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Risk factors for suicide in rural Italy: a case–control study

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Increased frequency of suicide in rural areas of Tuscany has been described since the 1970s. A case–control study was conducted in 2014 and 2015. The objective of this study was to identify major individual risk factors related to suicides in six rural districts of Tuscany.


Cases were identified as all 128 suicides occurred in six rural districts between 2009 and 2013. Controls (three for each case) were matched for age, sex, and general practice. Information was collected from GPs using a structured questionnaire. Univariate and multivariate analyses were carried out to investigate the association between individual risk factors and suicide.


Informants for 91 cases of the 128 identified cases were successfully interviewed (response rate 71.1%). About 40.5–65.9% suicide cases and 11.4–20.0% of controls had some psychiatric pathology, accordingly to different definitions. Univariate conditional regression analysis showed that living in isolated houses (OR 2.48), living alone (OR 2.97), not being married (OR 2.63), low income (OR 2.73), psychiatric pathology (OR 9.70), psychotropic medication (OR 5.58), problems with relatives (OR 14.78), psychiatric family history (OR 5.67), and suicidal ideation (OR 15.61) were all risk factors. Practising religion (OR 0.27) was the only protective factor identified. Multivariate regression identified two independently and significantly associated variables namely, psychiatric pathology (OR 8.87) and living alone (OR 2.30).


Results of this study showed, similarly to recent research, that not all suicide events are the results of psychiatric pathology. Prevention strategies should, therefore, target both socio-economic and clinical risk factors.

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The authors wish to thank all local coordinators: Dr L. Chiocchi (Amiata-Val d’Orcia); Dr A. Pennacchioni (Casentino); Dr F. Falorni (Colline Metallifere); Dr. A Guidi (Lunigiana), Dr C. Lucii (Valdichiana). The authors wish to thank all interviewers and general practitioners in the six districts.


UNCEM (Unione dei Comuni e delle Comunita’ Montane) della Toscana, Firenze (Italy).

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Authors and Affiliations



GB, MM and GC took a leading role in the conception and design of the study. GB, GC and DL organised the study, including obtaining ethics approval, and coordinated the data collection. MM completed the data entry, performed statistical analysis and interpretation of results, and wrote the initial draft of the manuscript. GC and DL contributed to the critical review of the manuscript. Authors read and approved the final manuscript.

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Correspondence to Michele Arcangelo Martiello.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Additional information

Giuseppe Boncompagni is deceased.

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Martiello, M.A., Boncompagni, G., Lacangellera, D. et al. Risk factors for suicide in rural Italy: a case–control study. Soc Psychiatry Psychiatr Epidemiol 54, 607–616 (2019).

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