Further increases in rural suicide in young Australian adults: Secular trends, 1979–2003

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Abstract

This study investigates changes in Australian urban–rural suicide differentials over time in the context of overall declines in (male) suicide in the late 1990s, and determines the extent to which differences in socio-economic status (SES) account for observed urban–rural trends. Suicide data were stratified for the period 1979–2003 by metropolitan, rural and remote areas and examined across five quinquennia, centred on each Australian census from 1981 to 2001. Suicide rates (per 100,000) were adjusted for confounding by sex, age, country-of-birth and the mediating effects of area SES, using Poisson regression models. Male suicide rates in metropolitan, rural and remote areas diverged significantly over time, especially in young males (15–24 years). Young male suicide rates increased significantly in metropolitan, rural and remote areas over 1979–1998, and in the most recent period (1999–2003) increased further in remote areas from 38.8 (per 100,000) to 47.9 (23% increase). In contrast suicide rates in rural areas decreased from a peak of 27.5 to 19.8 (28% decrease), and in metropolitan areas from a peak of 22.1 to 16.8 (24% decrease). Similar divergence in the 1999–2003 quinquennium, though of a lesser magnitude, was also evident for males aged 25–34 years. Female suicide rates in the earlier part of the period were significantly lower in rural and remote areas than in metropolitan areas, particularly for those aged 25–34 years, then increased in rural and remote areas to converge with female suicide rates in metropolitan areas. Adjusting for SES in addition to age and country-of-birth reduced urban–rural suicide differentials in both males and females, consistent with SES being an intermediary between rural residence and suicide. Nevertheless, urban–rural differences remained statistically significant. These results show that the largest urban–rural male suicide differentials for the 25-year study period occurred in the most recent period (1999–2003), in the context of decreasing male suicide rates overall.

Introduction

Differences in suicide rates in urban and rural areas have previously been investigated both in Australia (Burnley, 1995; Cantor & Slater, 1997; Dudley et al., 1997; Dudley, Kelk, Florio, Howard, & Waters, 1998; Dudley, Waters, Kelk, & Howard, 1992; Morrell, Taylor, Slaytor, & Ford, 1999; Wilkinson & Gunnell, 2000) and internationally (Connolly & Cullen, 1996; Kondrichin & Lester, 1998; Levin & Leyland, 2005; Middleton, Gunnell, Frankel, Whitley, & Dorling, 2003; Saunderson, Haynes, & Langford, 1998; Schorr, Crabtree, Wagner, & Wetterau, 1989; Singh & Siahpush, 2002), with (predominantly) rural male suicide rates higher compared to urban, or national, suicide rates. Significant differences between urban and rural areas in age-adjusted suicide rates have been found in Australia (Burnley, 1995; Cantor & Slater, 1997; Dudley, Waters, Kelk, & Howard (1992), Dudley et al. (1997), Dudley, Kelk, Florio, Howard, & Waters (1998); Morrell et al., 1999; Wilkinson & Gunnell, 2000), particularly in young males where suicide rates have increased substantially relative to young males in metropolitan areas (Dudley, Waters, Kelk, & Howard (1992), Dudley, Kelk, Florio, Howard, & Waters (1998)). Explanations for these differences have been largely speculative, and have included urban–rural differences in employment opportunities, access to means, and mental health service provision (Baume & Clinton, 1997; Dudley et al., 1997). Cross-sectional studies of urban–rural differences in Australian suicide have found that socio-economic factors, such as area-based economic, educational and occupational resources, and migrant composition, account for a greater proportion of the urban–rural suicide differential than psychiatric factors or health service access (Taylor, Morrell, Slaytor, & Ford, 1998; Taylor, Page, Morrell, Harrison, & Carter, 2005).

Few secular studies of Australian urban–rural suicide differences have explicitly considered confounders other than age, and analyses of observed divergence in suicide in rural and remote areas (relative to urban areas) have remained largely descriptive. Previous cross-sectional studies of suicide have shown that migrant status and socio-economic status (SES) are associated with suicide (Cantor & Slater, 1997; Morrell et al., 1999), and there are significant differences in patterns of suicide between urban and rural areas associated with these variables (Cantor & Slater, 1997; Morrell et al., 1999; Taylor, Morrell, Slaytor, & Ford (1998), Taylor, Page, Morrell, Harrison, & Carter (2005)). Socio-economic factors can be considered as intermediary variables between environmental factors (such as rural residence) and more proximate risk factors for suicide (Taylor et al., 2005), but no previous Australian studies have examined how trends in urban–rural suicide differentials have changed over time in conjunction with socio-economic factors.

There has been a general national decline in male youth suicide in the late 1990s (Fig. 1) in Australia, which followed the peak of the ‘youth suicide epidemic’ in 1997–1998. This also coincided with a national suicide prevention initiative (Fig. 1), and suicide declines that were more apparent in higher than lower, SES areas (Page, Morrell, Taylor, Carter, & Dudley, 2006). The impact of the decline in male youth suicide, and the differential effect by SES, on rural suicide trends is not clear.

Accordingly, the present study examines urban and rural suicide differences for the period 1979–2003 to quantify (a) urban–rural suicide differentials over time in the context of the overall decline in the late 1990s and (b) the extent to which SES accounts for observed trends in urban–rural differences in suicide.

Section snippets

Data

Unit record suicide data were obtained from the Australian Bureau of Statistics (ABS) for the period 1979–2003. Corresponding population data for each Local Government Area (LGA) were also obtained for the 1981, 1986, 1991, 1996 and 2001 censuses. Demographic variables included usual area of residence, sex, age, country-of-birth, urban–rural residence and SES. Age groups were defined in 10-year groups: 15–24, 25–34, 35–44, 45–54, 55–64, 65–74 and ⩾75 years. Six country-of-birth groups were also

Males

Male suicide rates were 4–5 times higher than female suicide rates (Table 1, Table 2). Male suicide rates in metropolitan, rural and remote areas diverged significantly over the study period, especially in young males (p for period×urban–rural area interaction <0.0001, Table 1), after adjusting for the effects of age and country-of-birth (Fig. 2), and age, country-of-birth and SES (Fig. 3). The largest differentials over the period were evident in the latter decade of the study period

Discussion

This study investigated secular trends in urban and rural suicide (1979–2003) to (a) determine if differentials had changed over time, and changed in the context of decreases in male suicide in the late 1990s and differential declines in male suicide by area-based SES (Page et al., 2006) and (b) determine the extent to which SES accounted for observed trends in urban–rural differences in suicide. Analyses were stratified by sex and focussed on younger age groups, and adjusted for effects of

Acknowledgements

This study was funded by the National Health and Medical Research Council, Project Grant no. 107322. The authors would also like to acknowledge the input of Dr. Jian Wu who contributed greatly to the algorithm used to resolve area coding differences between mortality and population data, and changes occurring in Local Government Areas over the study period.

References (29)

  • Rural, regional and remote health: A guide to remoteness classifications

    (2004)

  • International suicide rates—Recent trends and implications for Australia

    (2003)
  • P.J.M. Baume et al.

    Social and cultural patterns of suicide in young people in rural Australia

    Australian Journal of Rural Health

    (1997)
  • J.F. Connolly et al.

    Suicide trends in County Mayo Ireland: A brief report

    Crisis: Journal of Crisis Intervention & Suicide

    (1996)

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