Determinants of suicidal ideation and suicide attempts: parallel cross-sectional analyses examining geographical location

BMC Psychiatry

Brian J Kelly⁶  Tim Slade²  Terry J Lewin³  Clare Coleman¹  Natasha Weaver⁴  Amy Johnston²  Tonelle E Handley⁵  Kerry J Inder⁵ 

[1] Sydney Centre for Aboriginal and Torres Strait Islander Statistics, Faculty of Health Sciences, University of Sydney, Sydney, Australia;National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia;Hunter New England Mental Health Service, Newcastle, NSW, Australia;School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, NSW, Australia;Centre for Rural and Remote Mental Health, University of Newcastle, Newcastle, NSW, Australia;Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Newcastle, New South Wales (NSW), Australia

关键词: Social determinants of health;    Remoteness;    Psychiatric disorder;    Suicide attempts;    Suicidal ideation;    Rural mental health;   

Others  :  1123451
DOI  :  10.1186/1471-244X-14-208

 received in 2014-02-14, accepted in 2014-07-10,  发布年份 2014

【 摘 要 】

Background

Suicide death rates in Australia are higher in rural than urban communities however the contributors to this difference remain unclear. Geographical differences in suicidal ideation and attempts were explored using two datasets encompassing urban and rural community residents to examine associations between socioeconomic, demographic and mental health factors. Differing patterns of association between psychiatric disorder and suicidal ideation and attempts as geographical remoteness increased were investigated.

Methods

Parallel cross-sectional analyses were undertaken using data from the 2007 National Survey of Mental Health and Wellbeing (2007-NSMHWB, n = 8,463), under-representative of remote and very remote residents, and selected participants from the Australian Rural Mental Health Study (ARMHS, n = 634), over-representative of remote and very remote residents. Uniform measures of suicidal ideation and attempts and mental disorder using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI-3.0) were used in both datasets. Geographic region was classified into major cities, inner regional and other. A series of logistic regressions were undertaken for the outcomes of 12-month and lifetime suicidal ideation and lifetime suicide attempts, adjusting for age, gender and psychological distress. A sub-analysis of the ARMHS sample was undertaken with additional variables not available in the 2007-NSMHWB dataset.

Results

Rates and determinants of suicidal ideation and suicide attempts across geographical region were similar. Psychiatric disorder was the main determinant of 12-month and lifetime suicidal ideation and lifetime suicide attempts across all geographical regions. For lifetime suicidal ideation and attempts, marital status, employment status, perceived financial adversity and mental health service use were also important determinants. In the ARMHS sub-analysis, higher optimism and better perceived infrastructure and service accessibility tended to be associated with a lower likelihood of lifetime suicidal ideation, when age, gender, psychological distress, marital status and mental health service use were taken into account.

Conclusions

Rates and determinants of suicidal ideation and attempts did not differ according to geographical location. Psychiatric disorder, current distress, employment and financial adversity remain important factors associated with suicidal ideation and attempts across all regions in Australia. Regional characteristics that influence availability of services and lower personal optimism may also be associated with suicidal ideation in rural communities.

【 授权许可】

   
2014 Inder et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Australian Bureau of Statistics: 3309.0 - Suicides. Australia: Geography; 2010. http://www.abs.gov.au/ausstats/abs@.nsf/Products/893AED59D8C25231CA257AA9001641F8?opendocument webcite viewed on June 11, 2014
• [2]Australian Bureau of Statistics: 3309.0 - Suicides. Australia: Overview; 2010. http://www.abs.gov.au/ausstats/abs@.nsf/Products/8D157E15E9D912E7CA257A440014CE53?opendocument webcite viewed on June 11, 2014
• [3]Hawton K, Combabella CC, Haw C, Saunders K: Risk factors for suicide in individuals with depression: A systematic review. J Affect Disorders 2013, 147:17-28.
• [4]Slade T, Johnston A, Teesson M, Whiteford H, Burgess P, Pirkis J, Saw S: The Mental Health of Australians 2. Report on the 2007 National Survey of Mental Health and Wellbeing. Canberra: Department of Health and Ageing; 2009.
• [5]Peen J, Schoevers RA, Beekman AT, Dekker J: The psychiatric status of urban–rural differences in psychiatric disorders. Acta Psychiatr Scand 2010, 121:84-93.
• [6]Blakely TA, Collings SCD, Atkinson J: Unemployment and suicide. Evidence for a causal association? J Epidemiol Community Health 2003, 57:594-600.
• [7]Australian Institute of Health and Welfare: Mental health services – in brief 2012. Cat. No. HSE 125. Canberra: AIHW; 2012.
• [8]Hilton MF, Scheurer RW, Sheridan J, Cleary CM, Whiteford HA: Employee psychological distress and treated prevalence by indices of rurality. Aust N Z J Public Health 2010, 34:458-465.
• [9]Large MM, Nilessen OB: Suicide in Australia: meta-analysis of rates and methods of suicide between 1988 and 2007. Med J Aust 2010, 192:432-437.
• [10]Johnston AK, Pirkis JE, Burgess PM: Suicidal thoughts and behaviours among Australia adults: findings from the 2007 National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2009, 43:635-643.
• [11]Slade T, Johnston A, Oakley Browne MA, Andrews G, Whiteford H: 2007 National Survey of Mental Health and Wellbeing: Methods and key findings. Aust N Z J Psychiatry 2009, 43:594-605.
• [12]Handley TE, Inder KJ, Kelly BJ, Attia JR, Lewin TJ, Fitzgerald MN, Kay-Lambkin FJ: Contributors to suicidality in rural communities: beyond the effects of depression. BMC Psychiatry 2012, 12:105.
• [13]Caldwell TM, Jorm AF, Dear KBG: Suicide and mental health in rural, remote and metropolitan areas in Australia. Med J Aust 2004, 181:S10-S14.
• [14]Wilkinson D, Gunnell D: Youth suicide trends in Australian metropolitan and non-metropolitan areas, 1988–1997. Aust N Z J Psychiatry 2000, 34:822-828.
• [15]Judd FK, Jackson HJ, Komiti A, Murray G, Hodgins G, Fraser C: High prevalence disorders in urban and rural communities. Aust N Z J Psychiatry 2002, 36:104-113.
• [16]Smith KB, Humphreys JS, Wilson MGA: Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research? Aust J Rural Health 2008, 16:56-66.
• [17]Judd FK, Cooper A, Fraser C, Davis J: Rural suicide – people or place effects? Aust N Z J Psychiatry 2006, 40:208-216.
• [18]Kessler RC, Unstan TB: The World Mental Health (WMH) survey initiative version of the World Health Organisation (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatric Res 2004, 13:93-121.
• [19]Kelly BJ, Stain HJ, Coleman C, Perkins D, Fragar L, Fuller J, Lewin TJ, Lyle D, Carr VJ, Wilson JM, Beard JR: Mental health and well-being within rural communities: The Australian Rural Mental Health Study. Aust J Rural Health 2010, 18:16-24.
• [20]Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-LT, Walters EE, Zaslavsky AM: Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002, 32:959-976.
• [21]American Psychiatric Association: Diagnostic and statistical manual of mental disorders. 4th edition. 2000. In Volume text rev. doi:10.1176/appi.books.9780890423349
• [22]World Health Organization: International Classification of Diseases version 10. http://www.who.int/classification/icd webcite viewed June 11, 2014
• [23]Andrews G, Peters L: The psychometric properties of the Composite International Diagnostic Interview. Soc Psychiatry Psychiatr Epidemiol 1998, 33:80-88.
• [24]Australian Bureau of Statistics (ABS): 4102.0 - Australian Social Trends, 2008: Population distribution. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Chapter3002008 webcite viewed June 11 2014
• [25]Australian Institute of Health and Welfare: Rural, regional and remote health: a guide to remoteness classifications. Canberra: AIHW cat. No. PHE 53; 2004.
• [26]Andrews G, Henderson S, Hall W: Prevalence, comorbidity, disability and service utilisation: Overview of the Australian National Mental Health Survey. Br J Psychiatry 2001, 178:145-153.
• [27]Slade T, Grove R, Burgess P: Kessler Psychological Distress Scale: normative data from the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2011, 45:308-316.
• [28]Kelly BJ, Lewin TJ, Stain HJ, Coleman C, Fitzgerald MN, Perkins D, Carr VJ, Fragar L, Fuller J, Lyle D, Beard JR: Determinants of mental health and well-being within rural and remote communities. Soc Psychiatry Psychiatr Epidemiol 2011, 46:1331-1342.
• [29]Saunders JB, Aasland OG, Babor TF, de la Fuente JG, Grant M: Development of the Alcohol-Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. Addiction 1993, 88:791-804.
• [30]Brugha TS, Cragg D: The list of threatening experiences: The reliability and validity of a brief life events questionnaire. Acta Psychiatr Scand 1990, 82:77-81.
• [31]Henderson S, Duncan-Jones P, Byrne DG, Scott R: Measuring social relationships – the Interview Schedule for Social Interaction. Psychol Med 1980, 10:723-734.
• [32]Berkman LF, Syme SL: Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. Am J Epidemiol 1979, 109:186-204.
• [33]Chipuer HM, Pretty GM: A review of the sense of community index: Current uses, factor structure, reliability, and further development. J Community Psychol 1999, 27:659-679.
• [34]Australian Bureau of Statistics: Information paper number 1374, measuring social capital: An Australian framework and indicators. Canberra: Australian Bureau of Statistics; 2004.
• [35]Higginbotham HN, Connor LH, Albrecht GA, Freeman SR, Agho K: Validation of an Environmental Distress Scale. Eco Health 2006, 3:245-254.
• [36]Stain HJ, Kelly BJ, Carr VJ, Lewin TJ, Fitzgerald M, Fragar L: The psychological impact of chronic environmental adversity: Responding to prolonged drought. Soc Sci Med 2011, 73:1593-1599.
• [37]Nunn KP, Lewin TJ, Walton JM, Carr VJ: The construction and characteristics of an instrument to measure personal hopefulness. Psychol Med 1996, 26:531-545.
• [38]Simmons CA, Elias-Lambert : Hope, Optimism, and Humor. In Tools for Strengths-Based Assessment and Evaluation. Edited by Simmons CA, Lehmann P. New York: Springer Publishing Company; 2013:187-217.
• [39]Eysenck SBG, Eysenck HJ, Barrett PA: A revised version of the psychoticism scale. Pers Individ Differences 1985, 6:21-29.
• [40]Australian Bureau of Statistics: An introduction to Socio-Economic Indexes for Areas (SEIFA), 2006: information paper. Canberra: Commonwealth of Australia: ABS Catalogue No. 2039.0; 2008.
• [41]Watson N, Wooden M: The household, income and labour dynamics in Australia (HILDA) survey: An introduction. In Australian social policy 2001–02. Canberra: Department of Families, Community Services (FaCS); 2001:79-99.
• [42]Fragar L, Inder KJ, Kelly BJ, Coleman C, Perkins D, Lewin TJ: Unintentional injury, psychological distress and depressive symptoms: Is there an association for rural Australians? J Rural Health 2013, 29:12-19.
• [43]Perkins D, Fuller J, Kelly B, Lewin T, Fitzgerald M, Coleman C, Inder K, Allan J, Arya D, Roberts R, Buss R: Factors associated with reported service use for mental health problems by residents of rural and remote communities: cross-sectional findings from baseline survey. BMC Health Serv Res 2013, 13:157.
• [44]Kroenke K, Spitzer RL, Williams JBW: The PHQ-9 – Validity of a brief depression severity measure. J Gen Intern Med 2001, 16:606-613.
• [45]Lee JI, Lee MB, Liao SC, Chang CM, Sung SC, Chiang HC, Tai CW: Prevalence of suicidal ideation and associated risk factors in the general population. J Formos Med Assoc 2010, 109:138-147.
• [46]Casey PR, Dunn G, Kelly BD, Birkbeck G, Dalgard OS, Lehtinen V, Britta S, Ayuso-Mateos JL, Dowrick C: Factors associated with suicidal ideation in the general population Five-centre analysis from the ODIN study. Br J Psychiatry 2006, 189:410-415.
• [47]Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, Hegerl U, Lonnqvist J, Malone K, Marusic A, Mehlum L, Patton G, Phillips M, Rutz W, Rihmer Z, Schmidtke A, Shaffer D, Silverman M, Takahashi Y, Varnik A, Wasserman D, Yip P, Hendin H: Suicide prevention strategies: a systematic review. JAMA 2005, 294(16):2064-2074.
• [48]Handley TE, Inder KJ, Kay-Lambkin FJ, Stain HJ, Fitzgerald M, Lewin TJ, Attia JR, Kelly BJ: Contributors to suicidality in rural communities: beyond the effects of depression. BMC Psychiatry 2012, 12:105.
• [49]Fairweather-Schmidt AK, Anstey KJ, Mackinnon AJ: Is suicidality distinguishable from depression? Evidence from a community-based sample. Aust N Z J Psychiatry 2009, 43:208-215.
• [50]Handley TE, Inder KJ, Kay-Lambkin FJ, Stain HJ, Fitzgerald M, Lewin TJ, Attia JR, Kelly BJ: You’ve got to have friends: the predictive value of social integration and support in suicidal ideation among rural communities. Soc Psychiatry Psychiatr Epidemiol 2012, 47:1281-1290.
• [51]Handley TE, Inder KJ, Kelly BJ, Attia JR, Kay-Lambkin FJ: Urban–rural influences on suicidality: Gaps in the existing literature and recommendations for future research. Aust J Rural Health 2011, 19:279-283.
• [52]Rost K, Forney J, Fischer E, Smith J: Use, quality and outcomes of care for mental health: The rural perspective. Med Care Res Rev 2002, 59:231-265.
• [53]Fragar L, Stain HJ, Perkins D, Kelly B, Fuller J, Coleman C, Lewin TJ, Wilson JM: Distress among rural residents: does employment and occupation make a difference? Aust J Rural Health 2010, 18:25-31.
• [54]Butterworth P, Olesen S, Leach L: The role of hardship in the association between socio-economic position and depression. Aust N Z J Psychiatry 2012, 46:364-373.
• [55]Allen J, Inder KJ, Lewin TJ, Attia J, Kelly BJ: Social support and age influence distress outcomes differentially across urban-regional and remote Australia: an exploratory study. BMC Public Health 2012, 12:928.
• [56]Beaudoin CE, Wendel ML, Drake K: A study of individual-level social capital and health outcomes: Testing for variance between rural and urban respondents. Rural Sociol 2013. doi:10.1111/ruso.12036
• [57]Fraser C, Jackson H, Judd F, Komiti A, Robins G, Murray G, Humphreys J, Pattison P, Hodgins G: Changing places: the impact of rural restructuring on mental health in Australia. Health Place 2005, 11:157-171.
• [58]Jackson H, Judd F, Komiti A, Fraser C, Murray G, Robins G, Pattison P, Wearing A: Mental health problems in rural contexts: what are the barriers to seeking help from professional providers? Aust Psychol 2007, 42:147-160.
• [59]Handley TE, Kay-Lambkin FJ, Inder KJ, Attia JR, Lewin TJ, Kelly BJ: Feasibility of internet-delivered mental health treatments for rural populations. Soc Psychiatry Psychiatr Epidemiol 2014, 49:275-282.
• [60]Kõlves K, Milner A: Kathy McKay & Diego De Leo (eds). Brisbane: Suicide in rural and remote areas of Australia. Australian Institute for Suicide Research and Prevention; 2012.
• [61]Rhode P, Lewinsohn PM, Seelet JR: Comparability of telephone and face-to-face interviews in assessing Axis I and II disorders. Am J Psychiatry 1997, 154:1593-1598.
• [62]Australian Bureau of Statistics: 3309.0 - Suicides, Australia, 2010. Aboriginal and Torres Strait Islander Suicide Deaths. http://www.abs.gov.au/ausstats/abs@.nsf/Products/3309.0~2010~Chapter~Aboriginal+and+Torres+Strait+Islander+suicide+deaths?OpenDocument webcite viewed on June 11, 2014
• [63]Harrison JE, Pointer S, Elnour AA, Australian Institute of Health and Welfare (AIHW): A review of suicide statistics in Australia. Injury research and statistics series no. 49. Cat. no. INJCAT 121. Adelaide: AIHW; 2009.