Elsevier

Applied Geography

Volume 62, August 2015, Pages 201-209
Applied Geography

Geographic variation in male suicide rates in the United States

https://doi.org/10.1016/j.apgeog.2015.04.005Get rights and content

Highlights

  • We explored the non-stationarity of county level male suicides in the United States.

  • Global statistical models obfuscate regional variation.

  • Separated/divorced marital status has a positive association with male suicide.

  • Migration and unemployment have varying types of associations with male suicide.

Abstract

This study examines geographic variability of factors associated with male suicide in the United States using county-level data covering 2000 to 2006. Three variables are used as indicators of social isolation: separated/divorced marital status, migration status, and unemployment. A geographically weighted regression analysis shows variation from analogous global ordinary least squares and spatial error regression analyses. Separated/divorced marital status demonstrated a global positive influence. Migration and unemployment effects ranged from positive to negative across the United States, showing some geographic clustering. The findings suggest regional variation is masked by global models and the effect of social isolation indicators have on suicide may vary with geographic context. Any detection of at-risk population will require careful evaluation of privacy issues given the sensitive nature of the health topic.

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

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