Social Psychiatry and Psychiatric Epidemiology

, Volume 47, Issue 8, pp 1281–1290 | Cite as

You’ve got to have friends: the predictive value of social integration and support in suicidal ideation among rural communities

  • Tonelle E. HandleyEmail author
  • Kerry J. Inder
  • Brian J. Kelly
  • John R. Attia
  • Terry J. Lewin
  • Michael N. Fitzgerald
  • Frances J. Kay-Lambkin
Original Paper



To explore the role of social integration and support in the longitudinal course of suicidal ideation (SI) in a rural population.


Baseline and 12-month data were obtained from participants within the Australian Rural Mental Health Study, a longitudinal study of community residents within rural and remote New South Wales, Australia. SI was assessed using the Patient Health Questionnaire. Individual psychological factors, family and community characteristics were examined alongside personal social networks (Berkman Syme Social Network Index), availability of social support (Interview Schedule for Social Interaction) and perception of local community (Sense of Community Index).


Thirteen hundred and fifty-six participants were included in the analysis (39% male, mean age 56.5 years). Sixty-one participants reported recent SI at baseline, while 57 reported SI at follow-up. Baseline SI was a strong predictor of SI at 12 months [odds ratio (OR) 19.0, 95% confidence interval (CI) 8.6–42.3); significant effects were also observed for baseline values of psychological distress (OR 1.4, 95% CI 1.0–1.9) and availability of social support (OR 0.76, 95% 0.58–1.0) on 12-month SI. The emergence of SI at 12-month follow-up was predicted by higher psychological distress (OR 1.8, 95% CI 1.3–2.4); there was a marginal effect of lower availability of support (OR 0.74, 95% CI 0.55–1.0); neither of these variables predicted SI resolution.


This study investigated factors associated with SI over a 12-month period in a rural cohort. After controlling for known risk factors for SI, low availability of social support at baseline was associated with greater likelihood of SI at 12-month follow-up.


Suicidal ideation Rural mental health Social support Longitudinal Mental health 



We wish to recognise the contribution of the ARMHS chief investigators: Prof David Lyle, A/Prof David Perkins, A/Prof Lyn Fragar, Prof John Beard, Prof Vaughan Carr, Dr Helen Stain, Prof Jeffrey Fuller, and Senior Project Coordinator, Dr. Clare Coleman. The study was funded by the National Health and Medical Research Council (Project Grant #401241), and also supported by a Research Capacity Building Grant to the Australian Rural Health Research Collaboration. We wish to acknowledge the support of Area Directors of Mental Health Services during the course of this phase of the study: Dr Russell Roberts, Richard Buss, Judy Kennedy, Dinesh Arya and particularly acknowledge the research site coordinators in each site: Jan Sidford, John Ogle (Broken Hill), Trim Munro, Amy Strachan (Moree), Louise Holdsworth, Kath O’Driscoll (Lismore), Cheryl Bennett, Jannelle Bowler (Orange), along with Fleur Hourihan, Dr Gina Sartore, Denika Novello and the team of CIDI interviewers. Tonelle Handley is supported by a PhD scholarship from Australian Rotary Health/Rotary Club of Parramatta City, which is acknowledged with gratitude.


  1. 1.
    Kapusta ND, Zorman A, Etzersdorfer E, Ponocny-Seliger E, Jandl-Jager E, Sonneck G (2008) Rural-urban differences in Austrian suicides. Soc Psychiatry Psychiatr Epidemiol 43:311–318. doi: 10.1007/s00127-008-0317-1 PubMedCrossRefGoogle Scholar
  2. 2.
    Middleton N, Gunnel 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 57:1183–1194. doi: 10.1016/S0277-9536(02)00496-3 PubMedCrossRefGoogle Scholar
  3. 3.
    Zhang J, Xiao S, Zhou L (2010) Mental disorders and suicide among young rural Chinese: a case–control psychological autopsy study. Am J Psychiatry 167:773–781. doi: 10.1176/appi.ajp.2010.09101476 PubMedCrossRefGoogle Scholar
  4. 4.
    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 35:277–290. doi: 10.1521/suli.2005.35.3.277 PubMedCrossRefGoogle Scholar
  5. 5.
    Australian Institute of Health and Welfare (2010) A snapshot of men’s health in regional and remote Australia. Cat No. PHE 120 edn. AIHW, CanberraGoogle Scholar
  6. 6.
    Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A et al (2005) Suicide prevention strategies. JAMA 294:2064–2074. doi: 10.1001/jama.294.16.2064 PubMedCrossRefGoogle Scholar
  7. 7.
    Peen J, Schoevers RA, Beekman AT, Dekker J (2010) The current status of urban–rural differences in psychiatric disorders. Acta Psychiatr Scand 121:84–93. doi: 10.1111/j.1600-0447.2009.01438 PubMedCrossRefGoogle Scholar
  8. 8.
    Judd FK, Jackson HJ, Komiti A, Murray G, Hodgins G, Fraser C (2002) High prevalence disorders in urban and rural communities. Aust N Z J Psychiatry 36:104–113PubMedCrossRefGoogle Scholar
  9. 9.
    Fraser C, Jackson H, Judd F, Komiti A, Robins G, Murray G, Humphreys J, Pattison P, Hodgins G (2005) Changing places: the impact of rural restructuring on mental health in Australia. Health Place 11:157–171. doi: 10.1016/j.healthplace.2004.03.003 PubMedCrossRefGoogle Scholar
  10. 10.
    Romans S, Cohen M, Forte T (2010) Rates of depression and anxiety in urban and rural Canada. Soc Psychiatry Psychiatr Epidemiol. doi: 10.1007/s00127-010-0222-2
  11. 11.
    Berry HL, Butterworth P, Caldwell TM, Rodgers B (2006) Profiling Australian community members: different types of people, different needs. Australian National University, CanberraGoogle Scholar
  12. 12.
    Wenger GC (2001) Myths and realities of ageing in rural Britain. Ageing Soc 21:117–130. doi: 10.1017/S0144686X01008042 Google Scholar
  13. 13.
    Gerrard N (2003) Farm stress: resiliency in rural people. Saskatchewan Agriculture and Food, SaskatchewanGoogle Scholar
  14. 14.
    Siahpush M, Singh GK (1999) Social integration and mortality in Australia. Aust N Z J Public Health 23:571–577. doi: 10.1111/j.1467-842X.1999.tb01539.x PubMedCrossRefGoogle Scholar
  15. 15.
    Dorling D, Gunnell D (2003) Suicide: the spatial and social components of despair in Britain 1980–2000. Trans Inst Br Geogr 28:442–460. doi: 10.1111/j.0020-2754.2003.00103.x CrossRefGoogle Scholar
  16. 16.
    De Leo D, Cerin E, Spathonis K, Burgis S (2005) Lifetime risk of suicide ideation and attempts in an Australian community: prevalence, suicidal process, and help-seeking behaviour. J Affect Disord 86:215–224. doi: 10.1016/j.jad.2005.02.001 PubMedCrossRefGoogle Scholar
  17. 17.
    Kessler R, Borges G, Walters EE (1999) Prevalence of risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 56:617–626. doi: 10.1001/archpsyc.56.7.617 PubMedCrossRefGoogle Scholar
  18. 18.
    Beeson PG (2000) Some notes and data on rural suicide. Rural Mental Health 25:13–15Google Scholar
  19. 19.
    Hintikka J, Koivumaa-Honkanen H, Lehto S, Tolmunen T, Honkalampi K, Haatainen K, Viinamäki H (2009) Are factors associated with suicidal ideation true risk factors? Soc Psychiatry Psychiatr Epidemiol 44:29–33. doi: 10.1007/s00127-008-0401-6 PubMedCrossRefGoogle Scholar
  20. 20.
    Taylor A, Dal Grande E, Gill T, Fisher L, Goldney R (2007) Detecting determinants of suicidal ideation: South Australian surveillance system results. Int J Public Health 52:142–152. doi: 10.1007/s00038-007-5064-7 PubMedCrossRefGoogle Scholar
  21. 21.
    Kelly BJ, Lewin T, Stain H, Coleman C, Fitzgerald M, Perkins D, Carr V, Fragar L, Fuller J, Lyle D, Beard J (2010) Determinants of mental health and well-being within rural and remote communities. Soc Psychiatry Psychiatr Epidemiol. doi: 10.1007/s00127-010-0305-0
  22. 22.
    Kelly BJ, Stain HJ, Coleman C, Perkins D, Fragar L, Fuller J, Lewin TJ, Lyle D, Carr VJ, Wilson JM, Beard JR (2010) Mental health and well-being within rural communities: The Australian Rural Mental Health Study. Aust J Rural Health 18:16–24. doi: 10.1111/j.1440-1584.2009.01118.x PubMedCrossRefGoogle Scholar
  23. 23.
    Kroenke K, Spitzer RL, Williams JBW (2001) The PHQ-9. J Gen Intern Med 16:606–613. doi: 10.1046/j.1525-1497.2001.016009606.x PubMedCrossRefGoogle Scholar
  24. 24.
    Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normad S-LT, Walters EE, Zaslavsky AM (2002) Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 32:959–976. doi: 10.1017/S0033291702006074 PubMedCrossRefGoogle Scholar
  25. 25.
    Saunders JB, Aasland OG, Babor TF, De La Fuente JR, Grant M (1993) Development of the alcohol use disorders identification test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction 88:791–804. doi: 10.1111/j.1360-0443.1993.tb02093.x PubMedCrossRefGoogle Scholar
  26. 26.
    Henderson S, Duncan-Jones P, Byrne DG, Scott R (1980) Measuring social relationships: the Interview Schedule for Social Interaction. Psychol Med 10:723–734. doi: 10.1017/S003329170005501X PubMedCrossRefGoogle Scholar
  27. 27.
    Berkman LF, Syme SL (1979) Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol 109:186–204PubMedGoogle Scholar
  28. 28.
    Chipuer HM, Pretty GMH (1999) A review of the sense of community index: current uses, factor structure, reliability, and further development. J Community Psychol 27:643–658. doi: 10.1002/(sici)1520-6629(199911)27:6<643:aid-jcop2>;2-b CrossRefGoogle Scholar
  29. 29.
    Eysenck SBG, Eysenck HJ, Barrett P (1985) A revised version of the psychoticism scale. Pers Individ Differ 6:21–29. doi: 10.1016/0191-8869(85)90026-1 CrossRefGoogle Scholar
  30. 30.
    Hintikka J, Pesonen T, Saarinen P, Tanskanen A, Lehtonen J, Viinamaki H (2001) Suicidal ideation in the Finnish general population. A 12-month follow-up study. Soc Psychiatry Psychiatr Epidemiol 36:590–594. doi: 10.1007/s127-001-8198-x PubMedCrossRefGoogle Scholar
  31. 31.
    Johnston AK, Pirkis JE, Burgess PM (2009) Suicidal thoughts and behaviours among Australian adults: findings from the 2007 National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 43(7):635–643. doi: 10.1080/00048670902970874 PubMedCrossRefGoogle Scholar
  32. 32.
    Sher L (2006) Alcoholism and suicidal behavior: a clinical overview. Acta Psychiatr Scand 113:13–22. doi: 10.1111/j.1600-0447.2005.00643.x PubMedCrossRefGoogle Scholar
  33. 33.
    Beautrais AL, Joyce PR, Mulder RT (1999) Personality traits and cognitive styles as risk factors for serious suicide attempts among young people. Suicide Life Threat Behav 29:37–47. doi: 10.1111/j.1943-278X.1999.tb00761.x PubMedGoogle Scholar
  34. 34.
    Forsell Y (2000) Death wishes in the very elderly: data from a 3-year follow-up study. Acta Psychiatr Scand 83:135–138. doi: 10.1034/j.1600-0447.2000.102002135.x CrossRefGoogle Scholar
  35. 35.
    Carlton PA, Deane FP (2000) Impact of attitudes and suicidal ideation on adolescents’ intentions to seek professional psychological help. J Adolesc 23:35–45. doi: 10.1006/jado.1999.0299 PubMedCrossRefGoogle Scholar
  36. 36.
    Hirsch JK (2006) A review of the literature on rural suicide. Crisis 27:189–199. doi: 10.1027/0227-5910.27.4.189 PubMedCrossRefGoogle Scholar
  37. 37.
    Judd F, Jackson H, Komiti A, Murray G, Fraser C, Grieve A, Gomez R (2006) Help-seeking by rural residents for mental health problems: the importance of agrarian values. Aust N Z J Psychiatry 40:769–776. doi: 10.1111/j.1440-1614.2006.01882.x PubMedCrossRefGoogle Scholar
  38. 38.
    Letvak S (2002) The importance of social support for rural mental health. Issues Ment Health Nurs 23:249–261. doi: 10.1080/016128402753542992 PubMedCrossRefGoogle Scholar
  39. 39.
    Milner A, McClure R, De Leo D (2010) Socio-economic determinants of suicide: an ecological analysis of 35 countries. Soc Psychiatry Psychiatr Epidemiol 1–9. doi: 10.1007/s00127-010-0316-x
  40. 40.
    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 32:251–260. doi: 10.1007/bf00789037 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Tonelle E. Handley
    • 1
    Email author
  • Kerry J. Inder
    • 1
    • 2
  • Brian J. Kelly
    • 1
    • 2
    • 3
  • John R. Attia
    • 2
    • 4
    • 5
  • Terry J. Lewin
    • 1
    • 2
    • 7
  • Michael N. Fitzgerald
    • 2
  • Frances J. Kay-Lambkin
    • 1
    • 6
  1. 1.Centre for Brain and Mental Health ResearchUniversity of NewcastleNewcastleAustralia
  2. 2.Hunter Medical Research InstituteNewcastleAustralia
  3. 3.Centre for Rural and Remote Mental HealthUniversity of NewcastleOrangeAustralia
  4. 4.Centre for Clinical Epidemiology and BiostatisticsUniversity of NewcastleNewcastleAustralia
  5. 5.Department of MedicineJohn Hunter HospitalNewcastleAustralia
  6. 6.National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
  7. 7.Schizophrenia Research InstituteSydneyAustralia

Personalised recommendations