Suicide in rural Australia

Article in review: Fitzpatrick, S.J, Handley, T., Powell, N., Read, D., Inder, K.J., Perkins, D., Brew, B.K. (2021). Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilization. PLoS ONE, e0245271, https://doi.org/10.1371/journal.pone.0245271

Summary

Suicide rates are higher for non-Indigenous Australians in rural areas when compared to metropolitan areas and the suicide rates increase with remoteness. The increase of suicide in rural areas and the increasing frequency associated with remoteness could be associated with the reduced accessibility for mental health services and specialists and other socio-demographic factors. This study sought to determine any suicide risks, trends and factors in remote areas, and the prevalence of mental illness along with the frequency at which services were accessed in these areas.

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Findings of suicide risk in remote Australia

This study spanned the period 2010-2015, during which there are 3,163 closed cases of suicide by non-Indigenous Australians in rural New South Wales, Queensland, South Australia and Tasmania. During this period, the annual rate for the rural non-Indigenous populations was 12.7 deaths per 100,000 persons, which was 11.4% higher than the Australian national rate of 11.4 per 1000,000 persons.

Although the raw number of suicides actually decreased with remoteness, due to smaller populations in these areas, suicide rates increased to 14 deaths per 100,000 persons in remote and very remote areas. The suicide rates varied by state and the gradient towards more deaths in more remote areas were most noticeable in Queensland. The majority of these suicides were men 79.4%, and men were increasingly more likely to die by suicide in remote and very remote areas.

The data also demonstrated:
• A higher proportion of suicides occurred amounts the very young 15-24 years and older groups 74-85 years in remote and very remote areas. This necessitates further investigation and targeted prevention strategies.
• Nearly 36.3% were married or cohabitating, 26.8% were never married and 12.9 were separated.
• Just over a third were employed, one quarter was unemployed and another quarter was pensioners.
• Disadvantage is a significant risk factor for those living in remote areas, regardless of the degree of remoteness.

The most common methods of suicide were hanging or strangulation (49.5%) poisoning (22.4%) and firearms (12.8%), a figure which increased with remoteness.

In 40.4% of cases, there was a diagnosed mental illness including substance use disorder while 16.5% had no reported symptoms. Worryingly, 17% had undiagnosed symptoms of mental illness, demonstrating the vulnerability of this group who have unaddressed mental health issues. 26.2% had missing mental health data. A higher proportion of women had a diagnosed mental illness which is consistent with previous research that suggests women are more likely to be diagnosed and seek support for mood disorders.
The most common diagnosis was depression (61.9%), psychotic illness (8.8%), anxiety (8.1%), bipolar (8%) and substance disorders (6.5%). Almost 20% had co-occurring mental illnesses. The likelihood of mental health diagnosis decreased with remoteness.

Regarding support services:
• A total of 38.4% were receiving mental health treatment with medication or psychological therapies.
• A higher proportion of females than males were receiving treatment.
• A majority receiving treatment 81.6% reported a diagnosis of mental illness.
• Medication was the most common form of treatment at 76%.
• Medication was reported at much higher rates among those treated in rural and very rural areas in the six weeks before suicide, 22.3% had visited a health service at least once and 6.3% had seen two or more services.
• Of all health visits, 37.5% were to a primary health provider, 37% were to a mental health or drug and alcohol services.
• 17.2% visited the emergency department in the six weeks before suicide.

This study has demonstrated the need for improved mental health diagnosis and treatment in remote areas of Australia. More research is required to determine the factors contributing to this under-utilisation by what have been identified as vulnerable groups.