The Effects of Area and Individual Social Characteristics on Suicide Risk: A Multilevel Study of Relative Contribution and Effect Modification

Abstract

Martikainen, P., Ma¨ki, N., and Blomgren, J., 2004, The effects of area and individual social characteristics on suicide risk: A multilevel study of relative contribution and effect modification, European Journal of Population, 20: 323-350.Abstract. The aim of this study is to analyse how area characteristics affect suicide mortality and to assess whether the effects of individual socio-economic characteristics vary in socioeconomically different areas. Data come from the 1990 census records of 15-99-year-old Finns linked to death records in 1991-2001 including 13,589 suicides. Area characteristics were obtained for 85 functional regions. We show that hypotheses of interaction between individual and area socio-economic status for suicide mortality are not supported. However, area socioeconomic characteristics, family cohesion and voting turnout are consistently related to suicide. The effects of median income and income inequality are less consistent. Adjusting for individual level variables partly attenuate these associations. The results indicate that improving the areas people live in may prevent suicide. Martikainen, P., Ma¨ki, N., et Blomgren, J., 2004, Effets des caracte´ristiques sociales re´gionales et individuelles sur le risque de suicide : une e´tude multiniveau de leur contribution relative et de leur prise en compte, Revue Europe´enne de De´mographie, 20: 323-350. Re´sume´. Dans cette e´tude, nous analysons comment les caracte´ristiques locales pe`sent sur la mortalite´par suicide et comment les effets des caracte´ristiques socio-e´conomiques des individus varient en fonction des diffe´rentes re´gions. Pour ce faire, les de´ce`s enregistre´s en Finlande entre 1991 et 2001, dont 13 589 suicides, ont e´te´couple´s aux enregistrements individuels du recensement de 1990, pour les personnes de 15 a`99 ans. Les caracte´ristiques locales concernent 85 re´gions. L'hypothe`se de l'existence d'une interaction entre le statut socio-e´conomique de la re´gion et celui de l'individu n'est pas confirme´e. Cependant, certaines caracte´ristiques socio-e´conomiques de la re´gion, ainsi que la cohe´sion familiale et la European Journal of Population (2004) 20: 323-350 323participation e´lectorale, sont nettement associe´es au suicide. Les effets du revenu me´dian et des ine´galite´s de revenus sont moins nets. Ces relations sont atte´nue´es si l'on controˆle les variables individuelles. Les re´sultats montrent que l'ame´lioration globale de la situation socio-e´conomique des re´gions peut avoir un effet pre´ventif sur le suicide des individus qui y vivent.

The impact of social context on socio-demographic risk factors for suicide: a synthesis of data from case-control studies

“…These findings contrast with those of two recent studies that explored associations between individual and area-level characteristics on risk of suicide in Denmark and Finland 11 19. In the first of these studies, Martikainen and colleagues compared census data on area-level socio-economic characteristics with demographic characteristics of almost 14 000 people who died by suicide over a subsequent 10-year period.…”

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

“…One study reported that ethnic minority status was associated with increased suicide risk in areas with small minority populations, but with decreased risk in areas with large minority populations (Neeleman & Wessely, 1999), similar to the findings for schizophrenia. In another study there was no evidence of interaction between individual and area measures of socio-economic status on suicide (Martikainen et al 2004), whereas in the third study evidence for interactions was inconsistent across the subgroups examined (Agerbo et al 2007). Again, these studies examined the effects of area around the time of suicide.…”

“…Although some of these studies found that associations between suicide and area markers of deprivation, social fragmentation and ethnicity were explained by individual-level characteristics (Agerbo et al 2007;O'Reilly et al 2008;Collings et al 2009), other studies found that area-level associations persisted (Cubbin et al 2000;Martikainen et al 2004).…”

Does income inequality really influence individual mortality?

“…Results from earlier Nordic investigations, made at quite low levels of aggregation, have been somewhat mixed. On the one hand, income inequality was found to be unimportant both in a Swedish analysis of all-cause mortality based on about 40000 individuals living in 284 municipalities (Gerdtham and Johannesson 2004) and in Finnish studies on alcohol-related mortality and suicide in 84 'functional regions' Martikainen et al 2004). On the other hand, Dahl et al (2006) reported a clear mortality-enhancing impact of income inequality when 88 'economic regions' in Norway were considered.…”