Australia's rural localities face an increasing burden of death due to suicide (Hirsch, 2006). Those groups most vulnerable to suicide appear to be males, youth, farmers and Indigenous people. Data from the Queensland Suicide Register showed that, between 2005 and 2007, male suicide rates in remote areas (36.32 per 100,000) were significantly higher than male suicide rates in non-remote areas (18.25 per 100,000). Further research has also shown that the relative rate of male suicide in rural Queensland was 1.99 compared to rates in metropolitan locations (Kõlves et al, 2009). While the gap is widest between metropolitan and remote suicide rates and the rates highest among rural males, regional suicide rates are still higher and metropolitan rates and the rural female suicide rate is higher than the urban female suicide rate. The present report aimed to present a holistic examination of suicide in regional and remote Australia. It predominantly focused on the Queensland experience and has investigated a wide range of psychological, environmental and cultural factors, within this bound geographical context.

The ways in which suicide prevention initiatives can target different stages of the suicidal process have been described by Mann et al. (2005). These authors argue that suicidal ideation may stem from stressful life events and/or psychiatric disorders. These factors can be influenced through education and awareness programs, screening of individuals at risk, and various treatments. However, it must be noted that while the impacts of environmental factors, such as stressful life events, can sometimes be reduced, the events themselves may be unavoidable. Aspects of suicide prevention can focus on building resilience as a way to combat the impacts of these inevitable events. Once suicidal ideation is present, it can be detected by screening individuals at risk. Before ideation leads to a suicidal act, it can be targeted through treating issues such as underlying disorders and impulsivity, hopelessness and/or pessimism. Other suicide prevention initiatives may also limit access to suicide means and exposure to negative or harmful examples in the media. Australia was the one of the first countries to reflect upon the national and global evidence which recognised the devastating consequences of suicidal behaviours (Jenkins and Kovess, 2002; Department of Health and Ageing, 2008). Since the early 1990s, the Department of Health and Ageing has led the national approach for suicide prevention. The National Youth Suicide Prevention Strategy 1995-1999 was further expanded into the National Suicide Prevention Strategy (NSPS); a strategic plan to prevent suicide across the whole lifespan. In 2000, the Living Is For Everyone: A Framework for Prevention of Suicide and Self-harm in Australia (LIFE Framework) was launched. This was later evaluated and further development led to the release of the Living is For Everyone (LIFE) Framework (2007).

As examined previously, suicide in rural areas is affected by myriad factors, some of which are unique from the experience of suicide in urban areas. Chapter Two presented an analysis of contextual factors on an aggregated level. This is crucial when we assess suicide risk at an individual level, especially considering that suicide risk and protective factors differ depending on wider social, cultural and economic environments. Consequently, Chapter Three will continue with individual-level analyses, comparing risk factors in rural and urban areas of Queensland. It will also illustrate statistical analyses with four rural case studies. The aims of the quantitative analyses were: • To assess suicide predictors in rural and urban regions by comparing rural suicide to rural sudden-death, and urban suicide to urban sudden-death; and, • To compare the differences between rural suicide and urban suicide. This chapter will use information collected within the frames of the Australian Research Council Linkage Project (LP0562078) "Preventing suicide: A psychological autopsy study of the last contact with a health professional before suicide". This study used a case-control psychological autopsy study approach. The Psychological Autopsy (PA) method was applied when investigating completed suicides (study group) and sudden deaths (control group), aged 35+ years in QLD and NSW. The sudden death group included heart attacks, road traffic accidents (RTA) and other accidents, but excluded accidental overdoses, homicides and single vehicle RTAs. The PA obtained information from interviews with next-of-kin (NOK) and healthcare professionals about the deceased for both suicides and sudden deaths.

Australian social identity was traditionally grounded within its agricultural heritage. The 'farmer', be he primarily concerned with crops or livestock, not only provided the lynchpin of Australia's economy but his lifestyle also framed the ideals of masculinity which consequently became entrenched within Australia's culture. However, Australia's social identity has changed along with its economic reliance upon the farming industry and rural sector. The rural lifestyle, so idealised within Australian popular culture, is now increasingly marginalised in a country where the three-quarters of the population live in metropolitan areas (Australian Bureau of Statistics, 2006a), even though the majority of land is considered to be 'rural' (see also Alston, 2010). The once idealised rural lifestyle is also proving to be less ideal for those actually living it.

This chapter examines those groups of males who have been identifi ed to be at an elevated risk for suicide in Australia. These groups include: youth, elderly, Aboriginal and Torres Strait Islander Peoples, rural and remote, immigrants, gay and bisexual, homeless, separated, and suicide survivors (people who have lost their loved ones by suicide). It presents an overview of the available information from Australian and international studies on the epidemiological dimensions, as well as risk and protective factors, of fatal and non-fatal phenomena in these high-risk groups of males.

As noted in previous chapters and the Living Is for Everyone (LIFE) Framework (2007), people living in regional and remote areas of Australia appear to be more vulnerable to suicide than people living in metropolitan areas. The aim of this chapter was to provide an overview of the suicide prevention initiatives that target rural communities. We will first discuss suicide prevention initiatives for rural population in general, and then focus on two sub-populations within the rural environment that are at particularly high risk of suicide: farmers and Indigenous persons.