Individual- and area-level influence on suicide risk: a multilevel longitudinal study of Swedish schoolchildren

Zammit, Stanley; Gunnell, David; Leckie, George; Dalman, Christina; Allebeck, Peter

doi:10.1017/s0033291713000743

Cited by 25 publications

(22 citation statements)

References 45 publications

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“…The estimated variance of attempted suicide attributed to the community level factor (4% 95% CI 3–5%) in this study are consistent (though somewhat higher) with the two previous studies of suicide in HIC, which estimated this variance to be 0.76% 95% CI 0.05–3.99% ( Zammit et al, 2014 ); and 3% ( Denney et al, 2015 ). This support our hypothesis that contextual factors may be more important in LMIC.…”

Section: Discussionsupporting

confidence: 91%

“…This is consistent with the findings of our analysis which found that higher levels of deprivation, lower levels of social support (fewer cohabiting generations), and higher levels of problem alcohol consumption (possibly a proxy for social fragmentation) were independently associated with a higher odds of attempted suicide. Several previous studies did not show an independent association of contextual factors once compositional factors were included in analytical models ( Maimon and Kuhl, 2008 , Neeleman and Wessely, 1999 , O'Reilly et al, 2008 , Zammit et al, 2014 ). Possible explanations could be: 1) that the difference reflects cultural differences; 2) methodological differences due to the size of the area unit used (i.e.…”

Section: Discussionmentioning

confidence: 82%

“…large areas vs. smaller neighbourhoods); 3) the inclusion of several factors in the model which are highly correlated (at the same level) and which therefore attenuate the associations towards the null. Few studies have investigated whether the contextual socioeconomic environment modified the association of individual SEP on suicide risk ( Agerbo et al, 2007 , Martikainen et al, 2004 , Zammit et al, 2014 ). Consistent with this analysis, they showed no strong statistical evidence of a cross-level interaction.…”

Section: Discussionmentioning

confidence: 99%

“…a multilevel model with no explanatory variables) in order to estimate the variance partition coefficient (VPC). This is an estimate of the proportion of variation attributed to each level of the data structure, and has been previously been used in suicide research ( Zammit et al, 2014 ). This is sometimes interpreted as the “importance” of each level (i.e.…”

Section: Methodsmentioning

confidence: 99%

“…Multilevel modelling techniques allows the researcher to model individual relationships, group relationship, and the link between them. Studies have investigated the influence of compositional and contextual effects simultaneously on suicide risk in high income countries (HIC) ( Agerbo et al, 2007 , Collings et al, 2009 , Denney et al, 2015 , Hawton et al, 2001 , Johnston et al, 2006 , Maimon and Kuhl, 2008 , Martikainen et al, 2004 , Neeleman and Wessely, 1999 , O'Reilly et al, 2008 , Turnbull, 2014 , Zammit et al, 2014 ), with few studies investigating attempted suicide risk ( Hawton et al, 2001 , Maimon and Kuhl, 2008 ). There is evidence from these studies that contextual factors influence suicide risk ( Agerbo et al, 2007 , Denney et al, 2015 , Hawton et al, 2001 , Martikainen et al, 2004 , Zammit et al, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

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Attempted suicide in Sri Lanka – An epidemiological study of household and community factors

Knipe

Gunnell

Pearson

et al. 2018

Journal of Affective Disorders

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BackgroundAn individual's suicide risk is determined by personal characteristics, but is also influenced by their environment. Previous studies indicate a role of contextual effects on suicidal behaviour, but there is a dearth of quantitative evidence from Asia.MethodsIndividual and community level data were collected on 165,233 people from 47,919 households in 171 communities in rural Sri Lanka. Data were collected on individual (age, sex, past suicide attempts and individual socioeconomic position (SEP)) and household (household SEP, pesticide access, alcohol use and multigenerational households) level factors. We used 3-level logit models to investigate compositional (individual) and contextual (household/community) effects.ResultsWe found significant variation between households 21% (95% CI 18%, 24%) and communities 4% (95% CI 3%, 5%) in the risk of a suicide attempt. Contextual factors as measured by low household SEP (OR 2.37 95% CI 2.10, 2.67), low community SEP (OR 1.45 95% CI 1.21, 1.74), and community ‘problem’ alcohol use (OR 1.44 95% CI 1.19, 1.75) were associated with an increased risk of suicide attempt. Women living in households with alcohol misuse were at higher risk of attempted suicide. We observed a protective effect of living in multigenerational households (OR 0.53 95% CI 0.42, 0.65).LimitationsThe outcome was respondent-reported and refers to lifetime reports of attempted suicide, therefore this study might be affected by socially desirable responding.ConclusionsOur study finds that contextual factors are associated with an individual's risk of attempted suicide in Sri Lanka, independent of an individual's personal characteristics.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Attempted suicide in Sri Lanka – An epidemiological study of household and community factors

Knipe

Gunnell

Pearson

et al. 2018

Journal of Affective Disorders

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The social determinants of mental health and disorder: evidence, prevention and recommendations

Kirkbride,

Anglin,

Colman

et al. 2024

World Psychiatry

141

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People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high‐quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.

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Urban-Rural Differences in Major Mental Health Conditions

Solmi¹,

Dykxhoorn²,

Kirkbride³

2016

Mental Health and Illness Worldwide

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is a Research Associate in psychiatric epidemiology in the PsyLife group, Division of Psychiatry, UCL. She is interested in researching life course risk factors of various mental health problems in childhood, adolescence and young adulthood as well as ways to improve access to mental health services. Jennifer Dykxhoorn is a PhD student in the PsyLife Lab, Division of Psychiatry, UCL. Her research focuses on social and spatial determinants of psychotic disorders. She has a background in public mental health policy, having previously worked for the Public Health Agency of Canada and Mental Health Commission of Canada. Dr James Kirkbride is a Reader in Epidemiology in the Division of Psychiatry, UCL. He specialises in investigating the determinants of excess risk of schizophrenia and other psychotic disorders experienced by urban populations and ethnic minority groups. He runs the PsyLife group (www.PsyLife.eu) in the Division of Psychiatry, UCL.

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Individual- and area-level influence on suicide risk: a multilevel longitudinal study of Swedish schoolchildren

Cited by 25 publications

References 45 publications

Attempted suicide in Sri Lanka – An epidemiological study of household and community factors

Attempted suicide in Sri Lanka – An epidemiological study of household and community factors

The social determinants of mental health and disorder: evidence, prevention and recommendations

Urban-Rural Differences in Major Mental Health Conditions

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