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

Abstract

Purpose

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

Methods

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).

Results

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.

Conclusions

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.

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Acknowledgments

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.

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Correspondence to Tonelle E. Handley.

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Handley, T.E., Inder, K.J., Kelly, B.J. et al. You’ve got to have friends: the predictive value of social integration and support in suicidal ideation among rural communities. Soc Psychiatry Psychiatr Epidemiol 47, 1281–1290 (2012). https://doi.org/10.1007/s00127-011-0436-y

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Keywords

  • Suicidal ideation
  • Rural mental health
  • Social support
  • Longitudinal
  • Mental health