Rural−urban differences in Austrian suicides

  • Nestor D. KapustaEmail author
  • Arno Zorman
  • Elmar Etzersdorfer
  • Elisabeth Ponocny-Seliger
  • Elisabeth Jandl-Jager
  • Gernot Sonneck



The answer to the question whether suicide rates are higher in urban than in rural areas may have changed over the years. This study analyzes the longitudinal trends of rural and urban suicides in Austria from 1970 to 2005. The most recent decade, 1995–2005 was also investigated cross-sectionally in terms of age groups, gender, suicide methods and family status.


Official suicide statistics were calculated in a Poisson regression model to determine trends in suicide rates according to gender in rural and urban regions as well as the ratios of rural- to urban-suicide rates. Population density levels were used as a measure of urbanization. Differences in suicide rates across the rural–urban categories were investigated in terms of genders, age groups, suicide methods and family status using Spearman correlations.


The ratio of rural to urban suicide rates has continuously increased in both genders over the past 35 years, indicating a growing risk in rural areas. Suicide methods used in rural and urban areas vary significantly and suicide rates among men, but not women, were found to decrease with increasing urbanicity.


In line with recent findings from other western countries, we showed a growing gap between rural and urban suicide rates. This suggests a need for rural-specific suicide prevention efforts, especially aimed at the male rural population.

Key words

suicide urban rural public health prevention 


  1. 1.
    Ben Park BC, Lester D (2006) Social integration and suicide in South Korea. Crisis 27:48–50PubMedGoogle Scholar
  2. 2.
    Burnley IH (1995) Socioeconomic and spatial differentials in mortality and means of committing suicide in New South Wales, Australia, 1985–91. Soc Sci Med 41:687–698PubMedCrossRefGoogle Scholar
  3. 3.
    Caldwell TM, Jorm AF, Dear KB (2004) Suicide and mental health in rural, remote and metropolitan areas in Australia. Med J Aust 181(7 Suppl):S10–14PubMedGoogle Scholar
  4. 4.
    Cutright P, Stack S, Fernquist RM (2006) The age structures and marital status differences of married and not married male suicide rates: 12 developed countries. Arch Suicide Res 10:365–382PubMedCrossRefGoogle Scholar
  5. 5.
    Daigle MS (2005) Suicide prevention through means restriction: assessing the risk of substitution. A critical review and synthesis. Accid Anal Prev 37:625–632PubMedCrossRefGoogle Scholar
  6. 6.
    Dudley M, Kelk N, Florio T, Howard J, Waters B, Haski C, Alcock M (1997) Suicide among young rural Australians 1964–1993: a comparison with metropolitan trends. Soc Psychiatry Psychiatr Epidemiol 32:251–260PubMedCrossRefGoogle Scholar
  7. 7.
    Etzersdorfer E, Kapusta ND, Sonneck G (2006) Suicide by shooting is correlated to rate of gun licenses in Austrian counties. Wien Klin Wochenschr 118:464–468PubMedCrossRefGoogle Scholar
  8. 8.
    Greenland S (2001) Ecologic versus individual-level sources of bias in ecologic estimates of contextual health effects. Int J Epidemiol 30:1343–1350PubMedCrossRefGoogle Scholar
  9. 9.
    Gunnell DJ, Peters TJ, Kammerling RM, Brooks J (1995) Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation. BMJ 311:226–230PubMedGoogle Scholar
  10. 10.
    Hempstead K (2006) The geography of self-injury: spatial patterns in attempted and completed suicide. Soc Sci Med 62:3186–3196PubMedCrossRefGoogle Scholar
  11. 11.
    Hill SA, Pritchard C, Laugharne R, Gunnell D (2005) Changing patterns of suicide in a poor, rural county over the 20th century: a comparison with national trends. Soc Psychiatry Psychiatr Epidemiol 40:601–604PubMedCrossRefGoogle Scholar
  12. 12.
    Hirsch JK (2006) A review of the literature on rural suicide: risk and protective factors, incidence, and prevention. Crisis 27:189–199PubMedGoogle Scholar
  13. 13.
    Hunt K, Sweeting H, Keoghan M, Platt S (2007) Sex, gender role orientation, gender role attitudes and suicidal thoughts in three generations. A general population study. Soc Psychiatry Psychiatr Epidemiol 41:641–647CrossRefGoogle Scholar
  14. 14.
    Judd F, Cooper AM, Fraser C, Davis J (2006) Rural suicide––people or place effects? Aust N Z J Psychiatry 40:208–216PubMedCrossRefGoogle Scholar
  15. 15.
    Kapusta ND, Etzersdorfer E, Krall C, Sonneck G (2007) Firearm Legislation Reform in the European Union: its impact on firearm availability, firearm suicide and homicide rates in Austria. Br J Psychiatry 191:253–257PubMedCrossRefGoogle Scholar
  16. 16.
    Kelleher MJ, Keeley HS, Corcoran P (1997) The service implications of regional differences in suicide rates in the Republic of Ireland. Ir Med J 90:262–264PubMedGoogle Scholar
  17. 17.
    Kölbinger M (2003). Divorces in Upper Austria 2002. Upper Austria State Government, Buerau of Statistics, Linz, p 7Google Scholar
  18. 18.
    Leenaars AA (2006) Suicide by shooting and gun ownership (licenses) in Austria: would gun restriction help? Wien Klin Wochenschr 118:439–441PubMedCrossRefGoogle Scholar
  19. 19.
    Levin KA, Leyland AH (2005) Urban/rural inequalities in suicide in Scotland, 1981–1999. Soc Sci Med 60:2877–2890PubMedCrossRefGoogle Scholar
  20. 20.
    Lin JJ, Lu TH (2006) Association between the accessibility to lethal methods and method-specific suicide rates: an ecological study in Taiwan. J Clin Psychiatry 67:1074–1079PubMedCrossRefGoogle Scholar
  21. 21.
    McLaren S, Hopes LM (2002) Rural–urban differences in reasons for living. Aust N Z J Psychiatry 36:688–692PubMedCrossRefGoogle Scholar
  22. 22.
    Middleton N, Gunnell D, Frankel S, Whitley E, Dorling D (2003) Urban–rural differences in suicide trends in young adults: England and Wales, 1981–1998. Soc Sci Med 57:1183–1194PubMedCrossRefGoogle Scholar
  23. 23.
    Morrell S, Taylor R, Slaytor E, Ford P (1999) Urban and rural suicide differentials in migrants and the Australian-born, New South Wales, Australia 1985–1994. Soc Sci Med 49:81–91PubMedCrossRefGoogle Scholar
  24. 24.
    Page A, Morrell S, Taylor R, Carter G, Dudley M (2006) Divergent trends in suicide by socio-economic status in Australia. Soc Psychiatry Psychiatr Epidemiol 41:911–917PubMedCrossRefGoogle Scholar
  25. 25.
    Phillips MR, Li X, Zhang Y (2002) Suicide rates in China, 1995–99. Lancet 359:835–840PubMedCrossRefGoogle Scholar
  26. 26.
    Qin P (2005) Suicide risk in relation to level of urbanicity––a population-based linkage study. Int J Epidemiol 34:846–852PubMedCrossRefGoogle Scholar
  27. 27.
    Sakr L, Bibus B, Dutz W, Feigl W, Hackl H, Hanak H et al (1989) Zur hohen Autopsierate in Wien. Wien Klin Wochenschr 101:511–514PubMedGoogle Scholar
  28. 28.
    Singh GK, Siahpush M (2002) Increasing rural–urban gradients in US suicide mortality, 1970–1997. Am J Public Health 92:1161–1167PubMedCrossRefGoogle Scholar
  29. 29.
    Sonneck G (2000) Suizide und Suizidprävention in Österreich. Wien Klin Wochenschr 112:943–946PubMedGoogle Scholar
  30. 30.
    Statistics Austria (2007) Statistical yearbook 2007. Population. Statistics Austria, Vienna, p 41Google Scholar
  31. 31.
    Taylor R, Page A, Morrell S, Harrison J, Carter G (2005) Social and psychiatric influences on urban–rural differentials in Australian suicide. Suicide Life Threat Behav 35:277–290PubMedCrossRefGoogle Scholar
  32. 32.
    Waldhoer T, Berzlanovich A, Vutuc C, Haidinger G (2003) Rates of postmortem examination in Austria: the effect of distance between location of death and site of examination. J Clin Epidemiol 56:891–895PubMedCrossRefGoogle Scholar
  33. 33.
    Zacharakis CA, Madianos MG, Papadimitriou GN, Stefanis CN (1998) Suicide in Greece 1980–1995: patterns and social factors. Soc Psychiatry Psychiatr Epidemiol 33:471–476PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Nestor D. Kapusta
    • 1
    • 2
    Email author
  • Arno Zorman
    • 3
    • 4
  • Elmar Etzersdorfer
    • 5
  • Elisabeth Ponocny-Seliger
    • 1
  • Elisabeth Jandl-Jager
    • 1
  • Gernot Sonneck
    • 2
    • 4
  1. 1.Dept. of Psychoanalysis and PsychotherapyMedical University of ViennaViennaAustria
  2. 2.Center of Public HealthInstitute for Medical Psychology, Medical University of ViennaViennaAustria
  3. 3.Rhön-KlinikumNeurologische KlinikBad Neustadt an der SaaleGermany
  4. 4.Ludwig Boltzmann Institute for Social PsychiatryViennaAustria
  5. 5.Furtbachkrankenhaus, Klinik für Psychiatrie und PsychotherapieStuttgartGermany

Personalised recommendations