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Is suicide mortality associated with neighbourhood social fragmentation and deprivation? A Dutch register-based case-control study using individualised neighbourhoods
  1. Paulien Hagedoorn1,
  2. Peter P Groenewegen1,2,
  3. Hannah Roberts1,
  4. Marco Helbich1
  1. 1 Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
  2. 2 Netherlands Institute for Health Services Research, Utrecht, The Netherlands
  1. Correspondence to Dr Paulien Hagedoorn, Department of Human Geography and Spatial Planning, Utrecht University, Utrecht 3512 JE, Netherlands; p.hagedoorn{at}


Background Neighbourhood social fragmentation and socioeconomic deprivation seem to be associated with suicide mortality. However, results are inconclusive, which might be because dynamics in the social context are not well-represented by administratively bounded neighbourhoods at baseline. We used individualised neighbourhoods to examine associations between suicide mortality, social fragmentation, and deprivation for the total population as well as by sex and age group.

Methods Using a nested case-control design, all suicides aged 18–64 years between 2007 and 2016 were selected from longitudinal Dutch register data and matched with 10 random controls. Indices for social fragmentation and deprivation were calculated annually for 300, 600 and 1000 metre circular buffers around each subject’s residential address.

Results Suicide mortality was significantly higher in neighbourhoods with high deprivation and social fragmentation. Accounting for individual characteristics largely attenuated these associations. Suicide mortality remained significantly higher for women living in highly fragmented neighbourhoods in the fully adjusted model. Age-stratified analyses indicate associations with neighbourhood fragmentation among women in older age groups (40–64 years) only. Among men, suicide risk was lower in fragmented neighbourhoods for those aged 18–39 years and for short-term residents. In deprived neighbourhoods, suicide risk was lower for men aged 40–64 years and long-term residents. Associations between neighbourhood characteristics and suicide mortality were comparable across buffer sizes.

Conclusion Our findings suggest that next to individual characteristics, the social and economic context within which people live may both enhance and buffer the risk of suicide.

  • suicide mortality
  • social fragmentation
  • neighbourhood deprivation
  • individualised neighbourhoods
  • longitudinal register

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  • Contributors This study design was developed by PH and MH. PH did the data preparation, linkage and statistical analysis. MH processed the buffers. PH and MH had full access to the register data. With contributions from PPG, HR and MH, PH led on interpreting the results and writing the manuscript. The text was edited and the final version of the manuscript was approved by all authors.

  • Funding This project received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 714993).

  • Disclaimer The ERC had no involvement in the study design, writing of the manuscript nor the decision to submit the paper for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval (FETC17-060) for the NEEDS study (Dynamic Urban Environmental Exposures on Depression and Suicide) was obtained by the Ethics Review Board of Utrecht University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Results are based on own calculations by the authors using non-public microdata from Statistics Netherlands. Under certain conditions, these microdata are accessible for statistical and scientific research.