A regional approach to understanding farmer suicide rates in Queensland

Article (PDF Available)inSocial Psychiatry 49(4) · October 2013with 517 Reads
DOI: 10.1007/s00127-013-0777-9 · Source: PubMed
Abstract
Elevated suicide rates among farmers have been observed across a number of countries, including Australia. However, studies on farmer suicide have typically treated farmers as a homogenous group, and have predominately been focussed at a national level. This overlooks potential variability in suicide rates (and, by extension, contributory factors) within different groups of farmers (for example, different age groups), as well as across different geographical locations. Using a unique data source, the Queensland Suicide Register, the current study examined variation in farmer suicide rates by age, sex, and location within Queensland. Although farmer suicide rates varied substantially across different regions of Queensland, no significant associations were found between rates of farmer and non-farmer suicide, or between the proportion of farmers in a region and farmer suicide rates. This suggests that farmer suicide may be characterised by unique combinations of occupational and location-related effects that are likely to vary substantially within and between different regions, and provides caution against treating farmer suicide as a homogenous phenomenon. The highest rates of farmer suicide were observed among younger farmers (aged 18-34 years), highlighting a need for targeted suicide prevention initiatives for this group.
ORIGINAL PAPER
A regional approach to understanding farmer suicide rates
in Queensland
Urska Arnautovska Samara McPhedran
Diego De Leo
Received: 10 July 2013 / Accepted: 4 October 2013
ÓSpringer-Verlag Berlin Heidelberg 2013
Abstract
Purpose Elevated suicide rates among farmers have been
observed across a number of countries, including Australia.
However, studies on farmer suicide have typically treated
farmers as a homogenous group, and have predominately
been focussed at a national level. This overlooks potential
variability in suicide rates (and, by extension, contributory
factors) within different groups of farmers (for example,
different age groups), as well as across different geo-
graphical locations.
Methods Using a unique data source, the Queensland Sui-
cide Register, the current study examined variation in farmer
suicide rates by age, sex, and location within Queensland.
Results Although farmer suicide rates varied substantially
across different regions of Queensland, no significant
associations were found between rates of farmer and non-
farmer suicide, or between the proportion of farmers in a
region and farmer suicide rates.
Conclusions This suggests that farmer suicide may be
characterised by unique combinations of occupational and
location-related effects that are likely to vary substantially
within and between different regions, and provides caution
against treating farmer suicide as a homogenous phenom-
enon. The highest rates of farmer suicide were observed
among younger farmers (aged 18–34 years), highlighting a
need for targeted suicide prevention initiatives for this
group.
Keywords Occupation Suicide Geographical
location Farming
Introduction
There is considerable worldwide interest in better under-
standing the myriad of factors contributing to high suicide
rates in specific populations and communities. One of the
high-risk groups of particular note is that of farmers, whose
suicide rates were found to be elevated in various countries
across the world including the USA [1], Brazil [2], England
[3], India [4], New Zealand [5], and Australia [6,7]. In
Australia, a country traditionally associated with agricul-
tural production, it has been found that farmers (consisting
of farm managers and labourers) present from about 1.5 to
2 times higher suicide rates compared to the national
average [6]. A later study examining suicide in selected
occupations in one state (Queensland) found that farmers
(consisting of farm hands, overseers, farmers, and farm
managers) were around 2.2 times more likely to die by
suicide than the general employed population [7].
Typically, studies examining potential reasons for the
increased suicide rates among agricultural workers focus
on looking for any relevant similarities in risk factors
across farming communities [810]. Although definitions
of ‘farmers’ and understanding of what constitutes a
‘farming community’ vary considerably within existing
literature, there are notable similarities across studies in
terms of commonly hypothesised or identified risk factors
for suicide. These include cultural attitudes, such as mas-
culine myths related to health, including reluctance to seek
help [11], locational and demographic factors associated
with rural living such as geographic isolation and depop-
ulation of rural areas [12], natural disasters and financial
U. Arnautovska (&)S. McPhedran D. De Leo
Australian Institute for Suicide Research and Prevention,
National Centre of Excellence in Suicide Prevention,
W.H.O. Collaborating Centre for Research and Training
in Suicide Prevention, Griffith University, Building M24
Psychology, 176 Messines Ridge Road, Mt Gravatt Campus,
Griffith, QLD 4122, Australia
e-mail: urska.arnautovska@griffithuni.edu.au
123
Soc Psychiatry Psychiatr Epidemiol
DOI 10.1007/s00127-013-0777-9
stressors [8], and other economic and socio-political dis-
tress including work force migration, rural economic
decline and changing attitudes towards agricultural pro-
duction, diminishing political representation and reduction
of community interactions and community cohesion [12].
Mental illness is a commonly cited and well-docu-
mented risk factor for suicide [1315]. Various studies
around the world report on the increased risk of mental
illness in farming populations, including greater vulnera-
bility to psychiatric disorders among farmers exposed to
agricultural chemical use [16]. However, a review study of
the literature on mental health issues experienced by
farmers in the UK, Europe, Australia, Canada, and the
USA concluded that studies to date do not offer sufficient
conclusive evidence to indicate whether there would be
increased presence of mental health problems and psychi-
atric disorders among farmers compared with the non-
farming populations [8]. This implies that a different set of
factors, aside from those related to mental health problems,
may drive elevated farmer suicide rates.
Research evidence supports the effects of compositional
(e.g. demographic) and social factors (e.g. community
norms and attitudes) on farmer suicide; for example, it has
been indicated that farmer suicide is influenced by age
group and employment status [6,12], that suicide tends to
be stigmatised in farming communities [9], and that rural
male attitudes are not typically pro-help seeking [17,18].
Similarly, regarding contextual factors (such as physical
environment), there is evidence of barriers to suicide pre-
vention that may reasonably be thought to affect farmers,
such as limited access to health and other support services
arising from locational remoteness [17].
As a result of such studies, ‘farming communities’ are
characterised as being at higher than average risk of sui-
cide. This is based on the tacit assumption that the pro-
portion of farmers in a particular area relates meaningfully
to suicide rates in those areas, and implies that there may
be a special need for suicide prevention efforts in locations
with a high proportion of farmers. However, studies on
farmer suicide to date have predominately been focussed at
a national level [4,5,9,19,20], and have neglected
potential variability in suicide rates (and, by extension,
contributory factors) at the more ‘local level’ within a
specific country.
For instance, while farmers in Australia have about two
times higher suicide rate compared to the national average
[6], it is not known what the regional rates of farmer sui-
cide are across the country. Typically, studies have
examined national or jurisdictional suicide rates from an
epidemiological perspective focussing on compositional
factors or, alternatively, have taken a qualitative approach
to understanding contextual and social factors within small,
selected communities. Consequently, information about
relationships between geographic location and farmer sui-
cide is either extremely broad or extremely narrow.
Additionally, while it is documented that suicide rates in
rural areas of Australia are generally higher than those in
urban areas [21], it is not known whether elevated farmer
suicide rates may, in some regions, simply reflect elevated
suicide rates overall in those particular regions, or whether
farmer suicide rates are higher in regions with a higher
proportion of farmers (as a percentage of the population in
a given region). These gaps in knowledge in turn limit the
ability to identify particular factors or combinations of
factors that may impact differently on farmers across dif-
ferent locations and impede development of appropriately
tailored support strategies and interventions for individuals
and areas that may be at particular risk of suicide.
Approaching farmer suicide from a regional point of
view is particularly important in a country as large in size
as Australia. Due to Australia’s size, a diverse range of
region-specific characteristics undeniably affects its farm-
ers. Acknowledging this diversity, rather than continuing to
search for broad and general commonalities among risk
factors for suicide among farmers, would be necessary to
enable region-specific suicide prevention interventions.
However, to understand both risk and protective factors
that may distinguish between farmer suicides across dif-
ferent geographic regions, understanding the burden of
farmer suicide across these regions is first needed.
This paper aims, firstly, to quantify the burden of farmer
suicide across different age groups and sexes, and geo-
graphic regions in Queensland. It also explores whether
farmer suicide rates across regions differ from non-farmer
suicides in those same regions and considers whether
farmer suicide rates are related to the proportion of farmers
in a given region, as well as to the rate of non-farmer
suicides.
Method
Data sources and sample selection
Two data sources were used to identify suicide cases
among farmers: the Queensland Suicide Register (QSR), an
independent database of suicide cases and the National
Coronial Information System (NCIS), a computerised
database for Australian coronial cases. Information in the
QSR is based on four sources: post-mortem report, police
report following a possible suicide, toxicology report, and
coroner’s findings. The information gathered as part of
police investigations relates to circumstances of the death
(e.g. the time, location, and suicide method), demographic
characteristics of the deceased (e.g. marital status, occu-
pation, and type of living arrangement), as well as a wide
Soc Psychiatry Psychiatr Epidemiol
123
range of contextual factors preceding suicide (e.g. the
presence and treatment of physical and mental illness, past
suicidal behaviour, and stressful life events). Only cases
classified as ‘beyond reasonable doubt’ and ‘probable’ (but
not ‘possible’ cases) were considered in the analysis [22].
Considering that the QSR contains more detailed infor-
mation about the deceased’s occupation and employment
status compared to the information available in the NCIS,
the main data source for identifying suicide cases by
farmers was the QSR. The NCIS, however, was used for
‘cross-checking’ and identifying any potential ‘hidden’
case. The search in NCIS was limited to cases with external
cause of death (at notification or completion), with the
extracted cases being further classified and reviewed by the
intent type (the ‘intentional self-harm’ cases were included
in the sample without further checking whether it was a
suicide or not, while the remaining cases, including those
with ‘unintentional’ intent were checked for words ‘hang-
ing’, ‘driver’, and ‘poison*’; if these words were detected,
the case was reviewed individually). The search in NCIS
considered also a wide range of other criteria, including
search by text in the occupation field, by text in all docu-
ments, and by location of death. The key words and codes
were: farm*, station, grazier, picker, shearer, agriculture*
(all documents search); farm, grazier, shearer, picker,
ringer, primary producer, stockman (occupation field
search); and, ‘Farm or other place of primary production’
and ‘Farmhouse’ (location search). It should be noted,
however, that farming occupations identified through these
key words may not exactly correspond to the occupations
of the reference sample (described below); the reference
sample was identified based on the Australian and New
Zealand Standard Classification of Occupations (ANZ-
SCO), as employed by the Australian Bureau of Statistics
(ABS) [23].
Geographic location
The residential address of each individual suicide case was
classified into 1 of 13 statistical divisions (SDs), based on
the 2011 Australian Statistical Geography Standard
(ASGS) and 2006 Australian Standard Geographical
Classification (ASGC) [24,25]. The 2011 ASGS was used
as there was no available coding scheme that would enable
a direct aggregation of residential suburbs into higher-level
geographic units. Postcodes were therefore first recoded
into 2011 Statistical Local Areas (SLAs), using the 2011
ASGS, which were then matched to a relevant 2006 SLA
using the Localities to SLA Coding Index, which compares
the 2006 and 2011 SLAs. Once the 2006 SLAs were
obtained, they were recoded into relevant SDs by using the
ASGC 2006. The SDs were: Brisbane, Gold Coast, Sun-
shine Coast, Central West, Darling Downs, Far North,
Fitzroy, Mackay, North West, Northern, South West, West
Moreton, and Wide Bay-Burnett.
Population data–farmers and general
Population numbers of all farmers in Queensland were
extracted from the ABS Census data for 2006. Detailed
population by occupation figures could not be calculated
for each year the study covered, as these data are not
routinely collected by the ABS. Consequently, figures from
the 2006 census were used as a reference for the period
2000–2009, as well as to align with the 2006 geographic
coding. The number of persons by SD, occupation, age,
and sex was extracted for both farmers and the general
population.
Occupation coding
Occupations were coded using the ANZSCO, with ‘farm-
ers’ consisting of: Farmers and Farm Managers not further
disclosed (nfd), Crop Farmers, Livestock Farmers, Mixed
Crop and Livestock Farmers out of the higher Managers
level, and Farm, Forestry and Garden Workers nfd, Crop
Farm Workers, Livestock Farm Workers, Mixed Crop and
Livestock Farm Workers, and Other Farm, Forestry and
Garden Workers. All other occupations were collapsed into
one broad category (‘Other’). All employment categories
(full time, part time, and away from work/working
unspecified hours) were considered.
Analysis
Data were analysed using SPSS version 19.0. Farmer
suicides were compared to non-farmers on mean age,
using ttest for independent samples, and on suicide
method, using a Chi-square analysis. To quantify the
burden of farmer suicide, average standardised suicide
rates were calculated across a 10-year period, 2000–2009,
using the formula ‘number of suicide cases/number of
persons in the reference group*100,000/10’, by sex, age
group (up to 34, 35–54, and 55?years ), and geographic
region (SDs). The suicide rate was calculated in the same
way for non-farmers. Using Poisson regression and count
data (with population numbers as the exposure count),
incidence rate ratios (IRR) were then calculated by com-
paring the suicide rate of farmers with that of the non-
farmers, based on information from the QSR, as were the
95 % confidence intervals of these IRRs. Regression
analysis was used to examine whether the proportion of
farmers in a region, as a percentage of the total popula-
tion, was significantly associated with farmer suicide rates
and whether there were relationships between farmer and
non-farmer suicide rates.
Soc Psychiatry Psychiatr Epidemiol
123
Results
Out of 5,608 suicide deaths by Queensland residents that
occurred between 2000 and 2009, 147 suicides were by
farmers, accounting for 2.6 % of all suicides. Of those,
132 (89.8 %) were by males and 15 (10.2 %) were by
females. Across the same time period, the number of all
other suicides (‘non-farmers’) was 5,461. The average age
of farmers (45.8 years, SD =18.3) was significantly
higher than that of non-farmers (42.6 years, SD =17.4)
(t
(5603)
=2.3, p\0.05).
Prevalence of farmer vs. non-farmer suicide
During the period 2000–2009, the overall suicide rate for
farmers was 28.9/100,000, with an average ratio between
male and female of 3.8. The highest farmer suicide rate
was in the up to 34 year age group, for both males and
females. Farmer suicide rate was not calculated for
females in the age groups 35–54 and 55?due to small
incidence of cases in these age groups. For male farmers,
the suicide rate was the lowest in the 35–54 years age
group.
Table 1shows that the farmer vs. non-farmer ratio
was around two times higher for farmers overall.
Compared to suicide rates of non-farmers, overall farmer
suicide rates were significantly higher (p\0.01) in
the younger and older age groups (up to 34 and
55?years).
Suicide across geographic regions
Table 2shows differences in suicide rates between farmers
and non-farmers across geographic regions for all persons.
Overall, where suicide rates were able to be statistically
compared (with an inclusion rule set at 5 or more suicide
cases in a cell), the farmer suicide rates were around two to
three times higher than non-farmer suicide rates. In seven
out of eight geographic regions, this difference was also
statistically significant (p\0.05). The only exception was
the Fitzroy region, where the farmer suicide rate was 1.2
times higher compared to the suicide rate of non-farmers
(p=0.61).
Associations between proportion of farmers in a region
and suicide rates
As Table 2indicates, there were—as expected—differ-
ences in the proportion of farmers (as a percentage of the
total population) in each region. Compared to the propor-
tion of the population employed in farming in each region,
the high suicide rate among farmers in some regions (e.g.
the Far North and Northern region) corresponded with a
low proportion of farmers in the region, while in other
regions (e.g. the Central West), a high farmer suicide rate
was accompanied by a comparatively high proportion of
farmers in the region. However, although the relatively
small sample sizes in this study entails interpretive caution,
regression analysis did not find evidence of an association
Table 1 Suicide numbers, population numbers, suicide rates, incidence rate ratios (IRR), and confidence intervals (CI) for farmers and non-
farmers by sex and age group, 2000–2009
Farmer
suicides
Farmer
population
Rate Non-farmer
suicides
Non-farmer
population
Non-farmer
rate
IRR 95 % CI pvalue
Males
Up to 34 years 40 8,918 44.85 1,581 9,36,788 16.88 2.66 1.94–3.64 \0.01
35–54 years 46 14,664 31.37 1,652 5,31,496 31.08 1.01 0.75–1.35 0.95
55 years?46 11,985 38.38 1,003 4,31,530 23.24 1.65 1.23–2.22 \0.01
All ages 132 35,567 37.11 4,236 18,99,814 22.30 1.66 1.47–1.88 \0.01
Females
Up to 34 years 8 3,181 25.15 437 9,20,447 4.75 5.30 2.63–10.66 \0.01
35–54 years 4 6,638 6.03 521 5,61,954 9.27 0.65
55 years?3 5,436 5.52 267 4,71,494 5.66 0.97 –
All ages 15 15,255 9.83 1,225 19,53,895 6.27 1.57 1.09–2.25 0.02
All
Up to 34 years 48 12,099 39.67 2,018 18,57,235 10.87 3.65 2.74–4.86 \0.01
35–54 years 50 21,302 23.47 2,173 10,93,450 19.87 1.18 0.89–1.56 0.25
55 years?49 17,421 28.13 1,270 9,03,024 14.06 2.00 1.50–2.66 \0.01
All ages 147 50,822 28.92 5,461 38,53,709 14.17 2.04 1.73–2.41 \0.01
Not calculated because the number of farmer suicides was \5
Soc Psychiatry Psychiatr Epidemiol
123
between the proportion of farmers in a region and farmer
suicide rates in that region (B=0.24; t=0.15, p=0.88).
There was no observable relationship between farmer and
non-farmer suicide rates (B=0.37; t=0.51, p=0.62).
Discussion
The findings of this study provide a valuable initial insight
into the nature of farmer suicide across different regions of
Queensland, a jurisdiction with one of the highest number
of farmers in Australia. Prior research on farmer suicide in
Australia has typically treated farmers as a homogenous
group, comparing farmers with general populations [6]or
other occupations [7]. While comparisons of all farmers
with other population groups has provided convincing
evidence of the heightened suicide risk in this occupation
group—an ‘‘occupation effect’’ replicated in the current
study—such comparisons do not provide an understanding
of demographic and locational variability in farmer suicide
rates, which may in turn elucidate specific risk and pro-
tective factors for different groups of farmers in different
parts of the country.
The results show that the incidence and rates of suicide
in farmers vary substantially across different regions of
Queensland. In relative terms, in three regions the suicide
rates were below the average rate for all farmers, and in
five regions the suicide rates were higher than the average
farmer rate (the highest being the Far North region). Such
large regional disparities in suicide rates, however, have
also been observed among general populations [22,26],
which raises a question about whether the farmer suicide
rates in a specific region may be a reflection of general
suicide rates in the same region—that is, a ‘‘location
effect’’. If this was the case, then it would be expected that
farmer and non-farmer suicide rates would be positively
associated with one another. The results of this study,
however, do not support this hypothesis, as there was no
evidence of statistically significant associations between
farmer and non-farmer suicide rates (with a significance
level set at p\0.05).
For example, the North West region, which had the
highest suicide rate among the general (non-farmer) pop-
ulation in Queensland, had in the same time period one of
the lowest rates of farmer suicides across all regions
studied. Furthermore, the Wide Bay-Burnett and North-
ern regions (both coastal regions) had comparable suicide
rates among non-farmers, while the suicide rate in farmers
in the Northern region was nearly twice as high as that in
the Wide Bay-Burnett region.
It is important to acknowledge this apparent lack of
relationship between farmer and non-farmer suicide rates,
as this in turn supports theories concerning the role of
specific compositional factors in farmer suicide, over and
Table 2 Suicide numbers, population numbers, suicide rates, proportion of farmers within population, incidence rate ratios (IRR), and confi-
dence intervals (CI) for farmers and non-farmers by geographical region, 2000–2009
Region Farmer
suicides
Farmer
population
Rate Non-farmer
suicides
Non-
farmer
population
Non-farmer
rate
%
farmers
IRR 95 % CI pvalue
Brisbane 4 4,361 9.17 2,168 17,58,771 12.33 0.2
Central West 6 1,387 43.26 14 9,467 14.79 12.8 2.93 1.12–7.61 0.03
Darling
Downs
26 9,981 26.05 261 2,03,775 12.81 4.7 2.03 1.36–3.04 \0.01
Far North 29 5,135 56.48 450 2,25,916 19.92 2.2 2.84 1.95–4.13 \0.01
Fitzroy 8 4,220 18.96 291 1,84,183 15.80 2.2 1.20 0.59–2.42 0.61
Gold Coast 4 1,094 36.56 640 4,81,230 13.30 0.2
Mackay 10 3,838 26.06 194 1,46,339 13.26 2.6 1.97 1.04–3.71 0.04
North West 3 1,228 24.42 105 29,713 35.34 4.0
Northern 16 2,948 54.27 294 1,93,723 15.18 1.5 3.58 2.16–5.92 \0.01
South West 2 2,916 6.86 24 21,863 10.98 11.8
Sunshine
Coast
4 2,387 16.76 387 2,73,879 14.13 0.9
West Moreton 11 3,317 33.16 84 65,309 12.86 4.8 2.58 1.38–4.83 \0.01
Wide Bay-
Burnett
24 8,010 29.96 384 2,46,652 15.57 3.1 1.92 1.27–2.91 \0.01
The number of overall suicides by region is smaller than the overall number of suicides by age or year due to exclusion of cases with unknown
residential address (34) and those who were at the time of their death institutionalised or homeless (131). The IRRs are therefore higher in
analysis by geographical region than in overall, or analysis by age or year.
– Not calculated because the number of farmer suicides in the region was \5
Soc Psychiatry Psychiatr Epidemiol
123
above, or indeed distinct from the factors that may con-
tribute to suicide in broader rural populations [12,27]. For
example, while geographical and social isolation may be
factors associated with both farmer and non-farmer suicide
in rural areas [12], it is also possible that highly specific
risk and protective factors—such as weather conditions
affecting agricultural produce and causing a fall in prize
commodities, or a sense of belonging to a broader farming
community [28]—may exert differential influences on
farmers in different locations, potentially explaining the
apparent lack of relationship between farmer and non-
farmer suicide rates observed in this study.
Another important correlate of farmer suicide rates may
be the representation of farmers in a region. For instance,
communities with higher proportions of farmers may have
different attitudes towards mental health problems and
help-seeking behaviour [27] than communities with a small
percentage of farmers in the total population; this in turn
may affect suicide rates. This study, however, shows that
the proportion of persons employed in farming occupations
in a region does not predict the regional suicide rate of
farmers. Collectively, the lack of associations between
farmer suicide rate and the general population suicide rate
in the region (i.e. a location effect) and between farmer
suicide rates and proportion of farmers in the region (i.e. an
occupation effect) implies that high suicide rates among
farmers should be viewed as a combination of both location
and occupation effects, both of which can vary consider-
ably from region to region. The findings also suggest that
location and occupation effects may interact uniquely with
demographic factors such as age, given that higher farmer
suicide rates were found in this study for younger age
groups (under 35 years) and older age groups (over
55 years), whereas middle age groups did not display sta-
tistically significantly (at the p\0.05 level) elevated sui-
cide rates relative to non-farmers.
The findings of this study do not fit within the under-
standing of farmer suicide as a phenomenon that can be
treated as homogenous within a given jurisdiction (and, by
implication, across the whole country). The region-specific
suicide rates observed in this study, however, provide
concrete grounds for further research into region-specific
risk and protective factors of farmers and farming com-
munities. Also, the findings underline the need for suicide
prevention initiatives targeting younger farmer males, who
had the highest suicide rates of all. High vulnerability for
suicide among younger males working in the farming
industry may be a reflection of their job position; a pre-
vious study on Australian farmers found that young per-
sons who died by suicide were more often farm labourers,
while suicides by farm managers occurred predominately
in older age groups [6]. The reasons for a higher suicide
risk among young farmers merit further scrutiny; for
example, the high suicide rate of young farmers may
possibly be due to farm managers being able to cope
longer in times of financial hardship through making
adjustments to their business (such as laying off
employees), whereas younger labourers may be the first
ones to experience job insecurity and be made redundant
in situations of financial hardship on farms. Further
research exploring factors associated with suicides of
farmers in different job positions is therefore needed.
Equally important, future studies should examine the
demographic, socioeconomic, and other relevant charac-
teristics of farmers at the level of a farming/regional
community compared to other populations in these com-
munities, to inform the development of tailored suicide
prevention initiatives for specific farming communities.
A few limitations of this study need to be considered.
First, this study does not consider characteristics associated
with farming in each of the regions studied, such as the
number or size of the farms, the main type of production,
and the size of income from farming. Second, farming
occupations identified through QSR and the key words in
NCIS may not correspond exactly to the occupations of the
reference sample; the reference sample was identified
based on the ANZSCO, as employed by ABS. Third, the
reference sample of non-farmers may include members of
farming families who are working off the farm, in another
occupation. It is unknown how much of the farming
workload these family members may take in addition to
their work off the farm. Further, the suicide rates present an
average rate across a 10-year period and do not account for
possible variability across time. Currently, the numbers of
suicide cases in each year are too small to allow for a
calculation of yearly rates. These difficulties may have
obscured the real picture of regional differences in farmer
suicide in Queensland. Finally, this study did not take into
consideration different levels of remoteness within the
regions studied. Each region covers a large geographic area
that could include several levels of remoteness, and farmer
suicides may be associated with greater levels of relative
remoteness within given regions.
Acknowledging the above limitations, this study none-
theless provides unique information about relationships
between farmer and non-farmer suicide across different
regions in Queensland, as well as demonstrating an
apparent need to take into account both demographic and
region-specific factors in future suicide prevention strate-
gies aimed at reducing farmer suicide. While more detailed
study of region-specific contextual factors is required, the
current findings provide a necessary first step towards
improved understanding of the specific composition of
demographic, social, economic, and environmental factors
[29] that may contribute differently to farmer suicides
across different regions.
Soc Psychiatry Psychiatr Epidemiol
123
Acknowledgments The authors gratefully thank Queensland
Health/Queensland Mental Health Commission for their continuing
support of the Queensland Suicide Register.
Conflict of interest On behalf of all authors, the corresponding
author states that there is no conflict of interest.
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  • Article
    Objectifs: Les objectifs de l’étude étaient de quantifier le risque de suicide des travailleurs de l’agriculture, de la sylviculture et de la pêche via une revue systématique de la littérature et une méta-analyse et d’étudier les éventuelles variations de risque au sein de cette population selon ses caractéristiques professionnelles et sociodémographiques. Jusqu’à présent, le suicide au sein de cette population n’avait jamais fait l’objet d’une revue systématique de la littérature et/ou d’une méta-analyse. Méthodes: Une revue systématique de la littérature sur la période 1995–2016 et une méta-analyse à partir de la base de données MEDLINE via le moteur de recherche Pubmed ont été réalisées conformément aux recommandations PRISMA. La méta-analyse a permis de calculer une estimation poolée de la taille d’effet du risque de suicide au sein de la population d’intérêt. Des analyses par sous-groupes ont ensuite été effectuées pour déterminer si la taille d’effet variait selon des caractéristiques liées à la population ou des caractéristiques méthodologiques des études. Une méta-régression a enfin permis d’identifier les sources d’hétérogénéité entre les études. Résultats: Soixante-cinq études répondant aux critères de sélection ont été retenues pour la revue systématique et 32 d’entre elles ont été incluses dans la méta-analyse. L’estimation poolée de la taille d’effet était de 1,48 (IC à 95 % : 1,30 ; 1,68) représentant un excès de risque de suicide statistiquement significatif au sein de la population d’intérêt. Les analyses par sous-groupes ont montré que la taille d’effet variait selon la zone géographique et était plus élevé au Japon. La variance inter-études s’expliquait principalement par les caractéristiques des études : choix du groupe de référence, mesure de risque utilisée et type d’étude. Conclusions: Les résultats obtenus suggèrent un excès de risque de suicide au sein des travailleurs de l’agriculture, de la sylviculture et de la pêche. Cette revue et méta-analyse souligne l’intérêt de mener des politiques de prévention du suicide ciblant cette population. Les recherches à venir devront affiner ces résultats notamment afin de mieux comprendre cet excès de risque et d’explorer les variations de risque selon d’autres caractéristiques sociodémographiques et professionnelles telles que l’âge des travailleurs, leur statut (indépendant/salarié) ou encore leur niveau de qualification.
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    Suicide prevention policy in Australia has had an increasing focus on building the evidence base to address this major public health concern. In recent times, the Australian Government has increased its investment in suicide prevention research. It has provided support for several initiatives in this area, including funding Suicide Prevention Australia to act as the lead agency for a $12 million national Suicide Prevention Research Fund, and funding the Centre for Mental Health at the University of Melbourne to play a national leadership role in suicide prevention research. The current project aims to assist these agencies to identify priority research areas to be addressed in suicide prevention.
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    Introduction: Suicide remains an important public health issue in Australia, responsible for around 2500 deaths each year. Although suicide only accounts for around 1.7% of total mortality in Australia per year, 75% of suicide deaths are in males. This article reviews the factors contributing to suicide in older rural males in Australia and then categorises the papers into themes for ease of explanation. Living with experiences of drought, dramatic weather change, lower employment opportunities, out-migration, changing family dynamics, ageism in the community, economic change and competitive labour markets, all add to the diverse experience for an older person who is ageing in a rural setting. Methods: A literature search was conducted in March 2015, using the terms 'elderly' and 'older males' and then combined with 'rural', 'suicide' and 'Australia', to investigate the amount of research that has been conducted on the factors relating to suicide in older rural Australian males. Results: Reviewed articles consisted of research using either quantitative or qualitative approaches, which investigated suicide in older Australians published between 1950 and 2014. With strict adherence to the selection criteria, articles (21 in total) were removed because they were a literature review; a narrative review; they focused predominantly on youth or suicide risk, suicidal ideation or suicide attempts; or they discussed reasons for living. This article discusses the researcher's recommendations for further research into employment transitions for older Australian males, and the need to review policy change for further intervention in the future. Conclusions: This article highlights factors that may cause older rural Australians to be placed at a higher risk of suicide than their urban-dwelling counterparts. With the impact of the changing economy, unpredictable climatic conditions and dynamic changes in rural Australian families, there is a need to highlight research that has been conducted in this area. Future research should focus on identification of misclassification of suicide deaths, investigation of the possible effect that retirement pathways may have on older Australian males, suicide prevention strategies, mental wellbeing and the risk of suicidal behaviour. This will ascertain any compounding or protective factors that could influence this current trend.
  • Article
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    The study commences with a question that epidemiology would regard as 'old' viz. whether suicide rates are higher in rural areas or urban areas, and turns to applying an economic technique of analysis to studying regional suicide disparities. Several dispersion measures are applied to time series male and female suicide rates, including economic inequality measures and measures from regional studies. Equations are modelled on these dispersion measurements, establishing the sign on the slope coefficients. It is determined whether regional disparities in Queensland lessened, or increased, in the study period. The interpretations relevant to a regional studies literature are discussed.
  • Article
    Suicide rates among farm populations have been reported to be higher than among other populations. Overall economic stressors and exposure to hazardous work conditions have been reported to be associated with the increased rates of suicide. The purpose of this paper is to examine the pattern of suicide among white men in Colorado, contrasting the rates of on-farm suicides with those of other nonmetropolitan and metropolitan residents. The analysis indicated a high suicide rate in Colorado compared to white males in the United States; however, the farm suicide rate was similar to the U.S. rate. On-farm suicide rates in Colorado were lower than suicide rates for the metropolitan and nonmetropolitan males. Prior to targeting all farm populations as at high risk for suicide, more work needs to be done assessing actual risk and considering potential differences in agricultural populations across the country.
  • Article
    Aim: To determine the attitudes of rural men to matters of health and body image. Methods: Focus group discussions were used to examine the attitudes of a sample of Australian rural men to matters of health and body image in the context of their eating and exercise behaviours. Forty-two rural men, aged 25–64 years, took part in four focus groups, one exclusively for farmers, in south-western New South Wales (NSW). Results: Results from these focus groups reveal that many of the masculine myths surrounding male behaviour in relation to health and ideas on body image persist among rural men in south-western NSW. Talking about health is not considered a male past-time; visiting health professionals is still seen as a last resort; being a ‘big bloke’ is perceived to be advantageous and heavy drinking is still considered an Australian male domain, especially among the younger men in the groups. Conclusion: The present study provides a deeper understanding of rural men's attitudes to body image issues and lifestyle behaviours, which is critical to helping change health outcomes for this hard-to-reach group.
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    WHO estimates that about 170,000 deaths by suicide occur in India every year, but few epidemiological studies of suicide have been done in the country. We aimed to quantify suicide mortality in India in 2010. The Registrar General of India implemented a nationally representative mortality survey to determine the cause of deaths occurring between 2001 and 2003 in 1·1 million homes in 6671 small areas chosen randomly from all parts of India. As part of this survey, fieldworkers obtained information about cause of death and risk factors for suicide from close associates or relatives of the deceased individual. Two of 140 trained physicians were randomly allocated (stratified only by their ability to read the local language in which each survey was done) to independently and anonymously assign a cause to each death on the basis of electronic field reports. We then applied the age-specific and sex-specific proportion of suicide deaths in this survey to the 2010 UN estimates of absolute numbers of deaths in India to estimate the number of suicide deaths in India in 2010. About 3% of the surveyed deaths (2684 of 95,335) in individuals aged 15 years or older were due to suicide, corresponding to about 187,000 suicide deaths in India in 2010 at these ages (115,000 men and 72,000 women; age-standardised rates per 100,000 people aged 15 years or older of 26·3 for men and 17·5 for women). For suicide deaths at ages 15 years or older, 40% of suicide deaths in men (45,100 of 114,800) and 56% of suicide deaths in women (40,500 of 72,100) occurred at ages 15-29 years. A 15-year-old individual in India had a cumulative risk of about 1·3% of dying before the age of 80 years by suicide; men had a higher risk (1·7%) than did women (1·0%), with especially high risks in south India (3·5% in men and 1·8% in women). About half of suicide deaths were due to poisoning (mainly ingestions of pesticides). Suicide death rates in India are among the highest in the world. A large proportion of adult suicide deaths occur between the ages of 15 years and 29 years, especially in women. Public health interventions such as restrictions in access to pesticides might prevent many suicide deaths in India. US National Institutes of Health.
  • Article
    Several risk factors for suicide have been identified. We assessed the relative risks and population attributable risks of suicide associated with various socioeconomic factors and with previous mental illness that necessitated hospital admission. Our aim was to assist in the choice of potential strategies for preventing suicide in the general population. We did a population-based nested case-control study based on register data. Data were collected on a random 5% sample of the Danish population aged 16-78 years during a 15-year period (1980-94) and analysed with conditional logistic regression. 811 cases of suicide were found and 79871 controls were chosen in this population. Unemployment, low income, being single, and a history of mental illness necessitating hospital admission were associated with increased risk of suicide. However, in the multivariate analysis, the strongest risk factor was mental illness necessitating hospital admission; risk of suicide was especially high during admission (relative risk 62.6 [95% CI 41.1-95.4]) and during the year after discharge (6.51 [5.03-8.44]). The effect of socioeconomic variables decreased after adjustment for history of mental illness. The population attributable risk associated with mental illness necessitating admission to hospital was 44.6% (43.6-45.5); the attributable risks associated with the other factors were 3.0% (1.4-6.6) for unemployment and 10.3% (6.13-16.9) for being single. Suicide prevention aimed at patients who are admitted to hospital with mental disorders and improved detection and treatment of mental disorders in the general population may be the most efficient strategy to decrease risk of suicide. Reports of high relative risk and attributable risk associated with unemployment and other socioeconomic risk factors may be confounded and overestimated owing to the lack of adjustment for the association with mental disorders.
  • Article
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    Prior research has suggested an association between suicide and certain occupations. The aim of the present study was to report on suicide rates in selected occupations in Queensland (QLD). Suicide mortality data from the QLD Suicide Register and population data from the Australian Bureau of Statistics were obtained for the period 1990-2006. Suicide rates were calculated for each occupational group and compared to rates within the general population (15-64 year age group) and the employed population of QLD. There was significantly higher risk of suicide for male subjects in the agricultural, transport and construction sectors of QLD. High suicide rates were also found in female nurses, artists, agricultural workers and cleaners, while education professionals (of both genders) appeared at lower risk. The significantly higher suicide rates for employees of the agriculture, construction, and transport industries indicate a need for further research into the occupation-specific conditions and individual or other social-environmental factors that may accentuate suicide risk within these professions. Use of higher quality occupational data is also warranted in future studies.
  • Article
    This study investigated the applicability of 3 models of resiliency for the prediction of suicidal ideation from depression (the risk factor) and social support and sense of belonging (the protective factors). A sample of 99 Australian men farmers completed measures of depression, suicidal ideas, social support, and sense of belonging. Sense of belonging compensated for high levels of depression, and social support, sense of belonging, and an increasing number of protective factors each weakened the depression-suicidal ideation relation. The findings are limited because of the small sample and reliance on self-report measures, but suggest that increasing social support and sense of belonging may benefit the mental health of men farmers.