Friday, 18 March 2016

Rural suicide rates: research reveals role of place

Newly published research around alarming suicide rates in regional areas provides an important insight into the issue.

The research team from Monash Rural Health studied four Victorian communities to look for common links. It found there were several common factors in towns with lower suicide rates including seeking out help and positive attitudes to mental illness.

While the disproportionate rate between suicides in country and city is well documented, this latest research, published in Qualitative Health Research, looked at the reasons why.

Social cohesion and a focus on youth are among the factors associated with lower rates of suicide in small rural towns.

Comparing four rural towns

The study chose four small rural towns with populations under 4000 – two with high suicide rates and two with lower rates. Scoping research found suicide rates in rural areas have increased up to 12-fold in some demographics over a 30-year period in towns of this size.

The research formed part of Dr Jessica Collins’ doctoral studies with Monash Rural Health. According to Dr Collins, although the patterns and mechanisms of rural suicide were well documented, they remained “poorly understood”. She interviewed psychologists, GPs and other health professionals in the four towns.

What's the role of "place"?

Research colleague and Monash Rural Health Senior Research Fellow, Dr Bernadette Ward, said the research found there were several factors associated with lower suicide rates in the towns, including positive attitudes to mental illness and seeking help.

“High perceptions of community safety were also important,” she said. “Also the ability of town residents to work together in difficult times, and to change and accept the values and goals of young people, particularly when there were high levels of social support and attendance at community events.

“This is not to say that residents within low suicide towns didn’t experience difference but instead their perceptions of community were much stronger than those seen in towns with higher suicide rates.”

Dr Ward said the findings of this study supported previous findings that physical environment, climate, housing and employment influenced wellbeing.

“But we wanted to explore the role of ‘place’ in contributing to suicide rates in rural communities,” she said. “This is very different to ‘location’ because it takes into account the sense of connection rural town residents have with each other and how social cohesion, support, community values and attitudes to mental health influence this sense of connection.”

Differences between towns matter

Dr Collins said it was the first time this research ‘model’ had been tested in an in-depth way.  “A great deal of reporting around rural suicide puts all rural communities into one bucket when they are all very different,” she said. “While access to health and mental health services in particular is very important in promoting mental wellbeing, understanding the differences rather than the similarities provided insights to what drives the disproportionately high rates of suicide and poor mental health outcomes.”

Dr Collins said one of the “really interesting” aspects of the findings was that while there were lots of similarities between the four towns, there were also many differences. She said access to mental health services and social cohesion were significantly different between the towns with high and low suicide rates.

“One of our findings was that even the type of drugs these communities get greater access to seems, in some instances, to impact on mental health outcomes,” she said.

“Integration of services was working well in towns with a low rate. The absence or presence of social cohesion was consistently talked about as was perceptions of safety and attitudes towards mental illness.”

Importance of a focus on youth

One of the things Dr Collins found in the two towns with the lowest suicide rates was that they had created facilities and activities for youth. “One town had a particularly high suicide rate and made targeted interventions in the community and brought that rate down,” she said. “One town even created a youth cafĂ©. These things made a difference.”

Dr Collins said the results showed that suicide in rural areas remained a complicated issue needing continued and close research. “The issue remains complicated…but the underlying mechanism of connectedness was important. We must keep validating and sharpening the pencils so we can potentially point to things we can do to intervene.”

Compositional, Contextual and Collective Community Factors in Mental Health and Wellbeing in Australian Communities is an open access article, published in Qualitative Health Research, February 2016.

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