Determinants of suicidal ideation and suicide attempts: parallel cross-sectional analyses examining geographical location.

Kerry J Inder,Amy Johnston,Terry J Lewin,Clare Coleman,Brian J Kelly,Tim Slade,Natasha Weaver,Tonelle E Handley

doi:10.1186/1471-244x-14-208

Abstract

BackgroundSuicide death rates in Australia are higher in rural than urban communities however the contributors to this difference remain unclear. Geographical differences in suicidal ideation and attempts were explored using two datasets encompassing urban and rural community residents to examine associations between socioeconomic, demographic and mental health factors. Differing patterns of association between psychiatric disorder and suicidal ideation and attempts as geographical remoteness increased were investigated.MethodsParallel cross-sectional analyses were undertaken using data from the 2007 National Survey of Mental Health and Wellbeing (2007-NSMHWB, n = 8,463), under-representative of remote and very remote residents, and selected participants from the Australian Rural Mental Health Study (ARMHS, n = 634), over-representative of remote and very remote residents. Uniform measures of suicidal ideation and attempts and mental disorder using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI-3.0) were used in both datasets. Geographic region was classified into major cities, inner regional and other. A series of logistic regressions were undertaken for the outcomes of 12-month and lifetime suicidal ideation and lifetime suicide attempts, adjusting for age, gender and psychological distress. A sub-analysis of the ARMHS sample was undertaken with additional variables not available in the 2007-NSMHWB dataset.ResultsRates and determinants of suicidal ideation and suicide attempts across geographical region were similar. Psychiatric disorder was the main determinant of 12-month and lifetime suicidal ideation and lifetime suicide attempts across all geographical regions. For lifetime suicidal ideation and attempts, marital status, employment status, perceived financial adversity and mental health service use were also important determinants. In the ARMHS sub-analysis, higher optimism and better perceived infrastructure and service accessibility tended to be associated with a lower likelihood of lifetime suicidal ideation, when age, gender, psychological distress, marital status and mental health service use were taken into account.ConclusionsRates and determinants of suicidal ideation and attempts did not differ according to geographical location. Psychiatric disorder, current distress, employment and financial adversity remain important factors associated with suicidal ideation and attempts across all regions in Australia. Regional characteristics that influence availability of services and lower personal optimism may also be associated with suicidal ideation in rural communities.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-244X-14-208) contains supplementary material, which is available to authorized users.

Highlights

Suicide death rates in Australia are higher in rural than urban communities the contributors to this difference remain unclear
We investigated differing patterns of association between psychiatric disorder and suicidal ideation and suicide attempts as geographical remoteness increased, hypothesising that 12-month and lifetime rates of suicidal ideation and lifetime suicide attempts would be significantly higher in more remote residents
Sampling strategies Data were obtained from two existing complimentary studies to undertake parallel crosssectional analyses to explore the determinants of suicidal ideation and suicide attempts across geographical regions

Summary

Introduction

Suicide death rates in Australia are higher in rural than urban communities the contributors to this difference remain unclear. Geographical differences in suicidal ideation and attempts were explored using two datasets encompassing urban and rural community residents to examine associations between socioeconomic, demographic and mental health factors. Differing patterns of association between psychiatric disorder and suicidal ideation and attempts as geographical remoteness increased were investigated. Suicide death rates have been consistently higher in rural than in urban settings across all states and territories of Australia between 2001 and 2010 [1], in men [2]. Psychiatric disorder, depression, is the strongest predictor of suicide death rates, [3] the prevalence of depression is similar across urban and rural areas in Australia [4] and elsewhere [5]. Suicide deaths are higher in males; suicidal ideation and behaviours occur more commonly among females, younger people, those outside the workforce, and those experiencing a mental disorder [10]

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