​Is suicide mortality associated with neighbourhood social fragmentation and deprivation? A Dutch register-based case-control study using individualised neighbourhoods

Abstract

Background: Neighbourhood social fragmentation and socioeconomic deprivation seem to be associated with suicide mortality. However, results are inconclusive, which might be because dynamics in the social context are not well-represented by administratively bounded neighbourhoods at baseline. We used individualized neighbourhoods to examine associations between suicide mortality, social fragmentation, and deprivation for the total population as well as by sex and age group.Methods: Using a nested case-control design, all suicides aged 18-64 years between 2007 and 2016 were selected from longitudinal Dutch register data and matched with 10 random controls. Indices for social fragmentation and deprivation were calculated annually for 300, 600, and 1,000 metre circular buffers around each subject's residential address.Results: Suicide mortality was significantly higher in neighbourhoods with high deprivation and social fragmentation. Accounting for individual characteristics largely attenuated these associations. Suicide mortality remained significantly higher for women living in highly fragmented neighbourhoods in the fully adjusted model. Age-stratified analyses indicate associations with neighbourhood fragmentation among women in older age groups (40-64 years) only. Among men, suicide risk was lower in fragmented neighbourhoods for 18-39-yearolds and for short-term residents. In deprived neighbourhoods, the suicide risk was lower for 40-64-year-old men and long-term residents. Associations between neighbourhood characteristics and suicide mortality were comparable across buffer sizes.Conclusion: Our findings suggest that next to individual characteristics, the social and economic context within which people live may both enhance and buffer the risk of suicide. KeywordsSuicide mortality; social fragmentation; neighbourhood deprivation; individualized neighbourhoods; longitudinal register. What is already known Most ecological studies reported higher suicide risk in deprived and fragmented neighbourhoods. Most European multilevel studies showed no associations between neighbourhood socioeconomic characteristics and suicide mortality  Research on social fragmentation and deprivation based on administrative units at one point in time (i.e., at baseline) is prone to methodological limitations. What this study adds Using longitudinal register data, this is the first study assessing associations between neighbourhood fragmentation, deprivation, and suicide using annual address-based individualized buffers. Associations between neighbourhood deprivation and fragmentation were attenuated after adjusting for individual characteristics. Fully adjusted models show a higher suicide risk among women and a lower suicide risk among men aged 18-39 in highly fragmented neighbourhoods. Suicide risk was lower among men aged 40-64 in highly deprived neighbourhoods. Associations between suicide risk and neighbourhood fragmentation and deprivation were comparable across buffer sizes but varied by years of residence.None declared....

Geography of suicide in Japan: spatial patterning and rural–urban differences

“…Concerning gender differences, previous studies from Australia, Scotland, and USA reported that male rural residents were at higher risk but females were not [ 10 , 16 , 20 ]. On the other hand, in the Netherland, Portugal, South Korea, and Taiwan both male and female rural residents were shown to be at higher risk [ 4 , 5 , 13 , 21 ]. Furthermore, findings have not been consistent on rural–urban differences in area suicide risk by age in previous studies.…”

“…Furthermore, findings have not been consistent on rural–urban differences in area suicide risk by age in previous studies. Ecological studies in the Netherland, South Korea and Taiwan showed that, regardless of age, suicide risk tended to be higher in rural areas than in urban areas [ 4 , 13 , 21 ]. On the other hand, researches carried out in Austria, Denmark, New Zealand, and the UK found that rural–urban differences in suicide risk varied by age [ 14 , 15 , 18 , 22 ].…”

Objective and subjective neighbourhood characteristics and suicidality: a multilevel analysis

“…Living in neighbourhoods characterised by high levels of deprivation and distrust of neighbours may be linked to suicidal thoughts and attempts through entrapment or defeat, consistent with the arrested flight, 30 cry of pain, 31 Schematic Appraisal Model of Suicide, 3 and the Integrated Motivational-Volitional Model of suicidal behaviour. 32,33 These models suggest that individuals who feel trapped by external circumstances may exhibit suicidal thoughts as they fail to find a way to escape their problems.…”

Suicide rates and voting choice in the UK's 2016 national Brexit referendum on European Union membership: cross-sectional ecological investigation across England's local authority populations

“…9,10 Recent findings from the Netherlands suggest associations may be more complex, with differences observed in potential influences of social fragmentation by gender and according to individual-level characteristics. 11 European Union (EU) membership referendum Previously, area-level rates of abstention from voting in the general election have been used as a measure of social fragmentation. 9 However, recent political events in the UK provide another potential measure of anomie.…”

“…9,10 Recent findings from the Netherlands suggest associations may be more complex, with differences observed in potential influences of social fragmentation by gender and according to individual-level characteristics. 11…”