Rural Australia is rich in diversity and warrants nuanced understanding about suicide within and across rural areas. Suicide rates in Australia are consistently higher in rural areas compared to major cities.
Over the past 20 years, suicide rates in major cities and very remote regions are trending down, outer regional is relatively stable, yet inner regional and remote are increasing. The disparity in suicide rates between urban and rural areas continues to grow.
In 2019, the suicide rate in areas outside major Australian cities was more than 60% higher compared to urban centres. Specifically, New South Wales and the Northern Territory experienced suicide rates more than double those within their capitals.
Gender differences
In rural Australia, where the male population often slightly exceeds that of females, the rate of suicide deaths is disproportionately greater for males. For example, 2022 preliminary data from the Australian Institute of Health and Welfare (AIHW) show that the age-standardised suicide rate per 100,000 people for inner and outer regional areas was 25.5 for males compared to 7.1 (inner regional) and 6.2 (outer regional) for females.
This large gender gap is much greater than in major cities (15.8 for males; 5.5 for females). However, when the preliminary data is compared to 2020 official data, both male and females suicide rates are increasing for inner regional areas yet decreasing for outer regional areas.
Age groups most at risk
A study that reviewed data from the National Coronial Information System comprising 3,163 non-Indigenous suicide deaths from 2010-2015 in rural New South Wales, Queensland, South Australia, and Tasmania provides a snapshot of suicide rates by age group. When compared to the national average, almost all rural age groups had higher suicide rates. The exceptions being below 15-years (total and inner regional); 45-54 years (total, inner regional, remote, and very remote); and over 85 years (inner regional).
Whilst the age group of 35-44 years had the highest rate of suicide deaths during the years 2010-2015 (18.6 per 100,000 population), this was only slightly higher than national rate for this age group (17.2 per 100,000 population). Looking closer at age groups and remoteness, we see that the biggest discrepancies between rural and national suicide rates are in the age groups:
- 15-24 years for total rural (13.6 rural rate per 100,000 population / 11.2 national rate per 100,000 population)
- 25-34 years for inner regional (19.3 rate per 100,000 population / 13.9 rate per 100,000 population)
- 85 years and older for outer regional (22.3 rate per 100,000 population / 16.4 rate per 100,000 population)
- 75-84 years for remote and very remote (30.7 rate per 100,000 population / 13.2 rate per 100,000 population).
Taken together, these findings indicate that young adults in rural areas are dying by suicide at a greater rate than their urban counterparts. As remoteness increases, so do does the age at which the gap between rural and urban suicides widens the most.
Farmers vs non-farmer suicides
Farmers are a high risk for suicide in rural areas. Given the data highlights that the rate at which individuals are dying by suicide in Australia is greater outside major cities, there is a need to further inspect the data to see if there are differences between farmers and non-farmers. However, research that has looked at this difference is scarce.
Colleagues at the National Centre for Farmer Health explored differences between farming-related suicides (n = 133) and non-farming suicides (n = 1,165) in Victorian rural communities during 2009-2015. In addition to the larger number of suicide deaths, non-farming suicides were more likely to be unemployed, used substances, received mental health treatment more than six-weeks prior to their death, and died by poisoning; farmers dying more from firearms. No differences were found on sexuality, relationship status, interpersonal problems, or stressors. Thus, it appears that there may be rural-specific factors that affect both farmers and non-farmers.
One such factor is physical ill health. Drawing on the above dataset, almost two-thirds of the individuals that died by suicide (n = 802) in the years 2009-2015 were reported as having physical ill health. The findings suggest that experiencing physical ill health can mean living with chronic pain in an area that is less likely to have appropriate support services compared to major cities, which can create a sense of hopelessness, especially when paired with degenerative or terminal conditions. In turn, this can theoretically reduce an individual’s fearlessness about death whilst also increasing a tolerance for pain. Thus, elevating their suicide capability to enable them to act on suicidal thoughts.
What is needed to improve understanding of rural suicides?
Despite an exponential increase of publications in rural suicidology over the past decade (approximately 1,300 articles published in 80 journals since 2014), understanding suicide in rural areas, particularly beyond farmers, is less than clear. Four recommendations to improve this understanding are based on a systematic review that looked at rural suicides over the past decade:
- Offer a justification and clear definition of how “rural” measured (e.g. population size or density). This allows for an apples-to-apples comparison.
- Increase the focus beyond suicide deaths to include suicidal thoughts and behaviours. This builds a clearer picture of communal distress for efficient provision of public health resources.
- Utilise ideation-to-action framework and theories to understand the progression from suicidal thoughts to attempt. This can potentially help capture previously unidentified contributors of suicide capability whilst also supporting or refuting current theories.
- Use qualitative and mixed-methods methodologies. This provides a more holistic and clearer picture of rural suicidology that can inform evidence-based, rural-specific prevention strategies.
Australian individuals that live outside the major cities are dying by suicide at greater rates. It is males, and young and older adults, that have the largest discrepancies of suicide deaths between rural and cities. However, this only partially paints a picture. Further research within the ideation-to-action framework is needed to advance understanding about how individuals are becoming capable of acting on suicidal thoughts.
Authors
Dr Luke T. Bayliss works at the Australian Institute for Suicide Research and Prevention, School of Applied Psychology at Griffith University; he is also a research assistant for the International Association for Suicide Prevention.
Professor Kairi Kolves works at the Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University; she is Director of the WHO Collaborating Centre for Research and Training in Suicide Prevention.
The Australian Institute for Suicide Research and Prevention (AISRAP) is a national and international suicide prevention research centre. Further, AISRAP is a World Health Organisation collaborating centre for research and training in suicide prevention. AISRAP offers world-leading postgraduate programs in suicide prevention and suicidology to provide individuals with scientifically based and theoretical knowledge to deal with suicide in an academic, policy, or practical context. A range of workshops are also offered to up skill individuals in the field of suicide research and prevention.
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