Suicide in Rural, Regional and Remote Communities - Case Study Example

Suicide in Rural/Regional/Remote Communities Introduction Among high income countries, suicide rates were, in general, predominantly higher in rural and remote areas than in urban areas during the last half of the twentieth century (Davis, 2008). Australia is no exception. Evidence from developed countries including Australia has suggested higher rural and remote communities’ suicide rates than urban rates. This rural and remote population-at-risk is made up of males, youth, farmers, and indigenous people populations with higher rates of health risk factors such as obesity, smoking, substance abuse, lack of physical activity, fewer preventative health practices, and thus suicide (Australian Institute of Health and Welfare, 2008; Hirsch, 2006). For example, between 2005 and 2007, male suicide deaths in remote and rural Australia constituted 36.32% per 100,000 deaths which is significantly higher that 18.25% per 100,000 in urban population (Kõlves et al, 2009). Also, studies have found that completed suicide is more common among rural and remote males than females (Hirsch, 2006). In 2006, male suicide deaths constituted approximately 79% of all suicides (almost four times the female suicide death count) (Hirsch, 2006). Thus, in these communities, suicide is primarily a male phenomenon; the overwhelming majority of suicides are committed by that population in Australia. Overview of Suicide in Rural/Regional/Remote communities Rural/remote/regional communities in Australia comprise 21 percent of the Australian population (Australian Bureau of Statistics [ABS], 2015). These communities are diverse in demographic, economic, environmental and social characteristics. Rural populations vary from urban areas in relation to population density, cultural norms, and remoteness. Rural and remote communities also differ from urban areas in health care needs, resources, and access which can lead to increased vulnerability to suicide (Hirsch, 2006) and fewer preventative health practices (Australian Institute of Health and Welfare, 2007). Due to social, cultural, geographic and economic characteristics, rural and remote populations are not well integrated into the health care system (Australian Institute of Health and Welfare, 2007). Vulnerability is influenced by the available community and individual resources and potential risks to suicide (Hirsch, 2006). Thus, living in more urbanized areas has become a more protective factor or living in more rural areas has become a risk factor. This could indicate that, in contrast to Durkheim‘s observation, present-day rural areas are more vulnerable to suicidogenic factors than urban areas. Community Impact Suicide is impacting on the rural/remote/regional populations both physically and socially. These populations can be considered vulnerable due to higher numbers of risk factors as well as a potential lack of needed resources found in these communities (Australian Institute of Health and Welfare, 2015; Hirsch, 2006). Social resources may be compromised in rural inhabitants as well. The lack of resources and the number of risk factors in rural communities increase the risk of poor physical, mental, social health outcomes, and thus suicide (Hirsch, 2006). An individual’s health status is also reliant on social determinants of health such as poverty, isolation, unemployment, lack of education and social support (Marmot, 2005). Investigating the social determinants of health is important to gain understanding of disparities in health status (Marmot, 2005). The lack of social resources of a population can impact health as much as the lack of environmental or material resources (Marmot, 2005). Social resources include concepts like social status, human and social capital. Social status refers to the position an individual occupies in society. Age, gender, race and ethnicity impact social status. A low social status increases an individual’s vulnerability to poor health outcomes (Marmot, 2005). Level of education, employment opportunities and income all influence the amount of human capital a person has (Marmot, 2005). If a community has substandard schools, the opportunities for employment are limited and thus income levels are low. A higher level of education attainment leads to higher-status occupations with higher levels of income. As an additional benefit, these higher level occupations tend to provide health insurance and thus decrease vulnerability to poor health outcomes due to lack of access (Marmot, 2005). Social capital concerns the relationships an individual has in the community between friends, family and neighbors. Social capital and social connectedness are related concepts. These ties provide a sense of trust, belonging and social identity. Research has shown that individuals with poor social connectedness as in the case of rural and remote populations, are more vulnerable to suicide than the urban populations (Mitchinson, Kim, Geisser, Rosenberg, & Hinshaw, 2008). Potential Causes and Solutions While the contemporary variation of the rural-urban suicide differential appears to be a well-documented phenomenon, sociologists and social epidemiologists do not yet fully understand the causes why such a pattern would exist today. Many factors affect the health of communities and individuals. These factors are known as determinants of health and include the state of the environment where people live, genetics, socioeconomic factors such as income, education and occupation, and relationships with others. The characteristics of socioeconomic (SE) well-being have been indicated to play an important role in explaining the variation in suicide rate. The relationships between these factors determine individual and community health (Morrissey and Reser, 2007, Judd et al, 2006). First, representing economic resources in SE characteristics, income level is expected to have an inverse relationship with suicide rate in the contemporary period. The contemporary research has largely indicated the opposite of Durkheim‘s prediction about the relationship between wealth and suicide. In Australia (Page et al, 2006), income and economic resources have shown a significant relationship with suicide. In relation to income, poverty or economic deprivation is also of an important concern in suicide studies. This is a measure of population income level relative to a certain threshold focusing on the population in the lower part of an income continuum. Poverty has been argued to be a risk factor that increases suicide rate through suicidogenic conditions such as financial instability, unemployment, poor mental health, and marital dissolution. Studies found a positive association between poverty and suicide rate; the population that has a high poverty rate has higher suicide rates (Rehkopf and Buka, 2006). It was also found that, among area SE characteristics including income, unemployment, education, occupation, and others, a family of poverty and deprivation measures in ecological research are most likely to find a significant positive relationship in which suicide rate increases as SE conditions deteriorate. Another SE factor is education. Durkheim (2006) indicated that education could promote individuation and weaken one‘s degree of social integration, leading to a higher risk of suicide. In more contemporary periods, studies have presented mixed findings (both positive and negative relationships found) or no relationship between education and suicide (Rehkopf and Buka, 2006). The majority of ecological studies tend to find either no relationship or an inverse relationship (Rehkopf and Buka 2006). Unemployment is the last SE factor considered in this study and is also an indicator of the economic cycle. Durkheim (2006) identified unemployment as an important social factor that should increase the risk of suicide. Findings about the relationship between unemployment and suicide have been inconclusive, although unemployment is generally expected to have a positive relationship with suicide. Individual-based studies tended to provide more support for a positive relationship while ecological studies based on aggregate data provided mixed findings or no relationship (Stack, 2010). Using more recent data, ecological studies tended to find more evidence supporting a significant positive relationship between unemployment and suicide rate, especially when aggregate units of data are smaller to keep the population more homogeneous (Stack, 2010). However, the contemporary fast-evolving economy and the changing trend in the labor market composition provide some indication of the importance of studying the link between unemployment and suicide (Stack, 2010). So what could be the possible solutions to this health and well-being issue? The Australian Institute of Health created a program to foster health equity for this rural-urban suicide differential (Marmot, Friel, Bell, Houweling, & Taylor, 2008). The Institute came up with three principles of actions: “1) to improve the conditions of daily life, 2) tackle the inequitable distribution of power, money and resources, and 3) measure and understand the problem and assess the impact of action” (Marmot et al, 2008). One of the conclusions made by the Institute was for health equity to be assured; communities must be socially cohesive, ensure basic access to goods, be designed to promote physical and psychological well-being, and protect the natural environment (Marmot et al, 2008). While the Australian Institute of Health and Welfare primarily focused on urban areas, the authors specifically noted “relief of pressure of migration to urban areas and equity between urban and rural areas requires sustained investment in rural development, addressing the exclusionary policies and processes that lead to rural poverty, landlessness, and displacement of people from their homes” (Marmot et al, 2008). Rural public health policies to reduce disease and improve physical, mental, spiritual and social health will only succeed when the social determinants of health are addressed as well (Marmot, 2005). Conclusion This short report examined the contemporary rural-urban suicide disparity in Australia. In particular, the report indicated that the rural-urban suicide differential is widening over the years, males, especially rural and remote males in the case of Australia, remain a driving force. As was reported, the rural-urban differential was merely a manifestation of fatalism or limited opportunity structure through the SE differential between rural and urban areas. However, there was no clear evidence that SE factors could explain the rural-urban differential. Instead, the report indicated that other aggregate characteristics such as sociodemographic factors mattered more in explaining the rural-urban differential. There are many implications from this short report for rural community leaders and health care providers. First, health care policies at the rural, remote, and regional levels must be developed which will address the social determinants of health and health inequalities that arise from lack of social resources in rural and remote communities. Policies that address social determinants of health must also address the socioeconomic, social support and social capital issues. Lack of resources and increased risk factors in vulnerable rural and remote populations should also be explored. References Australian Bureau of Statistics (2015) Australian Standard Geographical Classification (ASGC) July 2015. Catalogue No. 1216.0, Canberra, Australian Bureau of Statistics. Australian Institute of Health and Welfare (2007) Rural, regional and remote health: A study on mortality (2nd edition). Australian Institute for Health and Welfare, Rural Health Series, 8, Canberra, AIHW. Australian Institute of Health and Welfare (2008) Rural, regional and remote health: indicators of health status and determinants of health. Rural Health Series, 9. Canberra: AIHW. Davis, B. (2005) Mediators of the relationship between hope and well-being in older adults. Clinical Nursing Research, 14(3), 253-272. Durkheim, Émile (2006). On Suicide. Translated by Robin Buss. London: Penguin Books. Hirsch, J. K. (2006) A review of the literature on rural suicide: Risk and protective factors, incidence, and prevention. Crisis, 27, 189-199 Judd, F., Cooper, A. M., Fraser, C., et al (2006) Rural suicide-people or place effects? Australian and New Zealand Journal of Psychiatry, 40, 208-16. Kõlves, K., Milner, A., De Leo, D. (2009) Suicide risk in different subpopulations in Australia (Queensland). A Report to the Commonwealth Department of Health and Ageing. Brisbane, Australian Institute for Suicide Research and Prevention. Marmot, M. (2005) Social determinants of health inequalities. Lancet, 365, 1099- 1104. Marmot, M. G., Friel, S., Bell, R., Houweling, T. A., & Taylor, S. (2008) Closing the gap in a generation: Health equity through action on the social determinants of health. Lancet, 372(9650), 1661-1669. Mitchinson, A. R., Kim, H. M., Geisser, M., Rosenberg, J. M., & Hinshaw, D. B. (2008). Social connectedness and patient recovery after major operations. Journal of the American College of Surgeons, 206(2), 292-300. Morrissey, S. A., Reser, J. P. (2007) Natural disasters, climate change and mental health considerations for rural Australia. Australian Journal of Rural Health, 15, 120-125. Page, A. N., Morrell, S., Taylor, R., et al (2007) Further increases in rural suicide in young Australian adults: Secular trends, 1979-2003. Social Science & Medicine, 65, 442-453. Rehkopf, David H., and Stephen L. Buka (2006) The Association between Suicide and the Socio-Economic Characteristics of Geographical Area: A Systematic Review.‖ Psychological Medicine 36: 145-157. Stack, Steven (2000) Suicide: A 15-Year Review of the Sociological Literature Part I: Culture and Economic Factors.‖ Suicide and Life-Threatening Behavior 30: 145-62. Read More