Abstract
Characteristics of the neighbourhood environment, including population density, social fragmentation, and trust, have been linked to mental health outcomes. Using a longitudinal population-based cohort, we explored the relationship between objective and subjective neighbourhood characteristics and the odds of suicidal thoughts and attempts. We conducted a longitudinal study of 20764 participants living in Stockholm County who participated in the Stockholm Public Health Survey. We used multilevel modelling to examine if suicidal thoughts and attempts were associated with neighbourhood characteristics, independent of individual associations. We included objective and subjective measures to explore if there was a different relationship between these measures of the neighbourhood environment and suicidality. Associations between neighbourhood factors and suicidality were predominantly explained by individual characteristics, with the exception of neighbourhood-level deprivation and average residential trust. Each unit increase of deprivation was linked to increased odds of suicidal thoughts [Odds ratio (OR) 1.04, 95% confidence interval (CI) 1.00-1.07] and attempts (OR 1.11, 95% CI 1.06-1.17). Decreasing residential trust was associated with increased odds of suicide attempts (OR 1.09, 95% CI 1.02-1.17). There was no evidence that neighbourhood-level fragmentation or average trust in public and political institutions had an independent effect on suicidality once individual and sociodemographic factors were accounted for. This study showed that much of the neighbourhood-level variation in suicidal thoughts and attempts could be explained by compositional factors, including sociodemographic clustering within neighbourhoods. The independent effect of neighbourhood-level deprivation and average residential trust provide evidence that the neighbourhood context may exert an independent effect on suicidality beyond the impact of individual characteristics.
Highlights
Characteristics of the neighbourhood environment, including population density, social fragmentation, and trust, have been linked to mental health outcomes
Ecological associations have suggested that there may be a link between area-level factors and rates of suicidal thought, attempts, and deaths but it has not been clearly shown whether these associations can be explained by individual-level characteristics or if area-level factors exert an independent effect on suicidality (Conrad et al, 2009; Hagedoorn, Groenewegen, Roberts, & Helbich, 2020; Middleton et al, 2004; O’Farrell, Corcoran, & Perry, 2016; Rehkopf, 2006; Whitley, Gunnell, Dorling, & Smith, 1999)
Multilevel studies attempt to disentangle compositional factors and contextual characteristics of the neighbourhood to more explore the independent effect of neighbourhood factors on suicidal thoughts and attempts (Martikainen, Mäki, & Blomgren, 2004; Qin, Agerbo, & Mortensen, 2003)
Summary
Characteristics of the neighbourhood environment, including population density, social fragmentation, and trust, have been linked to mental health outcomes. Associations between neighbourhood factors and suicidality were predominantly explained by individual characteristics, with the exception of neighbourhood-level deprivation and average residential trust. There was no evidence that neighbourhood-level fragmentation or average trust in public and political institutions had an independent effect on suicidality once individual and sociodemographic factors were accounted for. This study showed that much of the neighbourhood-level variation in suicidal thoughts and attempts could be explained by compositional factors, including sociodemographic clustering within neighbourhoods. One multilevel study which explored individual- and area-level deprivation in childhood and risk of later death by suicide found that most of the variance was explained by individual-level characteristics, with very little variation attributed to area-level factors (Zammit et al, 2014).
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