Preliminary spatiotemporal analysis of the association between socio-environmental factors and suicide

Self-harm and interpersonal violence due to high temperature from the global burden of disease study 2019: A 30-year assessment

BACKGROUND

The impact of global warming on health due to climate change is increasingly studied, but the global burden of self-harm and interpersonal violence attributable to high temperature is still limited. This study aimed to systematically assess the burden of self-harm and interpersonal violence attributable to high temperature globally or by region and climate zone from 1990 to 2019.

METHODS

We obtained the global, regional, and national deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized disability-adjusted life year rates (ASDR) of self-harm and interpersonal violence due to high temperature from 1990 to 2019 through the Global Burden of Disease Study (GBD) 2019. The burden of self-harm and interpersonal violence due to high temperature was estimated by age, sex, climate zone, the socio-demographic index (SDI), and the healthcare access and quality index (HAQ). Average annual percentage changes (AAPCs) in ASMR and ASDR were calculated for 1990-2019 using the Joinpoint model.

RESULTS

From 1990 to 2019, the global deaths and DALYs related to self-harm and interpersonal violence due to high temperature increased from 20,002 (95% UI, 9243 to 41,928) and 1,107,216 (95% UI, 512,062 to 2,319,477) to 26,459 (95% UI, 13,574 to 47,265) and 1,382,487 (95% UI, 722,060 to 2,474,441), respectively. However, the ASMR and ASDR showed varying degrees of decreasing trends, with decreases of 13.36% and 12.66%, respectively. The ASMR was high and declining in low and low-middle SDI regions, particularly in tropical and subtropical regions. In addition, SDI and HAQ index were negatively correlated with ASMR in 204 countries and regions.

CONCLUSIONS

The global burden of self-harm and interpersonal violence attributed to high temperature has decreased over the past 30 years, but the number of deaths and DALYs continues to rise. Climate change continues to make heat stress a significant risk factor for self-harm and interpersonal violence worldwide.

Short-term exposure to temperature and mental health in North Carolina: a distributed lag nonlinear analysis

Adverse mental health outcomes have been associated with high temperatures in studies worldwide. Few studies explore a broad range of mental health outcomes, and to our knowledge, none are specific to NC, USA. This ecological study explored the relationship between ambient temperature and mental health outcomes (suicide, self-harm and suicide ideation, anxiety and stress, mood disorders, and depression) in six urban counties across the state of NC, USA. We applied a quasi-Poisson generalized linear model combined with a distributed lag nonlinear model (DLNM) to examine the short-term effects of daily ambient temperature on emergency admissions for mental health conditions (2016 to 2018) and violent deaths (2004 to 2018). The results were predominately insignificant, with some key exceptions. The county with the greatest temperature range (Wake) displays higher levels of significance, while counties with the lowest temperature ranges (New Hanover and Pitt) are almost entirely insignificant. Self-harm and suicidal ideation peak in the warm months (July) and generally exhibit a protective effect at lower temperatures and shorter lag intervals. Whereas anxiety, depression, and major depressive disorders peak in the cooler months (May and September). Suicide is the only outcome that favored a 20-day lag period in the sensitivity analysis, although the association with temperature was insignificant. Our findings suggest additional research is needed across a suite of mental health outcomes to fully understand the effects of temperatures on mental health.

The application of spatial analysis to understanding the association between area-level socio-economic factors and suicide: a systematic review

BACKGROUND

Little is known about what impact the use of different spatial methodological approaches may have on understanding the relationship between area-level socio-economic factors and suicide.

METHODS

In this systematic review, we searched PubMed, Embase, CINAHL and PsycInfo for original empirical studies examining the relationship between socio-economic factors and suicide with a spatial lens, published up to January 22, 2022. Data on applied spatial methods, indicators of socio-economic factors, and risk of suicide related to socio-economic factors were extracted. The protocol for this systematic review was registered with PROSPERO (CRD42021251387).

RESULTS

A systematic search yielded 6290 potentially relevant results; 58 studies met the inclusion criteria for review. Of the 58 included studies, more than half of the studies (n = 34; 58.6%) used methods that accounted for spatial effects in analyses of the association between socio-economic factors and suicide or examined spatial autocorrelation, while 24 (41.4%) studies applied univariate and multivariate models without considering spatial effects. Bayesian hierarchical models and spatial regression models were commonly used approaches to correct for spatial effects. The risk of suicide relating to socio-economic factors varied greatly by local areas and between studies using various socio-economic indicators. Areas with higher deprivation, higher unemployment, lower income, and lower education level were more likely to have higher suicide risk. There was no significant difference in results between studies using conventional versus spatial statistic methods.

CONCLUSION

An increasing number of studies have applied spatial methods, including Bayesian spatial models and spatial regression models, to explore the relationship between area-level socio-economic factors and suicide. This review of spatial studies provided further evidence that area-level socio-economic factors are generally inversely associated with suicide risk, with or without accounting for spatial autocorrelation.

Spatio-Temporal Distribution of Suicide Risk in Iran: A Bayesian Hierarchical analysis of repeated cross-sectional data

Objectives

We aimed to estimate the space-time distribution of the risk of suicide mortality in Iran from 2006 to 2016.

Methods

In this repeated cross-sectional study, the age-standardized risk of suicide mortality from 2006 to 2016 was determined. To estimate the cumulative and temporal risk, the Besag, York, and Mollié and Bernardinelli models were used.

Results

The relative risk of suicide mortality was greater than 1 in 43.0% of Iran’s provinces (posterior probability >0.8; range, 0.46 to 3.93). The spatio-temporal model indicated a high risk of suicide in 36.7% of Iran’s provinces. In addition, significant upward temporal trends in suicide risk were observed in the provinces of Tehran, Fars, Kermanshah, and Gilan. A significantly decreasing pattern of risk was observed for men (β, −0.013; 95% credible interval [CrI], −0.010 to −0.007), and a stable pattern of risk was observed for women (β, −0.001; 95% CrI, −0.010 to 0.007). A decreasing pattern of suicide risk was observed for those aged 15–29 years (β, −0.006; 95% CrI, −0.010 to −0.0001) and 30–49 years (β, −0.001; 95% CrI, −0.018 to −0.002). The risk was stable for those aged >50 years.

Conclusions

The highest risk of suicide mortality was observed in Iran’s northwestern provinces and among Kurdish women. Although a low risk of suicide mortality was observed in the provinces of Tehran, Fars, and Gilan, the risk in these provinces is increasing rapidly compared to other regions.

Suicide disparities across metropolitan areas in the US: A comparative assessment of socio-environmental factors using a data-driven predictive approach

Disparity in suicide rates across various metropolitan areas in the US is growing. Besides personal genomics and pre-existing mental health conditions affecting individual-level suicidal behaviors, contextual factors are also instrumental in determining region-/community-level suicide risk. However, there is a lack of quantitative approach to model the complex associations and interplays of the socio-environmental factors with the regional suicide rates. In this paper, we propose a holistic data-driven framework to model the associations of socio-environmental factors (demographic, socio-economic, and climate) with the suicide rates, and compare the key socio-environmental determinants of suicides across the large and medium/small metros of the vulnerable US states, leveraging a suite of advanced statistical learning algorithms. We found that random forest outperforms all the other models in terms of both in-sample goodness-of-fit and out-of-sample predictive accuracy, which is then used for statistical inferencing. Overall, our findings show that there is a significant difference in the relationships of socio-environmental factors with the suicide rates across the large and medium/small metropolitan areas of the vulnerable US states. Particularly, suicides in medium/small metros are more sensitive to socio-economic and demographic factors, while that in large metros are more sensitive to climatic factors. Our results also indicate that non-Hispanics, native Hawaiian or Pacific islanders, and adolescents aged 15-29 years, residing in the large metropolitan areas, are more vulnerable to suicides compared to those living in the medium/small metropolitan areas. We also observe that higher temperatures are positively associated with higher suicide rates, with large metros being more sensitive to such association compared to that of the medium/small metros. Our proposed data-driven framework underscores the future opportunities of using big data analytics in analyzing the complex associations of socio-environmental factors and inform policy actions accordingly.

Alcohol-related suicide across Australia: a geospatial analysis

BACKGROUND

The acute effects of alcohol consumption are a major risk factor for suicide. Positive blood alcohol concentrations are present in almost one-third of all suicides at time of death. These suicides are defined as alcohol-related suicides. This cross-sectional study examines the geospatial distribution/clustering of high proportions of alcohol-related suicides and reports on socioeconomic and demographic risk factors.

METHODS

National Coronial Information System (NCIS) data were used to calculate proportions of suicides with alcohol present at the time of death for each level 3 statistical areas (SA3) in Australia. A density analysis and hotspot cluster analysis were used to visualise and establish statistically significant clustering of areas with higher (hotspots) and lower (coldspots) proportions. Subsequently, socioeconomic and demographic risk factors for alcohol use and suicide were reported on for hot and cold spots.

RESULTS

Significant clustering of areas with higher proportions of alcohol-related suicide occurred in northern Western Australia, the Northern Territory and Queensland, as well as inland New South Wales and inland Queensland. Clustering of SA3s with significantly lower proportions occurred in major city and inner regional Sydney and Melbourne. Conclusion and implications for public health: Results from this study identify areas in which prevention strategies should target alcohol use and can be used to inform prevention strategy design. Additionally, hotspots and coldspots identified in this study can be used for further analysis to better understand contextual risk factors for alcohol-related suicide.

Climate change-induced human conflicts and economic costs in Pakistani Punjab

Understanding causes of interpersonal conflicts, related costs, and the effects on investment in agriculture are important concerns of social sciences. The present study was designed to explore these aspects in relation to climate change, since rising temperature and precipitation are considered crucial causal factors in fueling interpersonal conflicts. The study used cross-sectional data collected from rural farm households from a large district of Pakistani Punjab. Cost of conflicts was estimated using standard economic methods whereas factors affecting interpersonal conflicts were estimated through employing logit model. The study found that interpersonal conflicts cost US$135 per month for following the proceedings of the conflicts filed in the court. Households involved in conflicts spent significantly very few resources in purchasing farm inputs which in turn declined productivity of maize (28%) and sugarcane (19%). Warm temperature, precipitation, and windstorm were perceived by households as causal factors for interpersonal conflicts. Socioeconomic characteristics namely, farm size, livestock, family size, and high monthly income of household, were significantly associated with interpersonal conflicts. The study concludes important policy implications.

Association between dust storm occurrence and risk of suicide: Case-crossover analysis of the Korean national death database

BACKGROUND

Asian dust storms (ADSs) have been associated with adverse health outcomes, including respiratory and cardiovascular diseases. Considering the increasing global desertification driven by climate change, it is necessary to assess dust storm-related adverse health effects for establishing appropriate public health interventions. Recent studies have found that ambient air pollution has negative effects on mental health including cognitive disorders, depression, and suicide. However, these studies mostly focused on traditional anthropogenic pollutants from traffic exhaust or fossil fuel power plants; the association between dust storms and suicidal death is yet to be determined.

OBJECTIVE

To assess the association between ADSs and suicide risk in Seoul, South Korea from 2002 to 2015.

METHODS

To determine whether increased risk of suicide is associated with occurrence of ADSs, we performed a time-stratified case-crossover study that linked the national death statistics database with ADS occurrence data from the Korea Meteorology Administration. Exposure to ADSs was compared between the day of suicide and control days, matched to the day of the week, month, and year. We further examined whether the effect of ADSs on suicide risk differed according to ADS duration and intensity.

RESULTS

Over the 14-year period, 30,704 people died by suicide and 133 ADSs were reported. Of these, 55 ADSs lasted over 2 days (long-duration ADSs), and 67 ADSs had higher levels of particulate matter < 10 μm in diameter (PM₁₀) that exceeded the 50th percentile value over the total 133 ADS days (high-intensity ADSs). Exposure to ADS was associated with a 13.1% (95% confidence interval [CI], 4.5-22.4; P = .002) increase in suicide risk on the day of ADS occurrence. Long-duration and high-intensity ADSs were associated with a 19.8% (95% CI, 6.5-34.7; P = .003) and 17.0% (95% CI, 5.2-30.0; P = .004) increase in suicide risk, respectively. These associations remained robust after adjusting for local air pollution levels and meteorological factors. However, this association was not replicated in the unconstrained distributed lag model which revealed inferior goodness-of-fit to our data.

CONCLUSIONS

Exposure to ADSs was associated with an increased risk of suicide, especially on the same day. This study provides novel evidence of a relationship between ADSs and suicide. These findings could help in establishing public health interventions for suicide prevention as well as in establishing dust storm warning systems. Future studies are warranted to confirm if our findings are replicable and to elucidate the underlying mechanisms.

Crisis support-seeking behavior and temperature in the United States: Is there an association in young adults and adolescents?

BACKGROUND

Mounting evidence demonstrates the relationship between high temperatures and adverse mental health outcomes. Yet, no study has examined the influence of temperature on crisis support-seeking behavior among youth in large urban areas.

METHODS

Crisis Text Line (CTL) is a text messaging service that provides crisis interventions for support-seeking individuals for a range of mental-health outcomes in the United States. We applied a distributed lag non-linear modeling technique to assess the short-term impacts of daily maximum and minimum temperature on crisis-related events in four metropolitan locations in the USA.

RESULTS

There were multiple positive associations in three of the four study locations that demonstrate crisis help-seeking behavior increased during anomalously warm conditions.

CONCLUSIONS

This study suggests that there is a significant association between high minimum or maximum temperatures and crisis help-seeking behaviors in young adults and adolescents in urban areas in the United States.

Spatial clustering of fatal, and non-fatal, suicide in new South Wales, Australia: implications for evidence-based prevention

BACKGROUND

Rates of suicide appear to be increasing, indicating a critical need for more effective prevention initiatives. To increase the efficacy of future prevention initiatives, we examined the spatial distribution of suicide deaths and suicide attempts in New South Wales (NSW), Australia, to identify where high incidence 'suicide clusters' were occurring. Such clusters represent candidate regions where intervention is critically needed, and likely to have the greatest impact, thus providing an evidence-base for the targeted prioritisation of resources.

METHODS

Analysis is based on official suicide mortality statistics for NSW, provided by the Australian Bureau of Statistics, and hospital separations for non-fatal intentional self-harm, provided through the NSW Health Admitted Patient Data Collection at a Statistical Area 2 (SA2) geography. Geographical Information System (GIS) techniques were applied to detect suicide clusters occurring between 2005 and 2013 (aggregated), for persons aged over 5 years. The final dataset contained 5466 mortality and 86,017 non-fatal intentional self-harm cases.

RESULTS

In total, 25 Local Government Areas were identified as primary or secondary likely candidate regions for intervention. Together, these regions contained approximately 200 SA2 level suicide clusters, which represented 46% (n = 39,869) of hospital separations and 43% (n = 2330) of suicide deaths between 2005 and 2013. These clusters primarily converged on the Eastern coastal fringe of NSW.

CONCLUSIONS

Crude rates of suicide deaths and intentional self-harm differed at the Local Government Areas (LGA) level in NSW. There was a tendency for primary suicide clusters to occur within metropolitan and coastal regions, rather than rural areas. The findings demonstrate the importance of taking geographical variation of suicidal behaviour into account, prior to development and implementation of prevention initiatives, so that such initiatives can target key problem areas where they are likely to have maximal impact.

Cause and context: place-based approaches to investigate how environments affect mental health

OBJECTIVES

Our surroundings affect our mood, our recovery from stress, our behavior, and, ultimately, our mental health. Understanding how our surroundings influence mental health is central to creating healthy cities. However, the traditional observational methods now dominant in the psychiatric epidemiology literature are not sufficient to advance such an understanding. In this essay we consider potential alternative strategies, such as randomizing people to places, randomizing places to change, or harnessing natural experiments that mimic randomized experiments.

METHODS

We discuss the strengths and weaknesses of these methodological approaches with respect to (1) defining the most relevant scale and characteristics of context, (2) disentangling the effects of context from the effects of individuals' preferences and prior health, and (3) generalizing causal effects beyond the study setting.

RESULTS

Promising alternative strategies include creating many small-scale randomized place-based trials, using the deployment of place-based changes over time as natural experiments, and using fluctuations in the changes in our surroundings in combination with emerging data collection technologies to better understand how surroundings influence mood, behavior, and mental health.

CONCLUSIONS

Improving existing research strategies will require interdisciplinary partnerships between those specialized in mental health, those advancing new methods for place effects on health, and those who seek to optimize the design of local environments.

Spatial Clustering Properties in the Temporal Variation of Suicide Rates/Numbers among Japanese Citizens: A Comprehensive Comparison and Discussion

Objective

The number of suicides in Japan has remained high for many years. To effectively resolve this problem, firm understanding of the statistical data is required. Using a large quantity of wide-ranging data on Japanese citizens, the purpose of this study was to analyze the geographical clustering properties of suicides and how suicide rates have evolved over time, and to observe detailed patterns and trends in a variety of geographic regions.

Methods

Using adjacency data from 2008, the spatial and temporal/spatial clustering structure of geographic statistics on suicides were clarified. Echelon scans were performed to identify regions with the highest-likelihood ratio of suicide as the most likely suicide clusters.

Results

In contrast to results obtained using temporal/spatial analysis, the results of a period-by-period breakdown of evolving suicide rates demonstrated that suicides among men increased particularly rapidly during 1988–1992, 1993–1997, and 1998–2002 in certain cluster regions located near major metropolitan areas. For women, results identified cluster regions near major metropolitan areas in 1993–1997, 1998–2002, and 2003–2007.

Conclusions

For both men and women, the cluster regions identified are located primarily near major metropolitan areas, such as greater Tokyo and Osaka.

Associations between climate variability, unemployment and suicide in Australia: a multicity study

BACKGROUND

A number of studies have examined the associations of suicide with meteorological variables (MVs) and socioeconomic status but the results are inconsistent. This study assessed whether MVs and unemployment were associated with suicide in eight Australian capital cities.

METHODS

Data on suicide, population and unemployment rate (UER) between 1985 and 2005 were from the Australian Bureau of Statistics. MVs was provided by Australian Bureau of Meteorology. A generalized linear regression model with Poisson link was applied to explore the association of suicide with MVs and UER.

RESULTS

Temperature difference (ΔT, the difference in mean temperature between current month and previous one month) was positively associated with suicide in Sydney, Melbourne, Brisbane and Hobart. There was also a significant and positive association between UER and suicide in Sydney, Melbourne, Brisbane and Perth. MVs had more significant associations with violent suicide than that of non-violent suicide. There were no consistent associations between other MVs and suicide. A significant interaction between ΔT and UER on suicide was found in Sydney, Melbourne and Brisbane, such that increased temperature amplified the magnitude of the association between UER and suicide.

CONCLUSIONS

ΔT and UER appeared to jointly influence the occurrence of suicide in Australian capital cities. This finding may have implications for developing effective suicide prevention strategies.

Environmental correlates of mental health measures for women in Western Australia

A recent study in Western Australia identified area level associations between soil salinisation and hospital admissions for depression. Our study assessed the quantitative relationship between mental health measures at the individual level and location specific environmental measurements on salinity, as well as two other indicators of environmental degradation and change: land surface temperature and normalised difference vegetation index, a proxy for rainfall. Location-specific environmental measurements were linked to individual mental health scores of women in three age cohorts from the Australian Longitudinal Study on Women's Health using a geographic information system. Bayesian geostatistical linear regression models were developed to assess associations between environmental exposures and mental health scores of women. In contrast to previous studies using area level measures, our study found no associations between individual level measurements of mental health scores for women in south-west Western Australia and salinity, LST or NDVI.

Climate change: the next challenge for public mental health?

Climate change is increasingly recognized as one of the greatest threats to human health of the 21st century, with consequences that mental health professionals are also likely to face. While physical health impacts have been increasingly emphasized in literature and practice, recent scholarly literature indicates that climate change and related weather events and environmental changes can profoundly impact psychological well-being and mental health through both direct and indirect pathways, particularly among those with pre-existing vulnerabilities or those living in ecologically sensitive areas. Although knowledge is still limited about the connections between climate change and mental health, evidence is indicating that impacts may be felt at both the individual and community levels, with mental health outcomes ranging from psychological distress, depression and anxiety, to increased addictions and suicide rates. Drawing on examples from diverse geographical areas, this article highlights some climate-sensitive impacts that may be encountered by mental health professionals. We then suggest potential avenues for public mental health in light of current and projected changes, in order to stimulate thought, debate, and action.

Socio-environmental drivers and suicide in Australia: Bayesian spatial analysis

BACKGROUND

The impact of socio-environmental factors on suicide has been examined in many studies. Few of them, however, have explored these associations from a spatial perspective, especially in assessing the association between meteorological factors and suicide. This study examined the association of meteorological and socio-demographic factors with suicide across small areas over different time periods.

METHODS

Suicide, population and socio-demographic data (e.g., population of Aboriginal and Torres Strait Islanders (ATSI), and unemployment rate (UNE) at the Local Government Area (LGA) level were obtained from the Australian Bureau of Statistics for the period of 1986 to 2005. Information on meteorological factors (rainfall, temperature and humidity) was supplied by Australian Bureau of Meteorology. A Bayesian Conditional Autoregressive (CAR) Model was applied to explore the association of socio-demographic and meteorological factors with suicide across LGAs.

RESULTS

In Model I (socio-demographic factors), proportion of ATSI and UNE were positively associated with suicide from 1996 to 2000 (Relative Risk (RR)ATSI = 1.0107, 95% Credible Interval (CI): 1.0062-1.0151; RRUNE = 1.0187, 95% CI: 1.0060-1.0315), and from 2001 to 2005 (RRATSI = 1.0126, 95% CI: 1.0076-1.0176; RRUNE = 1.0198, 95% CI: 1.0041-1.0354). Socio-Economic Index for Area (SEIFA) and IND, however, had negative associations with suicide between 1986 and 1990 (RRSEIFA = 0.9983, 95% CI: 0.9971-0.9995; RRATSI = 0.9914, 95% CI: 0.9848-0.9980). Model II (meteorological factors): a 1°C higher yearly mean temperature across LGAs increased the suicide rate by an average by 2.27% (95% CI: 0.73%, 3.82%) in 1996-2000, and 3.24% (95% CI: 1.26%, 5.21%) in 2001-2005. The associations between socio-demographic factors and suicide in Model III (socio-demographic and meteorological factors) were similar to those in Model I; but, there is no substantive association between climate and suicide in Model III.

CONCLUSIONS

Proportion of Aboriginal and Torres Strait Islanders, unemployment and temperature appeared to be statistically associated with of suicide incidence across LGAs among all selected variables, especially in recent years. The results indicated that socio-demographic factors played more important roles than meteorological factors in the spatial pattern of suicide incidence.

Predicting national suicide numbers with social media data

Suicide is not only an individual phenomenon, but it is also influenced by social and environmental factors. With the high suicide rate and the abundance of social media data in South Korea, we have studied the potential of this new medium for predicting completed suicide at the population level. We tested two social media variables (suicide-related and dysphoria-related weblog entries) along with classical social, economic and meteorological variables as predictors of suicide over 3 years (2008 through 2010). Both social media variables were powerfully associated with suicide frequency. The suicide variable displayed high variability and was reactive to celebrity suicide events, while the dysphoria variable showed longer secular trends, with lower variability. We interpret these as reflections of social affect and social mood, respectively. In the final multivariate model, the two social media variables, especially the dysphoria variable, displaced two classical economic predictors – consumer price index and unemployment rate. The prediction model developed with the 2-year training data set (2008 through 2009) was validated in the data for 2010 and was robust in a sensitivity analysis controlling for celebrity suicide effects. These results indicate that social media data may be of value in national suicide forecasting and prevention.

Spatial clusters of suicide in Australia

BACKGROUND

Understanding the spatial distribution of suicide can inform the planning, implementation and evaluation of suicide prevention activity. This study explored spatial clusters of suicide in Australia, and investigated likely socio-demographic determinants of these clusters.

METHODS

National suicide and population data at a statistical local area (SLA) level were obtained from the Australian Bureau of Statistics for the period of 1999 to 2003. Standardised mortality ratios (SMR) were calculated at the SLA level, and Geographic Information System (GIS) techniques were applied to investigate the geographical distribution of suicides and detect clusters of high risk in Australia.

RESULTS

Male suicide incidence was relatively high in the northeast of Australia, and parts of the east coast, central and southeast inland, compared with the national average. Among the total male population and males aged 15 to 34, Mornington Shire had the whole or a part of primary high risk cluster for suicide, followed by the Bathurst-Melville area, one of the secondary clusters in the north coastal area of the Northern Territory. Other secondary clusters changed with the selection of cluster radius and age group. For males aged 35 to 54 years, only one cluster in the east of the country was identified. There was only one significant female suicide cluster near Melbourne while other SLAs had very few female suicide cases and were not identified as clusters. Male suicide clusters had a higher proportion of Indigenous population and lower median socio-economic index for area (SEIFA) than the national average, but their shapes changed with selection of maximum cluster radii setting.

CONCLUSION

This study found high suicide risk clusters at the SLA level in Australia, which appeared to be associated with lower median socio-economic status and higher proportion of Indigenous population. Future suicide prevention programs should focus on these high risk areas.

Spatial analysis of suicide mortality in Australia: investigation of metropolitan-rural-remote differentials of suicide risk across states/territories

Studies of suicide epidemiology in regions of Australia have been conducted, but the spatial pattern in the whole country has not been fully investigated. This study aimed at visualizing the sex-specific suicide pattern over the country from 2004 to 2008, and studying the metropolitan-rural-remote differentials of suicide across all states/territories. We applied a Poisson hierarchical model to yield smoothed sex specific, age standardized mortality ratios of suicide in all postal areas, and compiled the age-standardized suicide rates across different levels of remoteness and different jurisdictions. We identified the area variation of suicide risk across states/territories, and metropolitan-rural-remote differential with rates higher in rural and remote areas for males. Spatial clusters of some high risk postal areas were also identified. Socio-economic deprivation, compositional factors, high risks for Indigenous people and low access to mental health service are the underlying explanations of the elevation of suicide risk in some 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.

Association between daily environmental temperature and suicide mortality in Korea (2001-2005)

Little attention has been paid to whether temperature is associated with suicide and to whether suicide seasonality appears in Asian countries as shown in Western countries, even though suicide rates in Korea have increased steadily. The goal of the present study was to examine the association between daily temperature and daily suicide rate in Korea, taking gender, age, and education level into account. Data were analyzed using a generalized additive model, adjusting for confounding factors such as sunshine, relative humidity, holidays, and long-term trends. Suicide rates were higher in spring and summer than other seasons. We observed a 1.4% increase (95% confidence interval=1.0-1.7%) in suicide with each 1°C-increase in daily mean temperature. The suicide risks related to the temperature for males, elderly people, and those with less education were higher than for females, younger people, and those with more education, respectively. These findings have confirmed that temperature is associated with suicide in Korea and further our understanding of more susceptible groups, the effects of gender, age, and education level. Therefore, temperature, one of the meteorological factors, is an important risk factor on suicide.

Constraints and barriers to public health adaptation to climate change: a review of the literature

Public health adaptation to climate change is an important issue and inevitably is needed to address the adverse health impacts of climate change over the next few decades. This paper provides an overview of the constraints and barriers to public health adaptation and explores future research directions in this emerging field. An extensive literature review was conducted in 2010 and published literature from 2000 to 2010 was retrieved. This review shows that public health adaptation essentially can operate at two levels, namely, adaptive-capacity building and implementation of adaptation actions. However, there are constraints and barriers to public health adaptation arising from uncertainties of future climate and socioeconomic conditions, as well as financial, technologic, institutional, social capital, and individual cognitive limits. The opportunities for planning and implementing public health adaptation are reliant on effective strategies to overcome these constraints and barriers. It is proposed here that high research priority should be given to multidisciplinary research on the assessment of potential health impacts of climate change, projections of health impacts under different climate and socioeconomic scenarios, identification of health co-benefits of mitigation strategies, and evaluation of cost-effective public health adaptation options.

Spatial distribution of suicide in Queensland, Australia

BACKGROUND

There has been a lack of investigation into the spatial distribution and clustering of suicide in Australia, where the population density is lower than many countries and varies dramatically among urban, rural and remote areas. This study aims to examine the spatial distribution of suicide at a Local Governmental Area (LGA) level and identify the LGAs with a high relative risk of suicide in Queensland, Australia, using geographical information system (GIS) techniques.

METHODS

Data on suicide and demographic variables in each LGA between 1999 and 2003 were acquired from the Australian Bureau of Statistics. An age standardised mortality (ASM) rate for suicide was calculated at the LGA level. GIS techniques were used to examine the geographical difference of suicide across different areas.

RESULTS

Far north and north-eastern Queensland (i.e., Cook and Mornington Shires) had the highest suicide incidence in both genders, while the south-western areas (i.e., Barcoo and Bauhinia Shires) had the lowest incidence in both genders. In different age groups (≤ 24 years, 25 to 44 years, 45 to 64 years, and ≥ 65 years), ASM rates of suicide varied with gender at the LGA level. Mornington and six other LGAs with low socioeconomic status in the upper Southeast had significant spatial clusters of high suicide risk.

CONCLUSIONS

There was a notable difference in ASM rates of suicide at the LGA level in Queensland. Some LGAs had significant spatial clusters of high suicide risk. The determinants of the geographical difference of suicide should be addressed in future research.

The impact of climate change on mental health (but will mental health be discussed at Copenhagen?)

Climate change will shortly be assuming centre stage when Copenhagen hosts the United Nations Climate Change Conference in early December 2009. In Copenhagen, delegates will discuss the international response to climate change (i.e. the ongoing increase in the Earth's average surface temperature) and the meeting is widely viewed as the most important of its kind ever held (http://en.cop15.dk/). International agreement will be sought on a treaty to replace the 1997 Kyoto Protocol. At the time of writing it is not known whether agreement will be reached on the main issues of reducing greenhouse gas emissions and financing the impacts of climate change, and it appears that the impact of climate change on mental health is unlikely to be on the agenda. We discuss here how climate change could have consequences for global mental health and consider the implications for future research and policy.