Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilisation.

Scott J. Fitzpatrick,Bronwyn K. Brew,Tonelle Handley,Donna Read,David Perkins,Nic Powell,Kerry J. Inder,Vincenzo De Luca

doi:10.1371/journal.pone.0245271

Abstract

BackgroundSuicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia.MethodsA retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010–2015 from the National Coronial Information System.ResultsThere were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010–2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated.ConclusionsHigher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.

Highlights

In Australia, suicide rates are higher in rural areas than in major cities, despite similar rates of diagnosed mental disorders [1,2]
Suicide rates are higher in rural Australia than in major cities, the factors contributing to this are not well understood
Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, in men

Summary

Introduction

In Australia, suicide rates are higher in rural areas than in major cities, despite similar rates of diagnosed mental disorders [1,2]. A few studies have linked socio-economic inequalities, unemployment, higher alcohol consumption, and limited access to services to elevated suicide risk in rural Australia [3,4,5,6,7,8]. Higher rates of suicide in rural Australia have been linked with rural traits such as stoicism and low health literacy [11,12]. Whether higher rates of suicide in these areas derive wholly from specific rural traits such as stoicism or low health literacy, or if rurality merely exacerbates the significant risks associated with suicide such as unemployment, drug and alcohol use, and accessibility of health and social services is unclear [14].

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Conclusion