Melbourne School of Population and Global Health - Theses
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ItemThe application of geo-statistical techniques to explore spatial and temporal patterns of suicide( 2012)Spatial health inequalities and disease clustering have been explored in many epidemiological studies, including studies of suicide. Previous studies have found evidence of contagion among teenagers and clustering among economically deprived people. Various measures have been proposed to prevent contagion following a suicide, but additional evidence regarding spatial patterns and clustering is essential for preventing these tragic events. This thesis seeks to identify the spatial and temporal patterns of completed suicide in Australia and identify the correlates of those patterns. Four studies were conducted using a variety of geographical and statistical methods to explore patterns and clustering. Using data from the Coroners Court of Victoria, study 1 investigated the temporal patterns of completed suicide by jumping from the West Gate Bridge in Melbourne. The remaining studies used data on suicide deaths from the National Coroners Information System. Study 2 applied techniques of risk smoothing and mapping to illustrate the spatial patterns of completed suicide over all postcodes in Australia. Study 3 used scan statistics to detect suicide clusters in Australia. Study 4 involved a comparison between clustered and non-clustered suicides to explore correlates of suicide clustering. A sustained increase in jumping suicide at the West Gate Bridge was detected for the 10-year study period, but no clustering pattern was found. Such a pattern was also apparent among jumping suicides at other locations, but not among other suicide methods. These findings supported the hypothesis that a growing reputation of a site as a suicide “hotspot” might sustain the continual increase of jumping suicide at the hotspot and other locations. Responsible media reporting of suicide at the hotspot, and suicide prevention activities at locations close to the hotspot are likely to be useful strategies for addressing suicidal behavior at hotspots. Spatial variation in suicide risk across states/territories were identified, as were metropolitan-rural-remote differentials with rates higher in rural and remote areas for males, and spatial clusters in some high risk postcodes for both sexes. Socio-economic deprivation, population composition, high suicidal risks among Indigenous Australians and low access to mental health services might explain the elevation of suicide risk in rural and remote areas. These findings suggest that it is important to take geographical variations in suicide risk into account in national policy making. Particular suicide prevention interventions might be targeted at males living in remote areas, and some localized areas in metropolitan zones. Based on cluster detection by scan statistics, about 2.5% of completed suicides in Australia occurred as part of suicide clusters. Major clusters were located in the Northern Territory, Queensland, Western Australia and South Australia, and some smaller clusters were found in Victoria and Western Australia. The risk of suicide clustering was greater among Indigenous Australians than non-Indigenous Australians, and among those living in socio-economically deprived areas. These findings suggest that more resources should be allocated to the mental health services for Indigenous people and those living in rural and remote and socially-deprived areas. Sustaining infrastructure and community development in these areas may also be protective against suicide clustering.