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Mental Health and Suicide: An Ecological Hierarchical Analysis of U.S. Counties and States

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Part of the book series: Applied Demography Series ((ADS,volume 2))

Abstract

Suicide is a leading cause of death both nationally and internationally (World Health Organization 2008; Nock et al. 2008, 2009). Recent statistics show that in 2000 there were an estimated one million suicides worldwide, a figure that translates into an alarming calculation of 1 suicide death every 40 seconds. Especially bothersome is the observation that the world’s suicide rate has increased steadily over the last 50 years. For instance, the male suicide rate rose from 17 per 100,000 in 1950 to 28 per 100,000 in 2000, and suicide now ranks as the world’s 13th leading cause of death (World Health Organization 2008; Stack and Kposowa 2011). Recent concerns have focused especially on the rise in suicide among youth and the associated rise in years of potential life lost (Stack and Kposowa 2011). The proportion of suicides among the relatively young to early middle age group (ages 5–44) rose from 40% of all suicides in 1950% to 55% of all suicides in 2000. World-wide, suicide now ranks as the third leading cause of death for the young (World Health Organization 2008). Given the increasing young age of suicide victims, years of potential life lost in suicides is much higher than for the top leading causes of death, cancer and heart disease (Stack and Kposowa 2011). For every completed suicide, there are family members and significant others whose lives are severely affected emotionally, economically, and socially by the death.

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References

  • Appleby, L., Shaw, J., Amos, T., McDonnell, R., Harris, C., McCann, K., Kiernan, K., Davies, S., Bickley, H., & Parsons, R. (1999). Suicide within 12 months of contact with mental health services: National clinical survey. BMJ, 318, 1235–1239.

    Article  Google Scholar 

  • Beautrais, A. L., Joyce, P. R., Mulder, R. T., Fergusson, D. M., Deavoll, B. J., et al. (1996). Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: A case control study. The American Journal of Psychiatry, 153, 1009–1014.

    Google Scholar 

  • Berkman, L. F., & Kawachi, I. (2000). Social epidemiology. New York: Oxford University Press.

    Google Scholar 

  • Berkman, L. F., & Syme, L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. American Journal of Epidemiology, 109, 186–204.

    Google Scholar 

  • Ben-Park, B. C., & Lester, D. (2006). Social integration and suicide in South Korea. Crisis, 27, 48–50.

    Article  Google Scholar 

  • Borges, G., Angst, J., Nock, M. K., Ruscio, A. M., & Kessler, R. C. (2008). Risk factors for the incidence and persistence of suicide-related outcomes: A 10-year follow-up study using the National Comorbidity Surveys. Journal of Affective Disorders, 105, 25–33.

    Article  Google Scholar 

  • Bostwick, J. M., & Pankratz, V. S. (2000). Affective disorders and suicide risk: A reexamination. The American Journal of Psychiatry, 157, 1925–1932.

    Article  Google Scholar 

  • Breault, K. (1986). Suicide in America: A test of Durkheim’s theory of religious and family integration, 1933–1980. The American Journal of Sociology, 92, 628–656.

    Article  Google Scholar 

  • Breault, K. (1994). Was Durkheim right? A critical survey of the empirical literature on Le Suicide. In D. Lester (Ed.), Emile Durkheim Le Suicide, 100 years later (pp. 11–29). Philadelphia: The Charles Press.

    Google Scholar 

  • Bureau of Health Professions. (2002). User documentation for the area resource file (ARF) February 2002 release. Washington, DC: Bureau of Health Professions.

    Google Scholar 

  • Burnley, H. (1995). Socioeconomic and spatial differentials in mortality and means of committing suicide in New South Wales, Australia, 1985–91. Social Science & Medicine, 41(5), 687–698.

    Article  Google Scholar 

  • Campo, J. V., & Bridge, J. A. (2009). Treatment of youth depression. The American Journal of Psychiatry, 166(9), 958–960.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2009). State level estimates of serious mental illness among adults. (Available online via query at http://apps.nccd.cdc.gov/HRQOL/)

  • Crawford, M. J., & Prince, M. (1999). Increasing rates of suicide in young men in England during the 1980s: The importance of social context. Social Science & Medicine, 49, 1419–1423.

    Article  Google Scholar 

  • Durkheim, E. (1897/2002). Le Suicide: Étude de Sociologie. Paris: Presses Universitaires de France.

    Google Scholar 

  • Evans, J., Middleton, N., & Gunnell, D. (2004). Social fragmentation, severe mental illness and suicide. Social Psychiatry and Psychiatric Epidemiology, 39, 165–170.

    Article  Google Scholar 

  • Exline, J. J., Yali, A. M., & Sanderson, W. C. (2000). Guilt discord and alienation: The role of religious strain in depression and suicidality. Journal of Clinical Psychology, 56, 1481–1496.

    Article  Google Scholar 

  • Fernquist, R. M. (2007). How do Durkheimian variables impact variation in national suicide rates when proxies for depression and alcoholism are controlled? Archives of Suicide Research, 11, 361–374.

    Article  Google Scholar 

  • Fraser, C. E., Smith, K. B., Judd, F., Humphreys, J. S., Fragar, L. J., & Henderson, A. (2005). Farming and mental health problems and mental illness. The International Journal of Social Psychiatry, 51, 340–349.

    Article  Google Scholar 

  • Gould, M. S., Fisher, P., Parides, M., Flory, M., & Shaffer, D. (1996). Psychosocial risk factors of child and adolescent completed suicide. Archives of General Psychiatry, 53, 1155–1162.

    Article  Google Scholar 

  • Hahm, H. C., & Segal, S. P. (2005). Failure to seek health care among the mentally ill. The American Journal of Orthopsychiatry, 75, 54–62.

    Article  Google Scholar 

  • Harris, C. E., & Barraclough, B. (1997). Suicide as an outcome of mental disorders: A meta analysis. The British Journal of Psychiatry, 170, 205–228.

    Article  Google Scholar 

  • Hawton, K., Harris, L., Hodder, K., Simkin, S., & Gunnell, D. (2001). The influence of the economic and social environment on deliberate self-harm and suicide: An ecological and person-based study. Psychological Medicine, 31, 827–836.

    Article  Google Scholar 

  • Huguelet, P., Mohr, S., Jung, V., Gillieron, C., Brandt, P., & Borras, L. (2007). Effect of religion on suicide attempts with schizophrenia or schizoid-affective disorders compared with inpatients with nonpsychotic disorders. European Psychiatry, 22, 188–194.

    Article  Google Scholar 

  • Isometsä, E., Heikkinen, M. E., Marttunen, M. J., Henriksson, M. M., Aro, H. M., & Lönnqvist, J. K. (1995). The last appointment before suicide: Is suicide intent communicated? The American Journal of Psychiatry, 152, 919–922.

    Google Scholar 

  • Kachur, S. P., Potter, L. B., James, S. P., & Powell, K. E. (1995). Suicide in the United States 1980–1992 (Violence Surveillance Summary Series, Vol. 1). Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

    Google Scholar 

  • Kalmar, S., Hendin, H., Rihmer, Z., & Mann, J. J. (2007). A suicide prevention program in a region with a very high suicide rate. Archives of General Psychiatry, 64, 914–920.

    Article  Google Scholar 

  • Koskinen, O., Pukkila, K., Hakko, T., Tiihonen, J., Vaisanen, E., Sarkioja, T., & Rasanen, P. (2002). Is occupation relevant in suicide? Journal of Affective Disorders, 70, 197–203.

    Article  Google Scholar 

  • Kposowa, A. J., Breault, K. D., & Singh, G. K. (1995). White male suicide in the United States: A multivariate individual-level analysis. Social Forces, 74, 315–323.

    Google Scholar 

  • Kposowa, A. J. (2000). Marital status and suicide in the National Longitudinal Mortality Study. Journal of Epidemiology and Community Health, 54, 254–261.

    Article  Google Scholar 

  • Kposowa, A. J. (2003). Divorce and suicide risk. Journal of Epidemiology and Community Health, 57, 993–995.

    Article  Google Scholar 

  • Kposowa, A. J., & McElvain, J. P. (2006). Gender, place, and method of suicide. Social Psychiatry and Psychiatric Epidemiology, 6, 435–443.

    Article  Google Scholar 

  • Kposowa, A. J., & D’Auria, S. (2010). Association of temporal factors and suicides in the United States, 2000–2004. Social Psychiatry and Psychiatric Epidemiology, 45, 433–445. doi:10.1007/s00127-009-0082-9.

    Article  Google Scholar 

  • Kposowa, A. J. (2009). Psychiatrist availability, social disintegration and suicide deaths in US counties, 1990–1995. Journal of Community Psychology, 37, 73–87.

    Article  Google Scholar 

  • Lagarde, E., Chastang, J. F., Gueguen, A., Coeuret-Pellicer, M., Chiron, M., & Lafont, S. (2004). Emotional stress and traffic accidents: The impact of separation and divorce. Epidemiology, 15(6), 762–766.

    Article  Google Scholar 

  • Leenaars, A. A., & Lester, D. (1999). Domestic integration and suicide in the provinces of Canada. Crisis, 20, 59–63.

    Article  Google Scholar 

  • Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. The American Journal of Psychiatry, 159, 909–916.

    Article  Google Scholar 

  • Manuck, S. B., Bleil, M. E., Petersen, K. L., Flory, J. D., Mann, J. J., Ferrell, R. E., & Muldoon, M. F. (2005). The socio-economic status of communities predicts variation in brain serotonergic responsivity. Psychological Medicine, 35, 519–528.

    Article  Google Scholar 

  • Matthews, K., Milne, S., & Ashcroft, G. W. (1994). Role of doctors in the prevention of suicide: The final consultation. British Journal of General Practice, 44, 345–348.

    Google Scholar 

  • Mechanic, D. M., & Rochefort, D. A. (1990). Deinstitutionalization: An appraisal of reform. Annual Review of Sociology, 16, 301–327.

    Article  Google Scholar 

  • Middleton, N., Whitley, E., Frankel, S., & Dorling, D. (2004). Suicide risk in small areas in England and Wales, 1991–1993. Social Psychiatry and Psychiatric Epidemiology, 39, 45–52.

    Article  Google Scholar 

  • Morselli, J. (1881). Suicide: An essay on comparative moral statistics. London: Paul Kegan.

    Google Scholar 

  • Neal, R. B. (1981). Preparing health educators to teach mental health. Journal of Mental Health, 51, 597–600.

    Google Scholar 

  • Neumayer, E. (2003). Socioeconomic factors and suicide rates at large-unit aggregate levels: A comment. Urban Studies, 40, 2769–2776.

    Article  Google Scholar 

  • Nishimura, M., Terao, T., Soeda, S., Nakamura, J., Iwata, N., & Sakamoto, K. (2004). Suicide and occupation: Further supportive evidence for their relevance. Progress in Neuropsychopharmcology and Biological Psychiatry, 28, 83–87.

    Article  Google Scholar 

  • Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., et al. (2008). Suicide and suicidal behaviors. Epidemiologic Review, 30, 133–154.

    Article  Google Scholar 

  • Nock, M. K., Hwang, I., Sampson, N., Kessler, R. C., Angermeryer, M., et al. (2009). Cross-national analysis of the associations among mental disorders and suicide behavior: Findings from the WHO World Mental Health Surveys. PLoS Medicine, 6(8), e1000123. doi:10.137/journal.pmed.1000123.

    Article  Google Scholar 

  • Pascual, J. C., Malagón, A., Arcega, J. M., Navinés, R., Gurrea, A., Garcia-Ribera, C., & Bulbena, A. (2008). Utilization of psychiatric emergency services by homeless persons in Spain. General Hospital Psychiatry, 30, 14–19.

    Article  Google Scholar 

  • Pratt, D. (1990). Occupational health and the rural worker: Agriculture, mining, and logging. The Journal of Rural Health, 6, 339–417.

    Article  Google Scholar 

  • Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (Secondth ed.). Thousand Oaks: Sage.

    Google Scholar 

  • Rehkopf, D. H., & Buka, S. L. (2006). The association between suicide and socio-economic characteristics of geographic areas: A systematic review. Psychological Medicine, 36, 145–157.

    Article  Google Scholar 

  • Robinson, S. (1950). Ecological correlations and the behavior of individuals. American Sociological Review, 15, 351–357.

    Article  Google Scholar 

  • SAS Institute. (2009a). SAS/STATS (computer software). Cary: SAS Institute.

    Google Scholar 

  • SAS Institute. (2009b). SAS/Stats: the MIXED procedure. [Computer software]. Cary: SAS Institute, Inc.

    Google Scholar 

  • Scocco, P., Girolamo, G. D., Viagut, G., & Alonso, J. (2008). Prevalence of suicide ideation, plans, and attempts and related risk factors in Italy: Results from the European study on the epidemiology of mental disorders – World Mental Health Study. Comprehensive Psychiatry, 49, 13–21.

    Article  Google Scholar 

  • Scoliers, G., Portzky, G., van Heeringen, K., & Audenaert, K. (2009). Sociodemographic and psychopathological risk factors for repetition of attempted suicide: A 5-year follow-up study. Archives of Suicide Research, 13(3), 201–213.

    Article  Google Scholar 

  • Simkin, S., Hawton, K., Yip, P. S. F., & Yam, C. H. K. (2003). Seasonality in suicide: A study of farming suicides in England and Wales. Crisis, 24, 93–97.

    Article  Google Scholar 

  • Singer, J. D. (1998). Using SAS PROC MIXED to fit multilevel models, hierarchical models, and individual growth models. Journal of Educational and Behavioral Statistics, 24, 323–355.

    Google Scholar 

  • Snijders, T., & Bosker, R. L. (1999). Modeled variance in two-level models. Sociological Methods and Research, 22, 342–363.

    Article  Google Scholar 

  • Snow, D. A., & Anderson, L. (1993). Down on their luck: A study of homeless street people. Berkeley: University of California Press.

    Google Scholar 

  • Sorock, G. S., Chen, L. H., Gonzalgo, S. R., & Baker, S. P. (2006). Alcohol drinking history and fatal injury in older adults. Alcohol, 40(3), 193–199.

    Article  Google Scholar 

  • Spijker, J., Graef, R. D., Ten Have, M., Nolen, W. A., & Speckens, A. (2009). Predictors of suicidality in depressive spectrum disorders in the general population: Results of the Netherlands Mental Health Survey and Incidence Study. Social Psychiatry and Psychiatric Epidemiology. doi:DOI10.1007/s00127-009-0093-6.

  • Stack, S. (2000). Suicide: A fifteen year review of the sociological literature: Part II: Modernization and social integration perspectives. Suicide & Life-Threatening Behavior, 30, 163–176.

    Google Scholar 

  • Stack, S., & Kposowa, A. J. (2011). The effect of survivalism-self-expressionism culture on black male suicide acceptability: A cross-national analysis. Social Science & Medicine, 72(7), 1211–1218.

    Article  Google Scholar 

  • Stark, C., Gibbs, D., Hopkins, P., Belbin, A., Hay, A., & Selvaraj, S. (2006). Suicide in farmers in Scotland. Rural and Remote Health, 6, 509. Available at: http://rrh.deakin.edu.au

  • Sutton, L., Hawton, K., Simkin, S., Turnbull, P., Kapur, N., Bennewith, O., & Gunnell, D. (2005). Gunshot suicides in England: A multicentre study based on coroners’ records. Social Psychiatry and Psychiatric Epidemiology, 40, 324–328.

    Article  Google Scholar 

  • Trovato, F. (1986). The relationship between marital dissolution and suicide: The Canadian case. Journal of Marriage and the Family, 48, 341–348.

    Article  Google Scholar 

  • Umberson, D. (1987). Family status and health behaviors: social control as a dimension of social integration. Journal of Health and Social Behavior, 28, 306–319.

    Article  Google Scholar 

  • U.S. Department of Commerce. (1995). Statistical abstract of the United States. Washington, DC: Department of Commerce.

    Google Scholar 

  • U.S. Department of Commerce. (2008). Statistical abstract of the United States. Washington, DC: Department of Commerce.

    Google Scholar 

  • Verbrugge, L. M. (1979). Female illness rates and illness behavior: Testing hypotheses about sex differences in health. Women Health Journal, 4(1), 61–79.

    Article  Google Scholar 

  • Vickers, K., & McNally, R. J. (2004). Panic disorder and suicide attempt in the National Comorbidity Survey. Journal of Abnormal Psychology, 113, 582–591.

    Article  Google Scholar 

  • Whitley, E., Gunnell, D., Dorling, D., & Davey-Smith, G. (1999). Ecological study of social fragmentation, poverty and suicide. BMJ, 319, 1034–1037.

    Article  Google Scholar 

  • Williams, M. E., Latta, J., & Conversano, P. (2007). Eliminating the wait for mental health services. Journal of Behavioral Health Services & Research, 35, 107–114.

    Article  Google Scholar 

  • World Health Organization. (2005). International statistical classification of diseases and health related problems (The) ICD-10 (2nd ed.). Geneva: World Health Organization.

    Google Scholar 

  • World Health Organization. (2008). Suicide prevention (SUPRE). Geneva: WHO.

    Google Scholar 

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Kposowa, A.J., Glyniadaki, A. (2012). Mental Health and Suicide: An Ecological Hierarchical Analysis of U.S. Counties and States. In: Hoque, N., Swanson, D. (eds) Opportunities and Challenges for Applied Demography in the 21st Century. Applied Demography Series, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-2297-2_16

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