- Title
- The effect of various risk factors on suicide and its prevention in regional and remote areas of Tasmania - a mixed methods study
- Creator
- Moch, Sophun
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Suicide rates for areas outside major cities were 50% higher than in major cities in Australia in 2020, despite similar levels of diagnosed mental illness. The higher rates of suicide in regional and remote areas are associated with different risk factors for suicide, particularly those unique to living in these areas, including geographical isolation. Most studies have examined urban-regional and remote differentials in risk factors using inconsistent classifications of geographical areas. Regional and remote areas are heterogeneous where people’s ways of life vary across these areas. This study aimed: 1) to examine the distribution of various risk factors for suicide among suicide deaths in regional and remote areas of Tasmania between 2010 and 2015 and 2) to assess the way in which existing suicide prevention strategies target these risk factors for suicide in regional and remote areas of Tasmania. Tasmania is a southern regional and remote state of Australia with many characteristics such as limited access to health services, geographical isolation, and high proportion of aging population, that are similar to those of other regional and remote areas. The study used sequential explanatory mixed methods design with two phases. Phase 1 involved quantitative analyses of suicide deaths undertaken to examine the distribution of various risk factors for suicide and co-occurrence of these risk factors using the National Coronial Information System (NCIS), a secure comprehensive database of information on deaths reported to a coroner. Data on demographic and clinical characteristics and social risk factors were extracted for all non-Indigenous suicide deaths in Tasmania from 2010 to 2015. Phase 2 involved qualitative analyses conducted through the analyses of policy documents on suicide prevention strategies to explore how these strategies targeted different risk factors for suicide in regional and remote areas. Concurrently, qualitative analyses were undertaken to explore key informants’ perspectives of the design, priority setting, implementation, monitoring and evaluation of existing suicide prevention strategies and programmes in Tasmania. Findings from Phases 1 and 2 were integrated in the final analysis to yield more rigorous findings. Key findings show that suicide deaths in regional and remote areas were influenced by various risk factors: male sex, diagnosed mental illness, chronic physical illness, risk factors related to primary support groups including family circumstances, and employment and unemployment issues. The majority of suicide deaths were reported as having two to four risk factors for suicide. These risk factors clustered together: 1) suicide attempt or self-harm and a history of mental illness, 2) risk factors related to upbringing and a history of mental illness, 3) risk factors related to upbringing and risk factors related to primary support groups, and 4) risk factors related to employment and unemployment and a history of mental illness. Risk factors for suicide varied significantly across geographical areas, by sex, and age groups. Suicide deaths in outer regional areas were associated significantly with being male and of older age. Those aged between 45 and 54 years were reported with significantly higher levels of diagnosed mental illness and mental health treatment compared to older age groups. Meanwhile, those aged 64 years or over were significantly more likely to have chronic physical illness such as physical injury and disability compared to younger age groups. These risk factors for suicide were addressed by suicide prevention strategies and programmes that adapted a public health model as a guiding principle for the provision of support services for those at risk of suicide. These approaches were based mainly on experts’ opinions and evidence from national and international literature given the lack of rigorous evidence in regional and remote areas. These deficiencies in evidence have led to some misalignment between risk factors for suicide and the key priorities of existing suicide prevention strategies. In particular, there was insufficient appropriate support services for some high-risk groups such as males and lesbian, gay, bisexual, transgender, and intersex (LGBTI) persons in regional and remote areas. Findings from this PhD study suggest suicide prevention strategies need to acknowledge that suicide deaths in regional and remote areas are not homogeneous. Suicide prevention strategies must be appropriate and responsive to the needs of each population group. Support services for regional and remote areas need to be prioritised based on strong evidence in regional and remote areas for what might potentially work for suicide prevention. For clinical practice, there is a need to assess whether an individual is at risk of suicide based on known risk factors for suicide such as mental illness, suicidal behaviour, relationship breakdown, and employment and unemployment issues. Integrated and coordinated support services must be made available for people at high risk of suicide, particularly those with complex needs. Regarding future research, a matched-case control study using appropriate control groups should be conducted to examine the combined effects and interactions of multiple risk factors on suicide deaths in regional and remote areas.
- Subject
- suicide; suicide prevention; regional and remote areas; Tasmania
- Identifier
- http://hdl.handle.net/1959.13/1449830
- Identifier
- uon:43758
- Rights
- Copyright 2022 Sophun Moch
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 4 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 364 KB | Adobe Acrobat PDF | View Details Download |