Neighborhood social context and suicide mortality: A multilevel register-based 5-year follow-up study of 2.7 million individuals

Neighborhood material versus social deprivation in Canada: different patterns of associations with child and adolescent mental health problems

PURPOSE

In a nationwide study, we aimed to study the association of neighborhood deprivation with child and adolescent mental health problems.

METHODS

We used data from the Canadian Health Survey on Children and Youth (N = 47,871; age range: 1-17 years) and linked these to Neighborhood Material and Social Deprivation data calculated using Canada's Census of Population. Using a series of logistic regressions, we studied the association between living in deprived areas and mental health problems among children and youth. We used bootstrap replicate weights for all analyses and adjusted them for individual sociodemographic characteristics.

RESULTS

In the adjusted model, the parent-reported developmental disorder was associated with more socially deprived neighborhoods (OR 1.29; 95% CI 1.07, 1.57 for most vs. least deprived quintiles). However, mental health service need or use was associated with living in less materially deprived areas (OR 0.78; 95% CI 0.63, 0.96 for most vs. least deprived quintiles). Among mental health problems reported by the youth (12-17 years old), poor/fair general mental health, alcohol drinking, and cannabis use were associated with neighborhood social deprivation in the adjusted models. In contrast, poor/fair general mental health, suicide ideas, alcohol drinking, and cannabis use were all negatively associated with higher materially deprived quintiles.

CONCLUSION

Our study provides further support for the existing evidence on the association between neighborhood deprivation, particularly social deprivation, and the mental health of children and adolescents. The findings can help public health policymakers and service providers better understand and address children's mental health needs in their neighborhoods.

The spatial overlap between risk of intimate partner violence against women and suicide-related emergency calls

Intimate partner violence against women (IPVAW) is a global problem, and suicidal behaviour is one of its most serious consequences. However, no study has investigated the spatial overlap between the two. The aim of this paper is to analyse whether there is spatial overlap between IPVAW and suicide-related calls in the same neighbourhoods, and to identify common risk factors. Geocoded data on IPVAW (N = 2060) and suicide-related calls (N = 4916) from the city of Valencia, Spain, between 2019 and 2021 were collected from the 112 emergency service and the Spanish National Police Corps. We used two analytical approaches: (i) a Bayesian spatial Poisson regression modelling analysis to identify the risk factors associated with IPVAW and suicide-related calls; (ii) Bayesian joint spatial modelling to examine the common spatial distribution of these outcomes. Relative risk maps are also displayed and analysed. The study revealed a higher incidence of IPVAW and suicide-related calls in neighbourhoods with lower income and population density, and greater residential instability and immigrant concentration. There was a 70% similarity between high- and low-risk areas for these incidents, with a moderate positive correlation of 0.43. Notably, 98% of IPVAW risk variance was explained by shared factors, while 30% applied to suicide-related calls; high IPVAW risk was also found in peripheral areas, while suicide-related calls were concentrated in the city centre. The findings highlight the need to identify areas with shared risk and neighbourhood characteristics for the development of more effective intervention strategies.

Role of individual deprivation and community-level deprivation on suicidal behaviors: Insights from the UK Biobank study

Introduction

This study aimed to investigate the impact of individual- and community-level deprivation on suicidal behaviors among community members.

Methods

Data from 350,884 UK Biobank participants were employed to construct an individual deprivation index. Absolute poverty was defined as a pre-tax annual household income below ₤18,000. Predictors for absolute poverty incorporated variables such as sex, ethnicity, type of accommodation, tenure status, number of vehicles owned, educational qualifications, current employment status, and subjective health rating. The individual deprivation index was constructed using a logistic regression model to predict absolute poverty. Townsend Deprivation Index (TDI) was employed to represent community-level deprivation. The associations between the individual deprivation index, TDI, and suicidal behaviors were examined through multivariate linear regression. Interaction analyses were conducted to investigate effect modification.

Results

The logistic regression model demonstrated high predictive accuracy for absolute poverty (area under the receiver operating curve = 0.840). The associations between individual deprivation index and suicidal behaviors were observed to be more substantial than those between TDI and suicidal behaviors. A positive interaction between the individual deprivation index and TDI was detected, indicating an amplifying effect of community-level deprivation on the impact of individual-level deprivation on suicidal behaviors.

Conclusion

Our study successfully constructed a comprehensive individual deprivation index that could be applied widely to measure individual-level deprivation. Our findings revealed that individual-level deprivation and community-level deprivation have a synergistic effect on suicidal behaviors, underscoring the importance of multilevel interventions in suicide prevention.

Social disconnection and suicide mortality among Japanese older adults: A seven-year follow-up study

BACKGROUND

Few prospective studies have examined the association between social disconnection and late-life suicide. Therefore, we conducted a large-scale prospective study of older adults in Japan to examine differences in suicide mortality according to specific aspects of social disconnectedness.

METHODS

We conducted a nationwide baseline survey of functionally independent older adults (age ≥65 years) from 12 municipalities in Japan from 2010 to 2011. We followed the participants (n = 46,144) for cause of death through December 2017 using vital statistics. Social disconnection was assessed based on the indicators of eating alone, a lack of instrumental/emotional support, no participation in community activities, and no contact with friends. We adopted Cox regression models with multiple imputation for missing values and calculated the population-attributable fraction (PAF).

RESULTS

A total of 55 suicide deaths were recorded during an average follow-up of 7 years. Older adults with social disconnection had a marginally increased risk of suicide. The hazard ratio for eating alone vs. eating together was 2.81 (95% confidence interval [CI]: 1.47-5.37). The direction of these associations and point estimations did not largely change after controlling for depressive symptoms, an evident risk factor for suicidal behavior. The PAF indicated that eating alone was attributable to around 1800 (29%) of the suicide deaths among older adults annually in Japan.

CONCLUSION

Avoidance of not only depressive symptoms, but also social disconnection including eating alone, is useful in suicide prevention among older adults.

The complexities of suicide: a multilevel survival analysis examining individual, familial and neighbourhood determinants of suicide risk using Danish register-based data

BACKGROUND

Suicide risk is complex and nuanced, and how place impacts suicide risk when considered alongside detailed individual risk factors remains uncertain. We aimed to examine suicide risk in Denmark with both individual and neighbourhood level risk factors.

METHODS

We used Danish register-based data to identify individuals born in Denmark from 1972, with full parental information and psychiatric diagnosis history. We fitted a two-level survival model to estimate individual and neighbourhood determinants on suicide risk.

RESULTS

We identified 1723 cases of suicide in Denmark during the follow-up period from 1982 to 2015. Suicide risk was explained mainly by individual determinants. Parental comorbidities, particularly maternal schizophrenia [incidence rate ratio (IRR): 2.29, 95% CI 1.56-3.16] and paternal death (2.29, 95% CI 1.31-3.72) partly explained suicide risk when adjusted for all other determinants. The general contextual effect of suicide risk across neighbourhoods showed a median incidence rate ratio (MRR) of 1.13 (1.01-1.28), which was further reduced with full adjustment. Suicide risk increased in neighbourhoods with a higher proportion of manual workers (IRR: 1.08; 1.03-1.14), and decreased with a higher population density (IRR: 0.89; 0.83-0.96).

CONCLUSION

Suicide risk varies mainly between individuals, with parental comorbidities having the largest effect on suicide risk. Suicide risk was less impacted by neighbourhood, though, albeit to a lesser extent than individual determinants, some characteristics were associated with suicide risk. Suicide prevention policies might consider targeting interventions towards individuals more vulnerable due to particular parental comorbidities, whilst taking into account that some neighbourhood characteristics might exacerbate this risk further.

The association between social fragmentation and deaths attributable to alcohol, drug use, and suicide: Longitudinal evidence from a population-based sample of Canadian adults

BACKGROUND

Social fragmentation has been theorized and empirically associated with suicide in prior research. However, less is known about whether social fragmentation is associated with deaths attributed to alcohol use or drug use. This research examined the association between social fragmentation and risk for deaths attributable to alcohol use, drug use, and suicide (collectively known as deaths of despair) among Canadian adults.

METHODS

A weighted sample representing 15,324,645 Canadians within 288 census divisions between 2006 and 2019 was used. Mortality data from the Canadian Vital Statistics Database (alcoholic liver disease, drug use, and suicide) was linked with census division socioeconomic data from the 2006 Canadian census using the Canadian Census Health and Environment Cohorts. Social fragmentation at the census division was created based on the Congdon Index. Cox-proportional hazard regression with survey weights and the sandwich estimator were used to account for clustering of individuals (level-1) nested within census divisions (level-2).

RESULTS

After adjusting for individual and census division confounders, social fragmentation was positively associated with all-cause mortality (HR = 1.04; 95% CI: 1.02, 1.07), suicide (HR = 1.09; 95%CI: 1.01, 1.18), drug overdose related mortality (HR = 1.13; 95%CI: 1.03, 1.24), and deaths of despair (HR = 1.10; 95% CI: 1.04, 1.16), and not significantly associated with alcohol related liver disease (HR = 1.06; 95% CI: 0.91, 1.23).

CONCLUSION

Social fragmentation is associated with an increased hazard of deaths of despair among Canadian adults. Efforts to improve social cohesion in areas that are highly socially fragmented need to be evaluated.

Long-term association between neighbourhood socioeconomic deprivation in early childhood and perceived stress in early adulthood: a multilevel cohort study

BACKGROUND

Previous studies have shown that neighbourhood socioeconomic deprivation is related to mental health problems, with chronic stress responses as one possible biopsychological pathway; however, less is known about the possible long-term effects of neighbourhood deprivation throughout the life course. The aim of this study was to examine the association between neighbourhood socioeconomic deprivation in early childhood and perceived stress in early adulthood.

METHODS

Data from the, Danish National Health Survey 2017 in which Cohen's 10-item Perceived Stress Scale was measured (range 0-40) were used to follow a cohort consisting of all survey respondents aged 20-24 years born between 1992 and 1996. The respondents were linked to Danish register data, including data on the parent(s) with whom the respondents lived, to measure family-level socioeconomic characteristics, parental mental health problems and neighbourhood socioeconomic deprivation at age 3 for each respondent. Furthermore, the respondents were linked to georeferenced neighbourhoods. Linear mixed models were used to estimate the association between neighbourhood socioeconomic deprivation at age 3 and perceived stress at age 20-24.

RESULTS

A 1 SD increase in neighbourhood socioeconomic deprivation in early childhood was associated with a 0.59-point increase in perceived stress in early adulthood (95% CI 0.41 to 0.77). The association was attenuated but remained statistically significant after controlling for individual and family characteristics and neighbourhood socioeconomic deprivation in early adulthood (coef 0.26, 95% CI 0.06 to 0.46).

CONCLUSION

The findings suggest that children growing up in more socioeconomically deprived neighbourhoods may be prone to higher levels of perceived stress later in life.

The association between nation-level social and economic indices and suicide rates: A pilot study

Ever since the pioneering work of Emile Durkheim, it has been known that regional or national suicide rates can be influenced by a variety of social and economic factors. Recent research has found a robust association between two country-level economic indices-gross national product and unemployment rate-and suicide rates, particularly in men. However, the association between other country-level social indices-such as measures of social integration, inequality, environmental preservation and political freedom-and suicide rates has not been studied at the cross-national level. In the current study, national suicide rates for men and women were examined in relation to seven indices measuring subjective wellbeing, sustainable development, type of political regime, economic and gender inequality, and social capital. It was found that the Happy Planet Index, a composite measure of subjective wellbeing and sustainable development, was negatively associated with suicide rates independent of gender, and even after adjusting for possible confounding factors. Economic inequality was associated with suicide in men, and social capital was associated with suicide in women. Moreover, the strength and direction of the associations observed between socioeconomic indices and suicide varied across income groups. These results highlight the need for a closer evaluation of the link between large-scale ("macro") social factors and individual ("micro") psychological factors, as well as the importance of integrating these factors into suicide prevention programmes at the national level.