Suicide among young Australians, 1964-1993: an interstate comparison of metropolitan and rural trends.

OBJECTIVES: (i) To compare suicide rates in 15-24 year old men and women; and (ii) for 15-24 year old men, to investigate differences in suicide rates between metropolitan and rural area, and changes in method-specific suicide rates and, in particular, firearm and hanging suicide rates in rural and metropolitan areas. DESIGN: Retrospective analysis of Australian Bureau of Statistics (ABS) suicide data (1964-1993). SETTING: All Australian States. SUBJECTS: Young women and men aged 15-24 years who died by suicide. RESULTS: Male youth suicide rates rose substantially over the 30 years in all Australian States, whereas female rates did not increase. Increases in suicide rates in young men in small rural towns consistently exceeded those in metropolitan areas in all Australian States. Metropolitan rates in 1964 were higher than those in small rural towns, but by 1993 the position was reversed. Medium-sized cities were the only areas where there was no consistent interstate trend. Differences were noted in suicide base rates in different States. High car exhaust suicide rates were noted in Western Australia, and high firearm suicide rates in Tasmania and Queensland. The ratio of firearm suicide rates in small rural areas to those in metropolitan areas rose in all mainland States, but the same ratio for hanging suicide rates changed little. CONCLUSIONS: All Australian States reflect national suicide trend in relation to sex and residential area. In some States, particular suicide methods predominate. A decreasing trend in overall firearm suicide rates in young men in all States from 1984 to 1993 conceals substantial increases in firearm suicide rates in small rural areas in all mainland States over the 30-year period. This, together with the marked rate ratio difference in firearm suicides between metropolitan and small rural areas, suggests that particular risk factors for suicide are operating in small rural areas. The fact that hanging rate ratios changed little suggests that more general factors in male youth suicide are also operating in all areas. A better understanding of similarities and differences in health risks faced by metropolitan and rural youth is required.

Coroners' records of rural and non-rural cases of youth suicide in New South Wales.

OBJECTIVE: The aim of this study is to compare the frequency of certain putative risk factors for youth suicide in New South Wales (especially use of alcohol, social class, unemployment, and internal migration) in metropolitan and rural settings. METHOD: A review of 137 files for 10-19-year-old subjects judged by the Coroner to have committed suicide in 1988-1990 was carried out. RESULTS: One hundred and fifteen males and 21 females were identified (one subjects sex was unavailable). The male-female ratio was higher in rural (13.0) areas than non-rural (4.9 chi 2 = 12.14, p < 0.01). Of 27 subjects migrating within Australia, most migrated in a rural direction, and most to rural shires. Unemployment was somewhat more common among rural (38.5%) than non-rural (28.9%) subjects (chi 2 = 0.75, p = 0.39). Eleven of 50 non-rural parents of the deceased, but none of the 11 rural parents, were ranked as being in social classes 2 or 3. Alcohol consumption appeared more common in rural shires (44%) than metropolitan areas (32.9%), but this was not statistically significant. Medical services were less utilised prior to death in rural (15%) than non-rural (25%) areas (chi 2 = 1.69, p = 0.19), and a psychiatric diagnosis was recorded more commonly in non-rural areas. CONCLUSIONS: Incomplete coronial file data and relatively small numbers limit this study's conclusions. Male suicides, principally by firearms, predominated in rural areas. Youth firearm access remains highly relevant to rural communities. Possible trends among rural subjects toward rural migration, higher unemployment, lower social class and lower medical attendance may point to resource deprivation among this group; these matters require further investigation.

Suicide among young rural Australians 1964-1993: a comparison with metropolitan trends.

The study tested hypotheses that from 1964 to 1993: (1) suicide rates among Australian 15- to 24-year-old males rose more sharply in rural than metropolitan areas; (2) firearm suicide rates among 15- to 24-year-old males, declining throughout Australia recently, rose continuously in rural areas; (3) suicide rates among 15- to 24-year-old females did not change significantly in either metropolitan or rural areas. Suicides of those aged 10-24 years recorded by the Australian Bureau of Statistics (ABS) were classified according to the subject's residential grouping. Rates were calculated using ABS population data corresponding to these groupings. Results were analysed using log-linear analysis and chi-square statistics. The results supported the first two hypotheses, but not the third. Suicide rates for 15- to 24-year-old males rose by a factor of 2.2 in metropolitan areas, by 4-fold in towns with populations between 4,000 and 25,000, and by 12-fold in towns with populations less than 4,000. Male firearm suicide rates continued to rise in rural areas, and the greatest proportion of deaths in those locations were by firearms, though male hanging rates increased most in recent years in all locations. Female youth suicide rates did not change overall, but in towns with populations less than 4,000, they increased 4.5-fold. Possible explanations for this epidemic, which are mostly speculative and require confirmation, are discussed.

Youth suicide in New South Wales: urban-rural trends.

OBJECTIVE: The study tested the hypotheses that (i) the rate of suicide by firearms among youth (aged 10-19 years) is increasing at a greater rate than rates of suicide by other methods; (ii) the rate of youth suicide in rural New South Wales is significantly higher than those in urban areas; and (iii) the increase in youth suicide by means of firearms is occurring at a greater rate in rural males aged 15-19 years than in other groups. DESIGN: Data were obtained from the NSW Office of the Australian Bureau of Statistics concerning 735 youth suicides in NSW between 1964 and 1988. These were reviewed for information concerning residential area and method of death. Five five-year periods were used, and rates were calculated with population figures obtained in the census years for the same age and sex group. RESULTS: From 1964 to 1988, suicide by firearms has risen most substantially, from 3.4 to 5.6 per 100,000 per year in 15-19-year-old males. There has also been a substantial increase in 15-19-year-old male suicides by hanging (0.7 to 3.4 per 100,000 per year). Poisoning suicides have declined among females and males in the past 15 years. Suicide rates in Sydney, Newcastle and Wollongong have remained stable. In rural cities, they have increased from 1.5 to 4.7 per 100,000 per year (F = 4.9, P less than 0.02) while in rural municipalities and shires they have increased from 1.3 to 6.4 (F = 14.6, P less than 0.0001). The suicide rate of 15-19-year-old males has shown a modest increase in Sydney and no change in Newcastle or Wollongong, but the rate for 15-19-year-old males in rural cities has more than doubled, from 5.1 to 12.5 (F = 7.7, P less than 0.003), while in rural municipalities and shires, the rate has increased more than fivefold, from 3.9 to 20.7 (F = 9.3, P less than 0.001). There has been no significant change in the suicide rates of 15-19-year-old females, or in 10-14-year-olds. The rate of suicide by firearms among 15-19-year-old males has not risen significantly in rural cities, but in rural municipalities and shires the rates have risen fivefold from 2.8 to 14.8 (F = 5.6, P less than 0.01). CONCLUSIONS: Each hypothesis was confirmed. An increase of this magnitude is not an artefact of coroners' verdicts. The findings are believed to be due to ready access to firearms, the use of alcohol and drugs (particularly in firearms suicides) and increasing socioeconomic, health, and identity problems for rural youth, especially males.