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

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Suicide in rural and remote areas of Australia
were no signifi cant differences between rural and
urban suicide groups (31.3% in rural and 28.4%
in urban suicide cases). Multiple contacts were
more frequently made by the suicide groups in both
areas. Case Study Two and Case Study Three both
sought help from different healthcare professionals.
However, the quality of help they received was
questionable as the informants for both case studies
mentioned various aspects with which they were
dissatisfi ed.
While the help provided from experts is important,
support from family and friends is also vital. Lack
of social support and increased social isolation
have been found to be important suicide risk
factors in psychological autopsy studies from rural
China (Zhang et al, 2004) and rural South India
(Manoranjitham et al, 2010). The present study
analysed the receiving and giving of moral and
practical support from family and friends (Bille-Brahe
& Jensen, 2004). Receiving less moral support then
needed from family and friends was found to be a
signifi cant suicide predictor in rural and urban areas.
Previous research has indicated that reluctance to
seek help may also be related to the perception that
there is less diagnosed mental illness connected
to suicide in rural areas (Judd et al, 2006b). Our
fi ndings showed that, according to the NOK,
those in the suicide group in both urban and rural
areas had a higher risk of being diagnosed with a
mental illness during their life, compared to their
sudden-death controls. However, the post-mortem
psychiatric disorders determined by the SCID-I
analysis indicated a considerable under-diagnosis
of mental illnesses for those in the suicide and
sudden-death control groups in both urban and rural
areas. In Case Study One, the male was not formally
diagnosed with depression or anxiety, although the
NOK informant believed he suffered from both these
disorders. However, SCID-I indicated a diagnosis of
anxiety disorder.
In the present study, the prevalence of mental
health disorders was higher in rural suicide (84%)
compared to urban suicide group (70%), and more
closer to the mean proportion found by previous
systematic reviews of PA studies (close to 90%;
Conner et al, 2001; Arsenault-Lapierre et al, 2004).
Further, a recent meta-analysis has indicated a strong
association between suicide, substance abuse and
mood disorders (Yoshimasu et al, 2008). High-risk
alcohol consumption in rural areas has been linked
to increased vulnerability to suicide (Cantor & Slater,
1997; Miller et al, 2010). However, alcohol abuse
disorder was not a predictor of suicide in rural
areas, considering the similarly high rate of alcohol
abuse disorder also found among the suddendeath
controls. Case Study Four demonstrates the
signifi cant vulnerability that alcohol dependency
can create where many of the deceased’s stressors
were directly caused by his addiction. It should also
be noted that self-medication with alcohol may be
used as a coping strategy in rural areas (Alston,
2010). Certainly, this was indicated in Case Study
Three where, after unsuccessful pharmacological
treatments, the deceased started drinking to replace
antidepressants and other medication.
However, in both urban and rural regions, the
presence of a mood disorders was a signifi cant
predictor for suicide, compared to suddendeath
controls. There were no differences in the
prevalence of the mood disorders between urban
and rural regions. These results are similar to those
from a Finnish psychological autopsy study which
compared urban and rural suicides (Isometsä et al,
1997). Further, our analysis showed that anxiety
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