Spatial clustering of fatal, and non-fatal, suicide in new South Wales, Australia: implications for evidence-based prevention

Abstract

BackgroundRates of suicide appear to be increasing, indicating a critical need for more effective prevention initiatives. To increase the efficacy of future prevention initiatives, we examined the spatial distribution of suicide deaths and suicide attempts in New South Wales (NSW), Australia, to identify where high incidence ‘suicide clusters’ were occurring. Such clusters represent candidate regions where intervention is critically needed, and likely to have the greatest impact, thus providing an evidence-base for the targeted prioritisation of resources.MethodsAnalysis is based on official suicide mortality statistics for NSW, provided by the Australian Bureau of Statistics, and hospital separations for non-fatal intentional self-harm, provided through the NSW Health Admitted Patient Data Collection at a Statistical Area 2 (SA2) geography. Geographical Information System (GIS) techniques were applied to detect suicide clusters occurring between 2005 and 2013 (aggregated), for persons aged over 5 years. The final dataset contained 5466 mortality and 86,017 non-fatal intentional self-harm cases.ResultsIn total, 25 Local Government Areas were identified as primary or secondary likely candidate regions for intervention. Together, these regions contained approximately 200 SA2 level suicide clusters, which represented 46% (n = 39,869) of hospital separations and 43% (n = 2330) of suicide deaths between 2005 and 2013. These clusters primarily converged on the Eastern coastal fringe of NSW.ConclusionsCrude rates of suicide deaths and intentional self-harm differed at the Local Government Areas (LGA) level in NSW. There was a tendency for primary suicide clusters to occur within metropolitan and coastal regions, rather than rural areas. The findings demonstrate the importance of taking geographical variation of suicidal behaviour into account, prior to development and implementation of prevention initiatives, so that such initiatives can target key problem areas where they are likely to have maximal impact.

Spatial clustering of suicide mortality and associated community characteristics in Kanagawa prefecture, Japan, 2011–2017

“…These methods are useful not only for studies of infectious diseases but also for studies of non-infectious diseases or events like suicide. Worldwide there have been several reports of suicide cluster analyses [14][15][16][17][18][19]. We performed spatial cluster analyses using several methods as well as examined related factors using the CAR model including spatial smoothing.…”

“…As for the application related to spatial epidemiology, there have been several reports of suicide cluster analyses worldwide [14][15][16][17][18][19]. Namely, a study in New South Wales, Australia, between 2005 and 2013 [14] demonstrated the importance of examining geographical variations in spatial clustering of fatal and non-fatal suicide attempts.…”

“…As for the application related to spatial epidemiology, there have been several reports of suicide cluster analyses worldwide [14][15][16][17][18][19]. Namely, a study in New South Wales, Australia, between 2005 and 2013 [14] demonstrated the importance of examining geographical variations in spatial clustering of fatal and non-fatal suicide attempts. A study in Central Brazil during 2000-2010 [15] showed spatial-temporal trends and risk of suicide; a study in Sergipe, Brazil, [16] performed spatial analysis and detected temporal trends in suicide mortality for the period from 2000 to 2015; in Kentucky a spatial epidemiologic investigation.…”

Geographic Variations of Stroke Hospitalization across France: A Diachronic Cluster Analysis

“…The spatiotemporal approach is also relevant because it attempts to highlight dynamics by identifying geographic codes that transitioned into high or low rate clusters, regarding stroke unit deployment efforts. Several studies use spatial statistics method in stroke but also in breast cancer [ 24 ], lower respiratory tract infection [ 25 ], or suicide [ 26 ] and make it an essential decision-making tool to implement effective strategies to improve health and reduce geographic disparities.…”

Protocol for a stepped-wedge, cluster randomized controlled trial of the LifeSpan suicide prevention trial in four communities in New South Wales, Australia

“…Accordingly, sites were required to have a minimum base population of 145,000 persons to allow for sufficient statistical power to detect a primary intervention effect. Archival data on suicide mortality and non-fatal hospital admissions for intentional self-harm were analyzed in a preceding early phase scoping study [10] to allocate LGA geographies into quartiles for suicide mortality and morbidity indicators.…”