple to understand. Although economic growth lowers suicide rates in all the income categories, the impact seems to be extremely low.</p>
            <p>This suggests that the benefits of economic growth do not necessarily reach the most vulnerable in lower- and upper-middle-income nations. If growth only benefits a small portion of the population, its protective effect is reduced and social inequality potentially worsened (
                <xref ref-type="bibr" rid="ref15">Fischer &amp; Andres, 2008</xref>). This highlights the need for inclusive economic policies.</p>
            <p>In conclusion, the regression models show how historical trends, economic conditions, and corruption affect suicide rates in the Americas. Unemployment, inflation, and economic growth all serve as moderating or interacting variables that modify the impact of corruption and other pressures on mental health. While suicide rates continue to be a strong predictor, corruption is especially significant in upper-middle-income countries, increasing socioeconomic inequities and contributing to mental health crises. Unemployment is substantial at all income levels, especially in lower-middle-income countries, where it indicates that economic insecurity and poor governance cause significant psychological distress. While inflation has not been shown to have a substantial impact on suicide, it could play an indirect function in increasing financial instability.</p>
            <sec id="sec17">
                <title>Policy implications</title>
                <p>This study&#x2019;s findings reveal a complex nexus of corruption, economic issues, and rising suicide rates throughout the Americas. To address these linked concerns, focused policy actions are required, providing a way to minimise corruption and its destructive impact on mental health.</p>
            </sec>
            <sec id="sec18">
                <title>Enhanced anti-corruption initiatives</title>
                <p>Corruption has a significant impact on suicide rates, particularly in upper-middle-income countries, where the consequences are most severe. According to the current study, corruption damages public trust, reduces institutional performance, and promotes social inequalities, creating a climate of hopelessness and despair. In response, upper-middle-income countries in the American region can execute anti-corruption measures. The adverse effects of corruption on mental health can be minimised by strengthening governance, boosting transparency, and promoting public sector accountability.</p>
            </sec>
            <sec id="sec19">
                <title>Comprehensive unemployment support programs</title>
                <p>Unemployment is another factor that contributes to higher suicide rates across all income categories, particularly middle-income nations (upper and lower). Joblessness, economic insecurity, and insufficient social safety nets, add to increased emotional distress. To tackle this, unemployment support programs should be created. To lessen the psychological burden of unemployment, focused job development strategies, vocational training, and entrepreneurial support should be implemented. Furthermore, strengthening social safety nets, such as unemployment benefits and mental health services, is critical in providing economic and emotional stability to people who are unemployed.</p>
            </sec>
            <sec id="sec20">
                <title>Mental health interventions and services</title>
                <p>Mental health initiatives must be prioritised in communities with high suicide rates, particularly those plagued by corruption and economic instability. It is critical to increase access to community-based mental health services and integrate mental health care into primary health care systems. These services should primarily target vulnerable groups, such as the unemployed and those living in highly corrupt local areas. Such interventions would lessen the psychological impact of economic stress while improving overall mental health outcomes, which can ultimately increase suicides.</p>
            </sec>
            <sec id="sec21">
                <title>Economic growth policies</title>
                <p>According to the current study, while economic progress gives some protection against suicide in high-income countries, its benefits do not necessarily extend to vulnerable populations in middle-income nations. Policies for inclusive growth are necessary to guarantee that more significant numbers of people benefit from economic benefits. While middle-income countries must concentrate on providing growth advantages to underprivileged domains, high-income countries should try to ensure that economic prosperity is distributed fairly. It is essential to carry out periodic assessments of the effects of economic expansion on mental health and inequality to prevent the increments of disparities or suicide rates.</p>
            </sec>
            <sec id="sec22">
                <title>Inflation management</title>
                <p>Even if there was only marginal and no statistically significant influence between inflation and suicide rates, controlling inflation is still essential to maintaining economic stability. As in the case of Venezuela, hyperinflation exacerbates economic instability and may have a secondary impact on mental health. Controlling the volatility of inflation should be a top priority for policymakers, especially in areas with high levels of inflation. Lowering the chances of suicide and the psychological effects of financial instability are two benefits of stabilising the overall economy.</p>
            </sec>
            <sec id="sec23">
                <title>Cross-national collaboration</title>
                <p>Finally, to address the interrelated problems of corruption, unstable economies, and mental health across the Americas, cross-national cooperation should be considered crucial. To exchange resources, best practices, and knowledge in economic policy, mental health interventions, and governance, countries should work together. Cooperation among nations can enhance anti-corruption initiatives, foster regional stability, and lead to better mental health outcomes. Cross-border collaborations, especially between neighbouring nations, will guarantee that these issues are addressed thoroughly and sustainably.</p>
                <p>Moreover, tackling the intricate associations among corruption, unemployment, economic growth, inflation, and mental health necessitates a multifaceted strategy. Vulnerable populations&#x2019; psychological burden can be lessened by implementing targeted anti-corruption measures, increasing unemployment support, encouraging inclusive growth, and improving mental health services. Cross-national collaboration is critical to sustaining these efforts and fostering long-term improvements in public health across the region to fight against the increasing trend of suicide in the American region.</p>
            </sec>
        </sec>
        <sec id="sec24" sec-type="conclusion">
            <title>Conclusion</title>
            <p>This study investigates how corruption, combined with economic factors such as unemployment, inflation, and economic growth, affects suicide rates across different income levels in the Americas. Examining panel data from 26 nations over 20 years, yields the following significant findings.</p>
            <p>First, the persistence of suicide rates is a significant result at all socioeconomic levels. The lagged suicide variable repeatedly showed an overwhelmingly substantial positive association with current suicide rates, implying that once suicide rates rise in a country, they likely continue to be elevated over time. This emphasises the long-term psychological and social consequences of economic insecurity and societal negativity, mainly in high-income countries with severe societal pressure.</p>
            <p>Second, corruption has been identified as a significant driver of suicide rates in upper-middle-income nations, exacerbating inequality and economic suffering. While corruption did not have a statistically significant impact at all income levels, there was a clear link between corruption and suicide in upper-middle-income countries, consistent with previous research linking poor governance and institutional corruption to adverse mental health outcomes.</p>
            <p>Third, unemployment was revealed as a significant moderator at all income levels, with a particularly substantial impact in lower-middle income nations. The combination of high unemployment and corruption produces an environment of economic uncertainty, which contributes to psychological stress and raises suicide rates. This implies that reducing unemployment is crucial in regions with substantial economic vulnerability.</p>
            <p>Fourth, while inflation did not demonstrate consistent statistical significance in our study, its impact on worsening financial stress, particularly in hyperinflationary regions such as Venezuela, must be considered. Inflation indirectly contributes to economic uncertainty, which, combined with other variables such as corruption, may have a long-term impact on suicide rates.</p>
            <p>Finally, the study discovered that when economic development is evenly distributed, suicide rates tend to fall across all income categories. However, in areas with high corruption, the advantages of financial success are less likely to reach poor populations, limiting its protective impact on mental health.</p>
            <p>In conclusion, this study emphasises the significance of a multifaceted approach to suicide prevention in the Americas, addressing not only corruption unemployment and inclusive economic growth Policy measures should prioritise strengthening governance, lowering economic inequities, and improving social safety, to reduce the psychological impact of corruption and financial instability. Future research should focus on these complicated relationships, particularly in low-income nations where the effects of economic factors may differ from those shown in this study. By tackling these crucial socioeconomic causes, authorities can more effectively counteract rising suicide rates and improve mental health outcomes throughout the American region.</p>
            <sec id="sec25">
                <title>Limitations</title>
                <p>This study, while providing valuable insights into the association between corruption and suicide rates in the Americas, has several limitations. First, the data included in the investigation spans a 20-year period, during which many social and political developments happened. These shifts may have altered the outcomes in ways the panel regression model does not entirely account for. Furthermore, the analysis is based on secondary data from trustworthy sources such as the World Bank and Transparency International, which may contain gaps or inconsistencies in reporting. Another limitation is that the current research only addresses governance and economic factors and, cultural and psychological characteristics, which are known to have a significant impact on suicide rates, outside the scope of this study.</p>
            </sec>
        </sec>
        <sec id="sec26">
            <title>Ethics and consent</title>
            <p>Ethics and consent are not required for the performed study.</p>
        </sec>
    </body>
    <back>
        <sec id="sec29" sec-type="data-availability">
            <title>Data availability statement</title>
            <sec id="sec30">
                <title>Underlying data</title>
                <p>Figshare: (The Hidden Toll-Dataset), 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.6084/m9.figshare.27637182">https://doi.org/10.6084/m9.figshare.27637182</ext-link> (
                    <xref ref-type="bibr" rid="ref30">Kularathne &amp; Jayathilaka, 2024</xref>).</p>
            </sec>
            <sec id="sec31">
                <title>Extended data</title>
                <p>This study contains the following extended data:</p>
                <p>Figshare: (Appendix 1), 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.6084/m9.figshare.27637434.v3">https://doi.org/10.6084/m9.figshare.27637434.v3</ext-link> (
                    <xref ref-type="bibr" rid="ref31">Kularathne &amp; Jayathilaka, 2024a</xref>)</p>
                <p>Figshare: (Appendix 2), 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.6084/m9.figshare.27637479.v1">https://doi.org/10.6084/m9.figshare.27637479.v1</ext-link> (
                    <xref ref-type="bibr" rid="ref32">Kularathne &amp; Jayathilaka, 2024b</xref>)</p>
                <p>Figshare: (Appendix 3), 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.6084/m9.figshare.27637557.v1">https://doi.org/10.6084/m9.figshare.27637557.v1</ext-link> (
                    <xref ref-type="bibr" rid="ref33">Kularathne &amp; Jayathilaka, 2024c</xref>)</p>
                <p>Figshare: (Appendix 4), 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.6084/m9.figshare.27637614.v1">https://doi.org/10.6084/m9.figshare.27637614.v1</ext-link> (
                    <xref ref-type="bibr" rid="ref34">Kularathne &amp; Jayathilaka, 2024d</xref>)</p>
                <p>Figshare: (Appendix 5), 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.6084/m9.figshare.27637647.v1">https://doi.org/10.6084/m9.figshare.27637647.v1</ext-link> (
                    <xref ref-type="bibr" rid="ref35">Kularathne &amp; Jayathilaka, 2024e</xref>)</p>
                <p>Figshare: (Appendix 6), 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.6084/m9.figshare.27637725.v1">https://doi.org/10.6084/m9.figshare.27637725.v1</ext-link> (
                    <xref ref-type="bibr" rid="ref36">Kularathne &amp; Jayathilaka, 2024f</xref>)</p>
                <p>Data are available under the terms of the 
                    <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/legalcode">Creative Commons Attribution 4.0 International license</ext-link> (CC-BY 4.0).</p>
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        <front-stub>
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                <article-title>Reviewer response for version 1</article-title>
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                        <surname>Nelson</surname>
                        <given-names>Febby Mutiara</given-names>
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                    <label>1</label>University of Indonesia, Depok, West Java, Indonesia</aff>
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                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
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            <pub-date pub-type="epub">
                <day>8</day>
                <month>1</month>
                <year>2025</year>
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            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2025 Nelson FM</copyright-statement>
                <copyright-year>2025</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport347489" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.158285.1"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>approve-with-reservations</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>
                <underline>
                    <bold>Review</bold>
                </underline>
            </p>
            <p> </p>
            <p> 
                <bold>Strenghts</bold>
            </p>
            <p> &#x00a0; 
                <list list-type="bullet">
                    <list-item>
                        <p>The study addresses a critical and understudied intersection of corruption and suicide rates in the Americas. By filling a gap in literature that lacks comprehensive regional analyses, it offers significant value for public health and governance discourse.</p>
                    </list-item>
                    <list-item>
                        <p>The research employs a robust framework to explore moderating variables like unemployment, inflation, and economic growth, effectively contributing to a nuanced understanding of the socio-economic determinants of suicide.</p>
                    </list-item>
                </list> </p>
            <p> 
                <bold>Areas for Improvement</bold>: 
                <list list-type="bullet">
                    <list-item>
                        <p>
                            <bold>Clarification of causal direction</bold>: The article implies a causal link between corruption and suicide but provides limited discussion of reverse causality or potential bidirectional influences.</p>
                    </list-item>
                    <list-item>
                        <p>
                            <bold>Policy Context</bold>: Although the article discusses policy implications, it could better integrate real-world examples or case studies where similar strategies have succeeded or failed.</p>
                    </list-item>
                </list> 
                <bold>Methodological Review</bold> 
                <list list-type="bullet">
                    <list-item>
                        <p>
                            <bold>Variable Definitions and Justification</bold>: The rationale for using specific metrics like the Corruption Perceptions Index (CPI) needs more explicit justification regarding its relevance and limitations in capturing nuanced governance issues.</p>
                    </list-item>
                    <list-item>
                        <p>
                            <bold>Modeling of Interaction Terms</bold>: The interaction effects involving corruption, unemployment, and inflation need more theoretical grounding to explain why specific relationships are anticipated.</p>
                    </list-item>
                </list> 
                <bold>Theoritical Review</bold>
            </p>
            <p> The literature review connects corruption to mental health through trust erosion and institutional failures, aligning well with existing governance theories</p>
            <p> </p>
            <p> 
                <bold>Areas for Improvement</bold>: 
                <list list-type="bullet">
                    <list-item>
                        <p>
                            <bold>Theoretical Integration</bold>: The theoretical framework could be enriched by incorporating more psychological theories linking economic stressors directly to mental health outcomes. References to Durkheim&#x2019;s theory of anomie or contemporary socio-political models would add depth.</p>
                    </list-item>
                    <list-item>
                        <p>
                            <bold>Conceptual Clarity</bold>: The term "persistence" of suicide rates is used frequently but could be defined more clearly, perhaps linking it to theories of path dependency in social outcomes.</p>
                    </list-item>
                </list> 
                <bold>Overall Recommendations</bold> 
                <list list-type="order">
                    <list-item>
                        <p>
                            <bold>Strengthen the theoretical foundation</bold> by integrating more detailed explanations for the mechanisms connecting corruption, economic conditions, and mental health.</p>
                    </list-item>
                    <list-item>
                        <p>
                            <bold>Expand on policy recommendations</bold> by providing examples or scenarios demonstrating the impact of governance reforms on suicide rates.</p>
                    </list-item>
                    <list-item>
                        <p>
                            <bold>Consider alternative data sources or indices</bold> to triangulate findings on corruption and governance quality.&#x00a0;</p>
                    </list-item>
                </list>
            </p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Yes</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Partly</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>Partly</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>Partly</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Partly</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>Partly</p>
            <p>Reviewer Expertise:</p>
            <p>Criminal law, Corruption Eradication, Economic crimes.</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.</p>
        </body>
        <sub-article article-type="response" id="comment13141-347489">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Jayathilaka</surname>
                            <given-names>Ruwan</given-names>
                        </name>
                        <aff>SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka</aff>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>14</day>
                    <month>1</month>
                    <year>2025</year>
                </pub-date>
            </front-stub>
            <body>
                <p>
                    <bold>
                        <underline>Authors Response to Reviewer 2</underline>
                    </bold>
                </p>
                <p> </p>
                <p> Dear Reviewer 2,</p>
                <p> </p>
                <p> We greatly appreciate the time invested in reading our manuscript and providing the necessary feedback to improve the overall quality of our work. All the mentioned comments have been considered and the revisions made accordingly.</p>
                <p> </p>
                <p> Thank you once again for your valuable feedback.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Reviewer 1 comment 1: Clarification of causal direction: The article implies a causal link between corruption and suicide but provides limited discussion of reverse causality or potential bidirectional influences.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Authors&#x2019; Response to Reviewer 1 comment 1: We sincerely appreciate the reviewer&#x2019;s insightful comment. However, we would like to kindly clarify that this study aimed to investigate the impact of corruption on suicide rates in the Americas, particularly how corruption interacts with economic moderators such as unemployment and economic growth. The study does not aim to analyze the potential bidirectional relationship between corruption and suicide rates, as this is beyond the scope of the current research.</p>
                <p> </p>
                <p> While the potential bidirectional relationship between corruption and suicide rates is indeed an important and interesting area of inquiry, it falls outside the scope of the current research. We hope this clarification aligns with the intended objectives of our study.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Reviewer 1 comment 2: Policy Context: Although the article discusses policy implications, it could better integrate real-world examples or case studies where similar strategies have succeeded or failed.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Authors&#x2019; Response to Reviewer 1 comment As per the reviewer&#x2019;s valuable suggestion, we included real-world examples with proper references in the study.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Reviewer 1 comment 3: Variable Definitions and Justification: The rationale for using specific metrics like the Corruption Perceptions Index (CPI) needs more explicit justification regarding its relevance and limitations in capturing nuanced governance issues.</p>
                <p> </p>
                <p> </p>
                <p> Authors&#x2019; Response to Reviewer 1 comment 3: We are grateful for this thoughtful feedback. In light of the reviewer&#x2019;s suggestion, we have updated the data section to provide a clearer rationale for the use of the Corruption Perceptions Index (CPI). The limitations section also updated to acknowledge the nuances it may not fully capture.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Reviewer 1 comment 4: Modeling of Interaction Terms: The interaction effects involving corruption, unemployment, and inflation need more theoretical grounding to explain why specific relationships are anticipated.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Authors&#x2019; Response to Reviewer 1 comment 4: Thank you for the suggestion. Kindly note that in Table 1, conceptual linkages are shown, as grounding work to the current study. The moderate effects in the current study will be introduced as a novel approach, to this specific study.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Reviewer 1 comment 5: Theoretical Integration: The theoretical framework could be enriched by incorporating more psychological theories linking economic stressors directly to mental health outcomes. References to Durkheim&#x2019;s theory of anomie or contemporary socio-political models would add depth.</p>
                <p> </p>
                <p> </p>
                <p> Authors&#x2019; Response to Reviewer 1 comment 5: Thank you for this insightful suggestion. In response, we have enriched the theoretical framework by incorporating additional psychological theories, including references to Durkheim&#x2019;s theory of anomie and contemporary socio-political models, to provide a more comprehensive foundation for the study.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Reviewer 1 comment 6: Conceptual Clarity: The term "persistence" of suicide rates is used frequently but could be defined more clearly, perhaps linking it to theories of path dependency in social outcomes.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Authors&#x2019; Response to Reviewer 1 comment 6: We appreciate for requesting more clarification on this to improve the clarity of the manuscript. In this study, &#x201c;Persistence&#x201d; means the continuing nature of suicides or the tendency of past suicide rates affecting future suicide. Evidence for this is mainly generated through results. As per the reviewer&#x2019;s concern, theis is&#x00a0; clearly mentioned in this revised version.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Reviewer 1 comment 7: Consider alternative data sources or indices to triangulate findings on corruption and governance quality.</p>
                <p> </p>
                <p> </p>
                <p> </p>
                <p> Authors&#x2019; Response to Reviewer 1 comment 7: Thank you for this valuable suggestion. We appreciate the importance of triangulating findings to enhance the robustness of the study. For this research, we employed the Corruption Perceptions Index (CPI) from Transparency International due to its widespread acceptance, reliability, and comprehensive coverage across countries and time. The CPI is particularly well-suited for cross-country comparisons, which aligns with our study&#x2019;s objective of analyzing corruption across the Americas.</p>
                <p> </p>
                <p> We acknowledge that exploring alternative data sources or indices, such as the Worldwide Governance Indicators (WGI) or Varieties of Democracy (V-Dem) dataset, could provide additional insights and strengthen our conclusions. While these datasets were considered during our initial planning, limitations such as shorter temporal coverage or lack of comparability for the specific variables of interest influenced our decision to focus on the CPI.</p>
                <p> </p>
                <p> To address your suggestion, we propose incorporating these alternative indices in future research to assess the robustness of our findings. This would enable a more nuanced understanding of how different measures of corruption and governance quality interact with suicide rates.</p>
                <p> </p>
                <p> We also included a discussion in the limitations section of the manuscript, acknowledging the potential benefits of triangulating data sources and suggesting this as an area for future exploration.</p>
            </body>
        </sub-article>
    </sub-article>
    <sub-article article-type="reviewer-report" id="report344324">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.173856.r344324</article-id>
            <title-group>
                <article-title>Reviewer response for version 1</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Yamamura</surname>
                        <given-names>Eiji</given-names>
                    </name>
                    <xref ref-type="aff" rid="r344324a1">1</xref>
                    <role>Referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-5903-3582</uri>
                </contrib>
                <aff id="r344324a1">
                    <label>1</label>Seinan Gakuin University, Fukuoka, Japan</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>11</day>
                <month>12</month>
                <year>2024</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2024 Yamamura E</copyright-statement>
                <copyright-year>2024</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport344324" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.158285.1"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>approve-with-reservations</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>Report on&#x00a0;</p>
            <p> &#x2018;The Hidden Toll: Investigating the influence of Corruption on Persistent Suicide in the Americas</p>
            <p> </p>
            <p> The aim of the study is to examine correlation between government corruption and occurrence of suicide in countries in north, central and south America by considering economic condition. As widely known, hyper-inflation occurred in Venezuera. The outcome of inflation in countries in America is valuable to be addressed.&#x00a0;</p>
            <p> However, readers would be confused due to puzzling definition of Corruption. Further, in some parts, interpretation of estimation results is not appropriate or not sufficiently provided. Further, estimation biases seem to occur. Authors should consider suggestions to improve the current version of manuscript.&#x00a0;</p>
            <p> </p>
            <p> Major issues:</p>
            <p> 1.&#x00a0;&#x00a0; &#x00a0;Corruption index might lead readers to misunderstand estimation results because the definition is opposed to intuition. &#x00a0;According to Table 2,&#x00a0;</p>
            <p> "Corruption Perception Index (0-100)" was defined by Transparency International.</p>
            <p> Ordinary saying, larger the value, the more corrupted the government is. However, in the text, to take an example of interpretation for corruption index,</p>
            <p> </p>
            <p> "As key observations, Argentina improved from 35 to 45, indicating a decrease in corruption,"(p.11). &#x00a0;This shows that smaller value of &#x201c;corruption&#x201d; is more corrupted. This is opposed to reader&#x2019;s intuition. Probably, authors follow the definition of the data source. However, I strongly request to modify the definition to be suitable to reader&#x2019;s intuition. Instead of it, in Table 2, authors explained that the definition is changed from that of &#x201c;Transparency International&#x201d; for convenience of reader&#x2019;s interpretation.</p>
            <p> </p>
            <p> 2.&#x00a0;&#x00a0; &#x00a0;By definition of variable, values of COR, SUI, and UNEMP must not be negative. I am not familiar with Violin plots in Figure 5. However, sharded area of these values covered negative area. What does it mean? Authors just mechanically illustrated the Figure 5, but was not informative unless authors carefully and appropriately explain importance of Violin plots. Figure 5 of current version is very curious and might lead readers to be confused. In my view, it is enough to just show mean value and 95% CI in Figure.&#x00a0;</p>
            <p> </p>
            <p> 3.&#x00a0;&#x00a0; &#x00a0;In results Fixed effects model in Table 5, estimation results of constant are shown. Basically, different from OLS, constant is not calculated in Fixed effects model because constant is completely captured by unobservable time invariant factors (Fixed effects). What does constant mean in Table 5?&#x00a0;</p>
            <p> </p>
            <p> 4.&#x00a0;&#x00a0; &#x00a0;In Table 5, Lagged dependent variable is included as independent variable. &#x00a0;In this model, the dynamic panel model is preferred, where Arellano-bond is the basic model although various types of dynamic model have been developed. Especially, time points is relatively long (20 years) and so the dynamic model is appropriated. Most of independent variables seems to be endogenous, that should be mitigated. Fortunately, the Dynamic model mechanically enables authors to deal with the issue of endogenous bias.&#x00a0;</p>
            <p> </p>
            <p> 5.&#x00a0;&#x00a0; &#x00a0;In conclusion, influence of lagged suicide variables is shown as below,</p>
            <p> &#x201c;The lagged suicide variable repeatedly showed an overwhelmingly substantial positive association with current suicide rates, implying that once suicide rates rise in a country, they likely continue to be elevated over time.&#x201d; (p.20).</p>
            <p> </p>
            <p> Their argument is too strong to be supported by the estimation results. In Fixed effects estimation results of Table 5, coefficient of lagged suicide variable is smaller than 1, despite being statistical significant positive sign. Suicide rate will converge among countries in the long run if the value is smaller than 1. &#x00a0;That is, their argument is supported only if the value is statistically positive and larger than 1. Authors hardly interpret values of coefficients, which lead to misinterpretation.&#x00a0;</p>
            <p> </p>
            <p> 6.&#x00a0;&#x00a0; &#x00a0;In table 5, coefficient of CORR is not interpreted as effect of corruption because there are interaction terms between CORR and other variables. &#x00a0;Authors should additionally report results including INFL, UNEMP, and EG, but excluding interaction term.</p>
            <p> </p>
            <p> 7.&#x00a0;&#x00a0; &#x00a0;Authors only interpret statistical significance of independent variables in Table 5. Authors should more carefully value of coefficients to indicate degree of impact of variables (see also Comment 5).</p>
            <p> </p>
            <p> 8.&#x00a0;&#x00a0; &#x00a0;Author&#x2019;s interpretation about results of Table 5 is ambiguous, and not so informative for readers. For instance,&#x00a0;</p>
            <p> &#x201c;corruption combined with increased unemployment rates increases suicide rates in middle-income countries.&#x201d;</p>
            <p> &#x00a0; &#x00a0; This is interpretation about &#x201c;CORR&#x00d7;UNEMP&#x201d; showing 0.0022 (coef) with 1 % level (***). &#x00a0;Actually, authors interpretation above is meaningless. Indicate more clearly and meaningfully interpretation and implication of results. I request authors to show,</p>
            <p> </p>
            <p> In the definition of CORR in the paper, large value of CORR show less corrupted government. Hence, in my interpretation, positive value of &#x201c;CORR&#x00d7;UNEMP&#x201d; means that less corrupted government reduces the negative effect of unemployment on citizen&#x2019;s mental health, and so suicide rate. Is it true? To argue as above, negative sign of &#x201c;UNEMP&#x201d; &#x00a0;should be shown &#x00a0;However, actually, authors did not indicate results of &#x201c;UNEMP&#x201d; in this estimation. So, authors should indicate not only interaction terms but also independent &#x201c;UNEMP&#x201d;. Further, how do authors interpret 0.0022 by considering scale of CRR and Unemployment?</p>
            <p> </p>
            <p> Apart from it, authors should interpret estimation results in more detail.</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Partly</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>No</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>Yes</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>Partly</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>No</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>Partly</p>
            <p>Reviewer Expertise:</p>
            <p>Empirical economics.</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.</p>
        </body>
        <sub-article article-type="response" id="comment13140-344324">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Jayathilaka</surname>
                            <given-names>Ruwan</given-names>
                        </name>
                        <aff>SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka</aff>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>14</day>
                    <month>1</month>
                    <year>2025</year>
                </pub-date>
            </front-stub>
            <body>
                <p>
                    <bold>
                        <underline>Authors Response to Reviewer 1</underline>
                    </bold>
                </p>
                <p> </p>
                <p> Dear Reviewer 1,</p>
                <p> We greatly appreciate the time invested in reading our manuscript and providing the necessary feedback to improve the overall quality of our work. All the mentioned comments have been considered and the revisions made accordingly.</p>
                <p> </p>
                <p> Thank you once again for your valuable feedback.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer 1 comment 1:</bold> Corruption index might lead readers to misunderstand estimation results because the definition is opposed to intuition.&#x00a0; According to Table 2,</p>
                <p> "Corruption Perception Index (0-100)" was defined by Transparency International.</p>
                <p> Ordinary saying, larger the value, the more corrupted the government is. However, in the text, to take an example of interpretation for corruption index,</p>
                <p> </p>
                <p> "As key observations, Argentina improved from 35 to 45, indicating a decrease in corruption,"(p.11).&#x00a0; This shows that smaller value of &#x201c;corruption&#x201d; is more corrupted. This is opposed to reader&#x2019;s intuition. Probably, authors follow the definition of the data source. However, I strongly request to modify the definition to be suitable to reader&#x2019;s intuition. Instead of it, in Table 2, authors explained that the definition is changed from that of &#x201c;Transparency International&#x201d; for convenience of reader&#x2019;s interpretation.</p>
                <p> </p>
                <p> 
                    <bold>Authors&#x2019; Response to Reviewer 1 comment 1:</bold> Thank you for highlighting this concern. As you fairly pointed out, we understand that the correct definition of the variable - &#x201c;Corruption Score&#x201d; (which represented the Corruption Perception Index), may battle with readers&#x2019; intuition, thinking the higher corruption score may indicate higher corruption. Therefore, we made changes in &#x201c;Table 2&#x201d; to clarify the measurement of Corruption Perception Index (0-100 scale, 100 is very clean and 0 is highly corrupt), and we changed the the variable name from Corruption score to corruption control score for readers clarity. This represents the definition and helps with readers' intuition on the variable&#x2019;s behavior.)</p>
                <p> We also made some amendments to the manuscript body to ease readers&#x2019; understanding regarding this matter pointed out.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer 1 comment 2: </bold>By definition of variable, values of COR, SUI, and UNEMP must not be negative. I am not familiar with Violin plots in Figure 5. However, sharded area of these values covered negative area. What does it mean? Authors just mechanically illustrated the Figure 5, but was not informative unless authors carefully and appropriately explain importance of Violin plots. Figure 5 of current version is very curious and might lead readers to be confused. In my view, it is enough to just show mean value and 95% CI in Figure.</p>
                <p> 
                    <bold>Authors&#x2019; Response to Reviewer 1 comment 2: </bold>As per the reviewer&#x2019;s suggestion, we have replaced the violin plots figure with a new figure that illustrates mean value and 95% CI. A new detailed description was added to explain the figure (We have included this replaced Figure 5 in TIFF format in the Figures zip file attached herewith.).</p>
                <p> However, just to clarify the reviewer&#x2019;s prior concern on Figure 5, the violin plots we illustrated extend into the negative values because they are based on a smoothed estimate of the data's distribution called kernel density estimation (KDE). This smoothing process doesn't strictly stop at the minimum or maximum values of the data - it spreads out to create a smooth curve. Even though there are no negative values in the dataset, the smoothing "overflows" slightly into the negative range because the KDE curve is designed to be continuous and smooth. However, the actual min and max values are in the upper and lower tails of the boxplot within the violin shape. But we understand the mean value and CI provides much more straightforward understanding for the study.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer 1 comment 3:</bold> In results Fixed effects model in Table 5, estimation results of constant are shown. Basically, different from OLS, constant is not calculated in Fixed effects model because constant is completely captured by unobservable time invariant factors (Fixed effects). What does constant mean in Table 5?</p>
                <p> 
                    <bold>Authors&#x2019; Response to Reviewer 1 comment 3: </bold>Thank you for this valuable observation. We agree with you that in a Fixed Effects Model, the constant term is absorbed into the fixed effects and does not carry the same interpretative meaning as in an OLS model. In Table 5, the constant term represents the average fixed effects across all entities after accounting for deviations. However, its presence might be misleading in the context of FEM.</p>
                <p> To address this, we will revise Table 5 by adding a footnote clarifying that the constant is there for the completion of results, and reflects average fixed effects rather than a traditional intercept term. This ensures alignment with the theoretical framework of the FEM, and avoids potential misinterpretation.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer 1 comment 4: </bold>In Table 5, Lagged dependent variable is included as independent variable.&#x00a0; In this model, the dynamic panel model is preferred, where Arellano-bond is the basic model although various types of dynamic model have been developed. Especially, time points is relatively long (20 years) and so the dynamic model is appropriated. Most of independent variables seems to be endogenous, that should be mitigated. Fortunately, the Dynamic model mechanically enables authors to deal with the issue of endogenous bias.</p>
                <p> 
                    <bold>Authors&#x2019; Response to Reviewer 1 comment 4:</bold> Thank you for this thoughtful comment. We agree that addressing endogeneity is crucial, and we appreciate the suggestion to use a dynamic panel model like the Arellano-Bond estimator. However, we would like to clarify our rationale for using the Fixed Effects Model (FEM) with a lagged dependent variable:</p>
                <p> Purpose and Model Fit: The FEM was chosen to control for unobservable, time-invariant heterogeneity across countries in the Americas. This aligns with the study&#x2019;s focus on examining variations in suicide rates influenced by country-specific characteristics.</p>
                <p> Lagged Dependent Variable and Time Period: While including a lagged dependent variable in FEM may introduce bias, this issue is significantly mitigated in panels with a relatively long time dimension. With 20 years of data, the Nickell bias is minimal, as supported by previous econometric literature (e.g., Judson &amp; Owen, 1999).</p>
                <p> Endogeneity and Robustness: To address potential endogeneity, we employed robust standard errors and conducted specification tests. While dynamic models can mitigate endogeneity, their reliance on strong assumptions about instrument validity may introduce new challenges, especially with a small number of entities.</p>
                <p> </p>
                <p> Practical Considerations: The FEM results provide clear and interpretable insights for policymakers and stakeholders. Introducing a dynamic model could add complexity without significantly improving the robustness of our findings.</p>
                <p> </p>
                <p> Based on these considerations, we believe the Fixed Effects Model with a lagged dependent variable is an appropriate and reliable approach for our analysis. We are, however, open to further discussing the potential application of dynamic models in future iterations or complementary analyses.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer 1 comment 5: </bold>In conclusion, influence of lagged suicide variables is shown as below,</p>
                <p> &#x201c;The lagged suicide variable repeatedly showed an overwhelmingly substantial positive association with current suicide rates, implying that once suicide rates rise in a country, they likely continue to be elevated over time.&#x201d; (p.20).</p>
                <p> Their argument is too strong to be supported by the estimation results. In Fixed effects estimation results of Table 5, coefficient of lagged suicide variable is smaller than 1, despite being statistical significant positive sign. Suicide rate will converge among countries in the long run if the value is smaller than 1.&#x00a0; That is, their argument is supported only if the value is statistically positive and larger than 1. Authors hardly interpret values of coefficients, which lead to misinterpretation.</p>
                <p> 
                    <bold>Authors&#x2019; Response to Reviewer 1 comment 5: </bold>We appreciate the reviewer for pointing this out. As he advised, the argument is adjusted and explained.</p>
                <p> The coefficient values are explained descriptively.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer 1 comment 6:</bold> In table 5, coefficient of CORR is not interpreted as effect of corruption because there are interaction terms between CORR and other variables.&#x00a0; Authors should additionally report results including INFL, UNEMP, and EG, but excluding interaction term.</p>
                <p> </p>
                <p> 
                    <bold>Authors&#x2019; Response to Reviewer 1 comment 6:</bold> We express our gratitude for the thoughtful suggestion provided by the reviewer on including the direct effect of the chosen moderating factors. However, while this can be a valuable extension for our study, the current study&#x2019;s scope limited to identifying the moderate effects. Therefore, we kindly suggest that measuring the individual effects of the moderating variables (INFL, UNEMP, and EG) may not be essential in this context. This study aims to explain how these moderating factors influence the strength and direction of corruption control&#x2019;s impact on suicide rates. We made changes to the manuscript to explain this further.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer 1 comment 7:</bold> Authors only interpret statistical significance of independent variables in Table 5. Authors should more carefully value of coefficients to indicate degree of impact of variables (see also Comment 5).</p>
                <p> 
                    <bold>Authors&#x2019; Response to Reviewer 1 comment 7:</bold> The manuscript is adjusted to explain the coefficient values more descriptively.</p>
                <p> </p>
                <p> 
                    <bold>Reviewer 1 comment 8: </bold>Author&#x2019;s interpretation about results of Table 5 is ambiguous, and not so informative for readers. For instance,</p>
                <p> &#x201c;corruption combined with increased unemployment rates increases suicide rates in middle-income countries.&#x201d;</p>
                <p> &#x00a0;&#x00a0;&#x00a0; This is interpretation about &#x201c;CORR&#x00d7;UNEMP&#x201d; showing 0.0022 (coef) with 1 % level (***).&#x00a0; Actually, authors interpretation above is meaningless. Indicate more clearly and meaningfully interpretation and implication of results. I request authors to show,</p>
                <p> In the definition of CORR in the paper, large value of CORR show less corrupted government. Hence, in my interpretation, positive value of &#x201c;CORR&#x00d7;UNEMP&#x201d; means that less corrupted government reduces the negative effect of unemployment on citizen&#x2019;s mental health, and so suicide rate. Is it true? To argue as above, negative sign of &#x201c;UNEMP&#x201d;&#x00a0; should be shown&#x00a0; However, actually, authors did not indicate results of &#x201c;UNEMP&#x201d; in this estimation. So, authors should indicate not only interaction terms but also independent &#x201c;UNEMP&#x201d;. Further, how do authors interpret 0.0022 by considering scale of CRR and Unemployment?</p>
                <p> </p>
                <p> 
                    <bold>Authors&#x2019; Response to Reviewer 1 comment 8: </bold>We sincerely appreciate the reviewer&#x2019;s thoughtful request on clarifying his suggested interpretation - &#x201c;A positive value of CORR &#x00d7; UNEMP means that less corruption reduces the negative effect of unemployment on citizens' mental health, thereby lowering the suicide rate.&#x201d; However, we kindly note that this interpretation does not align with the focus our study. Our analysis suggests that unemployment moderates the impact of corruption control on suicide rates, rather than corruption control mitigating the negative effects of unemployment. As the study focuses on moderating factors, not mediating factors, we believe it is not necessary to measure the individual effects of the moderating variables (INFL, UNEMP, and EG). Instead, the study aims to explain how these moderating factors influence the strength and direction of corruption control&#x2019;s impact on suicide rates.</p>
                <p> </p>
                <p> However, we have made amendments in the manuscript to highlight this to avoid any confusion to the readers.</p>
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