SUICIDE in RURAL & REMOTE AREAS of AUSTRALIA - Living is for ...

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Suicide in rural and remote areas of Australia 39 This may suggest that younger persons – one of the main groups ‘at risk’ of suicide in remote areas – are also least likely to be taking antidepressants (De Leo et al, 2006). Therefore, the positive effects of antidepressants on suicide may be confi ned to persons in older age-groups, rather than infl uencing the population most at-risk of suicide: the youth population. Findings from past ecological research in Ireland lends some support to this conclusion, by reporting that antidepressant prescribing is related to lower rates in older age-group but had no effect on suicide among younger age-group (Kelly et al, 2003). Therefore, our seemingly paradoxical fi nding regarding antidepressant expenditure may be due to contextual differences and the sub-populations actually exposed to antidepressants. However, given the distal nature of the independent variable, we cannot provide a fi rm explanation of the signifi cant relationship between expenditure on anti-depressant medication and suicide. Because of this diffi culty, we acknowledge the need for further investigation into different age-groups of suicides occurring in remote areas, as well examination of individual-level psychiatric or situational infl uences on suicide. Another signifi cant fi nding in remote areas related to the protective effect of education on suicide rates. Education has often been considered to be an indicator of human capital (Rose, 2000). Considering this, the benefi cial effect of education on suicide in remote areas may be explained by an increase in human capital. Human capital is mainly discussed in the context of activities that increase the economic output of individuals over a long period of time, including expenditures on education, training and medical care (Becker, 1993). Therefore, achieving education up until Year 12 may be seen as a way of furthering the economic and employment viability of young persons in remote areas and, thus, associated with a decline in male suicide. GriffithBook FINAL 20/09.indd 39 15/11/12 4:28 PM
40 Suicide in rural and remote areas of Australia In metropolitan locations, male suicide was adversely affected by unemployment. This result aligns with previous research on the relationship between suicide and social factors (Chuang & Huang, 2007; Milner et al, 2010). Aside from the loss of a job, unemployment may increase the risk of suicide by creating the feeling of role loss. This may be particularly detrimental to males, considering the emphasis males place on the role of “breadwinner” (Möller-Leimkühler, 2003). The adverse infl uence of mobility (measured as the proportion of person who lived overseas in the past year) on male suicide may be indicative of wider disruption in social and community networks. In the past, researchers have argued that mobility within a neighbourhood reduces social integration (bonds and relationships in society), leading to higher risk for suicide (Congdon, 1996; Middleton et al, 2006, Thorlindsson & Bernburg, 2009). This may provide some explanation for our results. A higher number of GPs services (per 100 persons) was related to lower female suicide in metropolitan and remote areas, perhaps providing support for past research on the relationship between GPs and suicide rates in a population (Mann et al, 2005). However, further investigation would be needed into how many of these GP services concerned the identifi cation and management of suicide before this explanation can be confi rmed. Expenditure on psychotropic medication, such as antipsychotics, anxiolytics, hypnotics and sedatives, and psychostimulants, was associated with an increase in female and male suicide within metropolitan areas. This may be related to the higher suicide rates of persons taking these types of medications in metropolitan localities, who may already be at high risk due to mental illness (Hawton et al, 2005; Siris, 2001) or other conditions for which psychotropic medication is prescribed, such as chronic pain. It is also necessary to consider that, compared to remote areas, there are more hospitals in metropolitan areas, as well as out-patient facilities and other services for mental health treatment (Dixon and Welch, 2000; Fraser et al, 2002). Therefore, the adverse effect of these psychotropic medications on suicide may be due to the infl uence of a specifi c high-risk sample group residing in metropolitan areas. However, confi rming this explanation would require further analysis controlling for rates of individual mental health contacts and actual number of deaths due to overdose of psychotropic medications. The proportion of males/females with a family (e.g., partner and child) was associated with a decrease in male suicide in remote areas and with lower female suicide rates in remote areas. These apparent protective effects of having children have been noted in previous studies in suicide research (Qin et al, 2003; Stack, 1997; Stack; 1996-97). A possible explanation for these results is that they provide an indication of social support – or social integration – in society (Durkheim, 1897/1951). GriffithBook FINAL 20/09.indd 40 15/11/12 4:28 PM
Page 1 and 2: Australia’s rural localities face
Page 3 and 4: Suggested quotation: Kairi Kõlves,
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Page 11 and 12: Introduction The burden of suicide
Page 17 and 18: 10 Suicide in rural and remote area
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Page 77 and 78: Chapter 4 Suicide prevention initia
Page 89 and 90: Conclusions As in any other part of
Page 93 and 94: References Agerbo, E., Sterne, J. A
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90 Suicide in rural and remote area
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