Determinants of suicidal ideation and suicide attempts: parallel cross-sectional analyses examining geographical location

Abstract

BackgroundSuicide death rates in Australia are higher in rural than urban communities however the contributors to this difference remain unclear. Geographical differences in suicidal ideation and attempts were explored using two datasets encompassing urban and rural community residents to examine associations between socioeconomic, demographic and mental health factors. Differing patterns of association between psychiatric disorder and suicidal ideation and attempts as geographical remoteness increased were investigated.MethodsParallel cross-sectional analyses were undertaken using data from the 2007 National Survey of Mental Health and Wellbeing (2007-NSMHWB, n = 8,463), under-representative of remote and very remote residents, and selected participants from the Australian Rural Mental Health Study (ARMHS, n = 634), over-representative of remote and very remote residents. Uniform measures of suicidal ideation and attempts and mental disorder using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI-3.0) were used in both datasets. Geographic region was classified into major cities, inner regional and other. A series of logistic regressions were undertaken for the outcomes of 12-month and lifetime suicidal ideation and lifetime suicide attempts, adjusting for age, gender and psychological distress. A sub-analysis of the ARMHS sample was undertaken with additional variables not available in the 2007-NSMHWB dataset.ResultsRates and determinants of suicidal ideation and suicide attempts across geographical region were similar. Psychiatric disorder was the main determinant of 12-month and lifetime suicidal ideation and lifetime suicide attempts across all geographical regions. For lifetime suicidal ideation and attempts, marital status, employment status, perceived financial adversity and mental health service use were also important determinants. In the ARMHS sub-analysis, higher optimism and better perceived infrastructure and service accessibility tended to be associated with a lower likelihood of lifetime suicidal ideation, when age, gender, psychological distress, marital status and mental health service use were taken into account.ConclusionsRates and determinants of suicidal ideation and attempts did not differ according to geographical location. Psychiatric disorder, current distress, employment and financial adversity remain important factors associated with suicidal ideation and attempts across all regions in Australia. Regional characteristics that influence availability of services and lower personal optimism may also be associated with suicidal ideation in rural communities.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-244X-14-208) contains supplementary material, which is available to authorized users.

Child abuse and the prevalence of suicide attempts among those reporting suicide ideation

“…Factors, such as mental illness [3, 12, 14, 18–21], substance abuse [3, 12, 19], sex [3, 12, 20–22], age [3, 12, 21, 22], marital status [3, 19], social interactions and belonging [14, 19], and life stressors [14, 18] have had conflicting findings. Other potential risk factors, such as financial strain [23, 24] and physical illness [25, 26], have not been studied as factors that may distinguish suicide ideators and attempters.…”

Substance Use Disorders and Poverty as Prospective Predictors of Adult First-Time Suicide Ideation or Attempt in the United States

“…Moreover, in one study, rates of suicide attempts were greater than rates of suicidal ideation (LeMaster et al, 2004). Fifth, determining the common predictors for either first-time suicide ideation or attempt is consistent with, and allows for comparison to, the majority of cross-national studies that have examined predictors of suicidal behavior (Inder et al, 2014; Nock et al, 2008; WHO, 2014). Finally, determining the mutual predictors of first-time suicide ideation or attempt can inform the development and testing of effective and efficient national and global prevention and treatment efforts (Inder et al, 2014; Nock et al, 2008).…”

Environmental factors and suicide in Australian farmers: A qualitative study

“…13 Overall, the reasons for increased rural suicide in Australia remain unclear. 11 Whilst nothing stood out in our focus groups to clearly explain the higher rate of suicide in QLD farmers, perhaps geographical isolation is relevant, given the larger size of this state, and greater distances between farms and major centres. This physical isolation may compound barriers to service utilisation within the sociocultural environment, making help seeking even less likely.…”

“…8,9 Despite the well documented disparity in farmer suicide compared to many other occupations in Australia, many researchers agree the reasons for this disparity remain poorly understood. [10][11][12] Further qualitative research has been recommended to better understand the complex interplay of contributing factors 10 so that targeted strategies can be designed and delivered to those most at risk, given demographic and geographical variation in farmer suicide mortality. 13,14 Suicidal behaviour is a complex interplay of psychological, social, biological and contextual factors.…”