Suicide Rates In Areas Research Articles

Does community cultural connectedness reduce the influence of area disadvantage on Aboriginal & Torres Strait Islander young peoples’ suicide?

ObjectiveThe study aimed to examine associations of community cultural connectedness with Aboriginal and Torres Strait Islander young peoples’ suicide rates in areas with elevated risk factors. MethodsAge‐specific suicide rates (ASSRs) were calculated using suicides recorded by the Queensland Suicide Register (QSR) of Aboriginal and Torres Strait Islander young people (aged 15–24 years) in Queensland from 2001–2015. Rate Ratios (RRs) compared young peoples’ suicide rates in areas with high and low levels of cultural connectedness indicators (cultural social capital and Indigenous language use) within areas with elevated risk factors (high rates of discrimination, low socioeconomic resources, and remoteness). ResultsWithin low socioeconomically resourced areas and where Aboriginal and Torres Strait Islander people experienced more discrimination, greater engagement and involvement with cultural events, ceremonies and organisations was associated with 36% and 47% lower young peoples’ suicide rates respectively (RR=1.57, 95%CI=1.13–2.21, p=<0.01; RR=1.88, 95%CI=1.25–2.89, p=<0.01). Within remote and regional areas, higher levels of community language use was associated with 26% lower suicide rates (RR=1.35, 95%CI=1–1.93, p=0.04), and in communities experiencing more discrimination, language use was associated with 34% lower rates (RR=1.53, 95%CI=1.01–2.37, p=0.04). ConclusionCultural connectedness indicators were associated with lower Aboriginal and Torres Strait Islander young peoples’ suicide rates in communities experiencing the most disadvantage. Implications for public healthThis provides initial evidence for trialling and evaluating interventions using cultural practices and engagement to mitigate against the impacts of community risk factors on Aboriginal and Torres Islander suicide.

Spatial patterning, correlates, and inequality in suicide across 432 neighborhoods in Taipei City, Taiwan

More than half of the world's population now lives in urban areas. Understanding the spatial distribution of suicide in these settings may inform prevention. Previous analyses of the spatial distribution of suicide in cities have largely been conducted in Western nations. We investigated the spatial pattern of suicide and factors associated with its spatial distribution in Taipei City, Taiwan. We estimated smoothed standardized mortality ratios for overall suicide and suicide by sex/age group across 432 neighborhoods (mean population size: 5500) in Taipei City (2004–2010) using Bayesian hierarchical models. A range of area-level characteristics including socioeconomic deprivation, social fragmentation, income inequality, and linking social capital were investigated for their associations with suicide mortality. Overall suicide rates were below average in the city center, whereas above average rates were found in some suburbs. The cartogram highlighted the concentration of suicide burden in one western area of the city. Male suicides demonstrated generally similar spatial patterning across age groups, while the geographic distribution of female suicides differed by age. After adjusting for other variables, two area characteristics were found to be associated with area suicide rates: the proportion of divorced/separated adults (rate ratio [RR] per one standard deviation increase = 1.08, 95% confidence interval 1.01–1.16), an indicator of social fragmentation; and median household income (RR = 0.80, 0.73–0.86), an indicator of socioeconomic deprivation. There was a 1.8-fold difference in suicide rates between neighborhood quintiles with the lowest and the highest median household income, with middle-aged males showing the largest gradient (3.2-fold difference). The geography of suicide in Taipei City showed spatial patterning and socioeconomic correlates distinct from cities in Western nations. There is a need for future research to better understand the correlates of change in the geographic distribution of suicide throughout the process of urban development.

Suicide Rates in Evacuation Areas After the Fukushima Daiichi Nuclear Disaster

. Background: Associations between nuclear disasters and suicide have been examined to a limited extent. Aim: To clarify the suicide rates in evacuation areas after the nuclear disaster in Fukushima, which occurred in March 2011. Method: This descriptive study used monthly data from vital statistics between March 2009 and December 2015. Suicide rates in areas to which evacuation orders had been issued, requiring across-the-board, compulsory evacuation of residents from the entire or part of municipalities, were obtained and compared with the national average. Results: Male suicide rates in evacuation areas increased significantly immediately after the disaster, and then began to increase again 4 years after the disaster. Female suicide rates declined slightly during the first year and then increased significantly over the subsequent 3-year period. Moreover, male rates in areas where evacuation orders were issued for the total area declined over the course of approximately 2 years, but then began to increase thereafter. Analysis by age revealed postdisaster male rates in evacuation areas decreased for those aged 50–69 years and increased for those aged ≤ 29 years and ≥ 70 years. Limitations: The number of suicides among females and the female population in the evacuation area was small. Conclusion: Our findings suggest the need to keep in mind that, when providing post-disaster mental health services, suicide rates can eventually increase even if they initially decrease.

Mapping suicide mortality in Ohio: A spatial epidemiological analysis of suicide clusters and area level correlates

Previous studies have investigated spatial patterning and associations of area characteristics with suicide rates in Western and Asian countries, but few have been conducted in the United States. This ecological study aims to identify high-risk clusters of suicide in Ohio and assess area level correlates of these clusters. We estimated spatially smoothed standardized mortality ratios (SMR) using Bayesian conditional autoregressive models (CAR) for the period 2004 to 2013. Spatial and spatio-temporal scan statistics were used to detect high-risk clusters of suicide at the census tract level (N=2952). Logistic regression models were used to examine the association between area level correlates and suicide clusters. Nine statistically significant (p<0.05) high-risk spatial clusters and two space-time clusters were identified. We also identified several significant spatial clusters by method of suicide. The risk of suicide was up to 2.1 times higher in high-risk clusters than in areas outside of the clusters (relative risks ranged from 1.22 to 2.14 (p<0.01)). In the multivariate model, factors strongly associated with area suicide rates were socio-economic deprivation and lower provider densities. Efforts to reduce poverty and improve access to health and mental health medical services on the community level represent potentially important suicide prevention strategies.

Pesticides, depression and suicide: A systematic review of the epidemiological evidence

It has been suggested that high exposure to pesticides, including poisoning, experienced by agriculture workers and rural residents may result in an elevated risk of psychiatric disorders and suicidal behavior. Epidemiological data supporting this hypothesis are very limited. An updated systematic review was conducted in epidemiologic literature on the relationship of pesticide exposure with depression and suicide published over the last 15 years by using MEDLINE database. A total of 11 studies on depression and 14 studies on suicide met inclusion criteria. Depression or other psychiatric disorders have shown increased risks associated with previous pesticide poisoning in 5 studies, with statistically significant odds ratios (OR) ranging from 2.08 to 5.95. Lower risk estimates have been found for chronic pesticide exposure. Among studies on suicide, 4 reports found increased suicide rates in areas with intensive pesticide use (OR between 1.60 and 2.61) compared to areas with lower pesticide use. Occupation in agriculture has shown a significant association with higher suicide risk than other occupational groups in 4 studies (OR between 1.30 and 4.13), but not in one recent report. Regarding specific pesticides, lifetime use of chlorpyrifos was related with increased suicide mortality (OR=2.37) in one study. Scientific evidence of association between pesticide exposure and either depression or suicide has been shown in some populations, in studies using varying epidemiological approaches, but is still very limited and inconclusive. Review of the literature warrants further research to explore such relationships, in particular prospective studies among large samples of high- and low-dose-exposed workers, using detailed exposure assessments, and evaluating other potential sources of psychological stress.

Effectiveness of Australian youth suicide prevention initiatives

After an epidemic rise in Australian young male suicide rates over the 1970s to 1990s, the period following the implementation of the original National Youth Suicide Prevention Strategy (NYSPS) in 1995 saw substantial declines in suicide in young men. To investigate whether areas with locally targeted suicide prevention activity implemented after 1995 experienced lower rates of young adult suicide, compared with areas without such activity. Localities with or without identified suicide prevention activity were compared during the period of the NYSPS implementation (1995-1998) and a period subsequent to implementation (1999-2002) to establish whether annual average suicide rates were lower and declined more quickly in areas with suicide prevention activity over the period 1995-2002. Male suicide rates were lower in areas with targeted suicide prevention activity (and higher levels of funding) compared with areas receiving no activity both during (RR = 0.89, 95% CI 0.80-0.99, P = 0.030) and after (RR = 0.86, 95% CI 0.77-0.96, P = 0.009) implementation, with rates declining faster in areas with targeted activity than in those without (13% v. 10% decline). However, these differences were reduced and were no longer statistically significant following adjustment for sociodemographic variables. There was no difference in female suicide rates between areas with or without targeted suicide prevention activity. There was little discernible impact on suicide rates in areas receiving locally targeted suicide prevention activities in the period following the NYSPS.

Geography of suicide in Taiwan: Spatial patterning and socioeconomic correlates

In industrialised Western nations suicide rates tend to be high in inner city areas and socially fragmented neighbourhoods. Few studies have investigated spatial variations in suicide in non-Western settings. We estimated smoothed standardised mortality ratios (1999–2007) for suicide for each of the 358 Taiwanese districts (median population aged 15+: 27,000) and investigated their associations with area characteristics using Bayesian hierarchical models. The geographic distribution of suicide was similar in men and women; young people showed the greatest spatial variation in rates. Rates were highest in East Taiwan, a mostly mountainous rural area. There was no evidence of above average rates in large cities. Spatial patterns of method-specific suicide rates varied markedly, with solids/liquids poisonings showing the greatest geographic variation and hangings the least. Factors most strongly associated with area suicide rates were median household income, population density and lone-parent households. Spatial patterning of suicide in Taiwan differed from that observed in Western nations. Suicide prevention strategies should take into account unique local patterns.

Effect of 11 September 2001 terrorist attacks in the USA on suicide in areas surrounding the crash sites

The terrorist attacks in the USA on 11 September 2001 affected suicide rates in two European countries, whereas overall US rates remained stable. The effect on attack site rates, however, has not been studied. To examine post-attack suicide rates in areas surrounding the three airline crash sites. Daily mortality rates were modelled using time series techniques. Where rate change was significant, both duration and geographic scope were analysed. Around the World Trade Center, post-attack 180-day rates dropped significantly (t = 2.4, P = 0.0046), whereas comparison condition rates remained stable. No change was observed for Pentagon or Flight 93 crash sites. The differential effect by site suggests that proximity may be less important that other event characteristics. Both temporal and geographic aspects of rate fluctuation after sentinel events appear measurable and further analyses may contribute valuable knowledge about how sociological forces affect these rates.

The association between suicide and the socio-economic characteristics of geographical areas: a systematic review

Despite an extensive literature, there have been widely divergent findings regarding the direction of the association between area socio-economic characteristics and area suicide rates, with high-quality studies finding either a direct relation (higher rates of suicide in higher socio-economic areas), an inverse relation (lower rates of suicide in higher socio-economic areas) or no association. We performed a systematic review of the literature dating from 1897 to 2004 and identified 86 publications with 221 separate analyses that met our inclusion criteria. We examined the percent of direct, inverse and null findings stratified by key study characteristics including size of aggregated area, socio-economic measure used, region of study, control variables and study design. Analyses at the community level are significantly more likely to demonstrate lower rates of suicide among higher socio-economic areas than studies using larger areas of aggregation. Measures of area poverty and deprivation are most likely to be inversely associated with suicide rates and median income is least likely to be inversely associated with suicide rates. Analyses using measures of unemployment and education and occupation were equally likely to demonstrate inverse associations. Study results did not vary significantly by gender or by study design. The heterogeneity of associations is mostly accounted for by study design features that have largely been neglected in this literature. Enhanced attention to size of region and measurement strategies provide a clearer picture of how suicide rates vary by region. Resources for suicide prevention should be targeted to high poverty/deprivation and high unemployment areas.