Geographic variation in male suicide rates in the United States
Introduction
Deaths resulting in suicide have been steadily increasing over the past decade in the United States (Hu, Wilcox, Wissow, & Baker, 2008) with male suicide occurring at a rate nearly four times that of women (NCHS, 2010). From 2000 to 2006, suicide ranked as the eleventh leading cause of death in the United States and the eighth leading cause of death among American men (NCHS, 2011a). Examining the suicides of males age 35–64, the Centers for Disease Control identified a 28.4 percent increase in the suicide rate between 1999 and 2010 (CDC, 2013). In 2009 more Americans died from suicide than from motor vehicle accidents, falls, poisoning, or homicide (Rockett et al., 2012). These statistics reaffirm the need to focus resources and investigations on understanding suicide in the United States, in particular, the incidence of male suicide.
The complex etiology of suicide and the difficulty in identifying at-risk populations make the study of suicide a public health challenge (Baca-Garcia et al., 2011, Hawton and van Heeringen, 2009, Knox and Caine, 2005). Within the United States, suicide rates exhibit a non-random geographic distribution with higher rates primarily in western states, which suggests local factors likely influence suicidal behavior. Research highlights the importance of localized effects when examining connections between suicide and unemployment (e.g., mass lay-offs) (Classen & Dunn, 2012), specific ethnic groups (e.g., Hispanic migrants) (Borges et al., 2009, Wadsworth and Kubrin, 2007), or social isolation (e.g., lack of religiosity) (Dervic et al., 2004, Pesosolido and Georgianna, 1989, Rasic et al., 2011). However, the majority of these studies examine relationships with suicide risk factors as global effects that are consistent across an area of study. Those investigations that do use spatial methodologies to analyze suicide rates only account for the spatial nature of the suicide data itself, while continuing to assume that associations between risk factors and of suicide are spatially stationary (Baller and Richardson, 2002, Chang et al., 2011; Rezaeian et al., 2005; Rezaeian et al., 2007a, Rezaeian et al., 2007b). These models may mask differential spatial effects of factors associated with suicide incidence.
Variation in relationships between risk factors and suicide in one region vis-à-vis another needs to be further explored. Identifying localized patterns in those associations is important to community-oriented public health practitioners seeking to develop policy interventions and researchers attempting to understand the antecedents of suicidal behavior. However, privacy restrictions limit the availability of detailed national scale datasets tracking the incidence and antecedents of suicide, which in turn restricts our ability to examine regional variation. Without the detailed national scale personal histories or medical records necessary to establish localized causal connections between risk factors and suicide, an approach exploring regional variation in relationships identified in the literature is a productive way forward. Policy makers and public health practitioners will be interested in the spatial patterning of suicidal risk factors as they work to identify which intervention strategies and resource deployments are most effective in alternative regional contexts.
Section snippets
Research context
The literature examining risk factors associated with suicide is extensive. Previously examined risks include temporal relationships (Chuanc and Huang, 1997, Kposowa and D'Auria, 2010), the natural environmental (e.g., altitude) (Brenner et al., 2011, Selek, 2013), economic factors (e.g., foreclosure) (Classen and Dunn, 2012, Fowler et al., 2014, Suzuki et al., 2014) and the proximity of health care providers (Wagenaar et al., 2012, Windfuhr and Kapur, 2011). More commonly, a range of
Data and methodology
To examine localized variation in relationships between male suicide and measures of social isolation and fragmentation, this study uses ordinary least squares regression (OLS), spatial error regression (SER), and geographically weighted regression (GWR) model. By examining spatial variations in the estimated parameters of the GWR model, this study identifies regional patterns in male suicide risk factors unobservable in alternative global models.
The suicide data used in this study were
Results
There were a total of 221,487 suicide deaths in the United States from 2000 to 2006, resulting in an age adjusted rate of 10.82 deaths per 100,000 individuals during the seven year period. Of these deaths, 176,683 or 79.8 percent of suicides were committed by men, producing a male age-adjusted suicide rate of 18.09 per 100,000. This rate is over four times greater than the female age-adjusted rate of 4.28 per 100,000 for the same period.
When disaggregated into subnational units, the male
Discussion
Examination of the coefficient maps produced by the GWR model show that while global measures such as OLS and SER can provide an overall picture of suicide patterns, explanation of observed patterns in localized factor associations is complex and should be understood in the context of the country's regional geographies (Rogerson & Kim, 2005). The OLS model developed here suggests that each of the variables used in this study have statistically significant positive associations with male suicide
Conclusions
This study uses data on male suicides annualized and age adjusted to avoid mortality rates being affected by age or sex. The analysis identified considerable geographic variation in relationships between measures of social isolation and suicides among the counties of the co-terminous United States. The Western portion of the United States appears to most closely align with existing theories of social isolation and suicide, while the Eastern portion of the country demonstrates a number of
References (96)
- et al.
Estimating risk for suicide attempt: are we asking the right questions? Passive suicidal ideation as a marker for suicidal behavior
Journal of Affective Disorders
(2011) - et al.
Geography of suicide in Taiwan: spatial patterning and socioeconomic correlates
Health and Place
(2011) - et al.
Economic and social correlates of regional suicide rates: a pooled cross-sectional and time-series analysis
The Journal of Socio-Economics
(1997) - et al.
Neighborhood characteristics and depressive symptoms of older people: local spatial analyses
Social Science and Medicine
(2012) - et al.
The who and where of HIV in rural Malawi: exploring the effects of person and place on individual HIV status
Health and Place
(2010) - et al.
Suicide prevention programs through community intervention
Journal of Affective Disorders
(2011) - et al.
Suicide
Lancet
(2009) The geography of self-injury: spatial patterns in attempted and completed suicide
Social Science & Medicine
(2006)- et al.
Mid-life suicide: an increasing problem in US whites, 1999–2005
American Journal of Preventative Medicine
(2008) Explaining regional differences in suicide
Social Science & Medicine
(1995)
Protective associations of importance of religion and frequency of service attendance with depression risk, suicidal behaviours and substance use in adolescents in Nova Scotia, Canada
Journal of Affective Disorders
Marital status and the risk of suicide
American Journal of Public Health
The effects of low-pay and unemployment on psychological well-being: a logistic regression approach
Journal of Health Economics
Exploring spatial data with Geoda: A workbook
Social integration, imitation, and the geographic patterning of suicide
American Sociological Review
The social structure of suicide
Sociological Forum
Geographically weighted regression
Immigration and suicidal behavior among Mexican and Mexican Americans
American Journal of Public Health
Domestic violence, employment, and divorce
International Economic Review
Suicide in America: a test of Durkheim's theory of religious and family integration, 1933–1980
American Journal of Sociology
Explaining divorce in the United States a study of 3,111 counties, 1980
Journal of Marriage and Family
Positive association between altitude and suicide in 2584 U.S. counties
High Altitude Medicine and Biology
Assessment of spatiotemporal varying relationships between rainfall, land cover and surface water area using geographically weighted regression
Environmental Modeling
Suicide among adults aged 35–64 – United States, 1990–2010
Morbidity and Mortality Weekly Report
Geographical heterogeneity of the relationship between childhood obesity and socio-environmental status: empirical evidence from Athens, Greece
Applied Geography
Job loss and employment patterns of older workers
Journal of Labor Economics
Geographically weighted regression – White paper
The effect of job loss and unemployment duration on suicide risk in the United States: a new look using mass-layoffs and unemployment duration
Health Economics
Suicide and parasuicide in London: A small-area study
Urban Studies
A multivariate model for spatio-temporal health outcomes with an application to suicide mortality
Geographical Analysis
Explaining the spatial pattern of suicide and self-harm rates: A case study of east and south east England
Applied Spatial Analysis and Policy
Socioeconomic status and the occurrence of fatal and nonfatal injury in the United States
American Journal of Public Health
Scale, context, and causes of suicide in the United States
Social Science Quarterly
Family and household formations and suicide in the United States
Journal of Marriage and Family
Adult suicide mortality in the United States: marital status, family size, socioeconomic status, and differences by sex
Social Science Quarterly
Religious affiliation and suicide attempt
American Journal of Psychiatry
Suicide: the spatial and social components of despair in Britain 1980–2000
Transactions of the Institute of British Geographers
Suicide
Suicidal ideation and reported suicide attempts in Greece during the economic crisis
World Psychiatry
Geographically Weighted Regression: The Analysis of Spatially Varying Relationships
Increase in suicides associated with home eviction and foreclosure during the US housing crisis: findings from 16 national violent death reporting system states, 2005–2010
American Journal of Public Health
Status integration and suicide: occupational, marital, or both?
Social Forces
Religiosity, attributional style, and social support as psychosocial buffers for African American and white adolescents perceived risk for suicide
Suicide and Life-Threatening Behavior
Suicide and socioeconomic context in the Appalachian region
Deaths: Final data for 1999
Long-term earning losses of high-seniority displaced workers
Economic Perspectives
The ecology of self-injury – a multivariate approach
Suicide and Life-Threatening Behavior
Spatial analysis for environmental health research: concepts, methods, and examples
Journal of Toxicology and Environmental Health
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