Abstract
BackgroundRates of suicide appear to be increasing, indicating a critical need for more effective prevention initiatives. To increase the efficacy of future prevention initiatives, we examined the spatial distribution of suicide deaths and suicide attempts in New South Wales (NSW), Australia, to identify where high incidence ‘suicide clusters’ were occurring. Such clusters represent candidate regions where intervention is critically needed, and likely to have the greatest impact, thus providing an evidence-base for the targeted prioritisation of resources.MethodsAnalysis is based on official suicide mortality statistics for NSW, provided by the Australian Bureau of Statistics, and hospital separations for non-fatal intentional self-harm, provided through the NSW Health Admitted Patient Data Collection at a Statistical Area 2 (SA2) geography. Geographical Information System (GIS) techniques were applied to detect suicide clusters occurring between 2005 and 2013 (aggregated), for persons aged over 5 years. The final dataset contained 5466 mortality and 86,017 non-fatal intentional self-harm cases.ResultsIn total, 25 Local Government Areas were identified as primary or secondary likely candidate regions for intervention. Together, these regions contained approximately 200 SA2 level suicide clusters, which represented 46% (n = 39,869) of hospital separations and 43% (n = 2330) of suicide deaths between 2005 and 2013. These clusters primarily converged on the Eastern coastal fringe of NSW.ConclusionsCrude rates of suicide deaths and intentional self-harm differed at the Local Government Areas (LGA) level in NSW. There was a tendency for primary suicide clusters to occur within metropolitan and coastal regions, rather than rural areas. The findings demonstrate the importance of taking geographical variation of suicidal behaviour into account, prior to development and implementation of prevention initiatives, so that such initiatives can target key problem areas where they are likely to have maximal impact.
Highlights
Rates of suicide appear to be increasing, indicating a critical need for more effective prevention initiatives
While spatial epidemiology utilising Geographical Information System (GIS) technology is established in the broader field of ‘injury’ prevention research [4], currently little has been done, ecologically, to map geographical variability and patterning of suicide among the general population at global, national, or regionally more discrete levels [5]
Across New South Wales (NSW), 14.3% (N = 74) of Statistical Area 2 (SA2) identified as members of SaTScan suicide mortality clusters, 14.5% (N = 75) identified as suicide mortality Hot-Spots, 17.4% (N = 90) as members of SaTScan self-harm clusters, and, 23.8% (N = 123) as self-harm Hot-Spots (Figs. 1 and 2)
Summary
Rates of suicide appear to be increasing, indicating a critical need for more effective prevention initiatives. To increase the efficacy of future prevention initiatives, we examined the spatial distribution of suicide deaths and suicide attempts in New South Wales (NSW), Australia, to identify where high incidence ‘suicide clusters’ were occurring Such clusters represent candidate regions where intervention is critically needed, and likely to have the greatest impact, providing an evidence-base for the targeted prioritisation of resources. While spatial epidemiology utilising GIS technology is established in the broader field of ‘injury’ prevention research (i.e., violence, accidents, motor vehicle) [4], currently little has been done, ecologically, to map geographical variability and patterning of suicide among the general population at global, national, or regionally more discrete levels [5] Given that it holds considerable value as a methodology for increasing our ability to detect high-risk areas, monitor the disease burden, and identify causal mechanisms, there is significant scope for uptake of GIS to advance and innovate evidence-based suicide prevention efforts
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