Suicide in Rural and Remote Areas of Australia
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.
Suicidal behaviours in rural and remote areas in Australia: A review
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.
Suicide and accidental death in Australia's rural farming communities: a review of the literature
Introduction: Australia's farmers constitute a heterogeneous group within the rural population. This literature review incorporates four broad areas: an understanding of farming communities, families and individuals and the contexts in which they live and work; an exploration of the challenges to morbidity and mortality that these communities face; a description of the patterns of suicide and accidental death in farming communities; and an outline of what is missing from the current body of research. Recommendations will be made on how these gaps may be addressed. Methods: In developing this comprehensive literature review, a snowballing and saturation approach was adopted. Initial search terms included suicid*, farm*, accident*, fatal*, death, sudden death, rural OR remote, Australia and NOT Australia. Databases searched included SCOPUS, PubMed, Proquest and SafetyLit; research from 1995 onwards was examined for relevance. Earlier seminal texts were also included. Reference lists of retrieved articles were searched and citations explored for further relevant research material. The primary focus was on Australian peer-reviewed research with supplementary grey literature. International material was used as examples. Results: The literature variously describes farmers as members of both rural farming communities and farming families, and as individuals within an occupational classification. Within each of these classifications, there is evidence of the cumulative impact of a multiplicity of social, geographical and psychological factors relating to work, living and social arrangements that impact the health and wellbeing of Australia's farmers and their families, particularly accidental death and suicide. Research consistently demonstrates traumatic death to be at a greater rate than in the general Australian population, with reductions found more recently in some modes of farming-related accidental death. Patterns of accidental death and suicide are commonly linked to the changing shape of contemporary farming. Suicide rates are also frequently described in relation to lethality and accessibility of means. The limitations of suicide and accidental death data are considerable. Conclusion: While there is consistent reporting of heightened levels of risk for suicide and accidental death in farming communities the limitations of the research remain significant. There are substantial gaps in current knowledge, and the body of research to date lacks clarity, inclusiveness and contextual specificity. Absent from the literature is any investigation of the impact of these frequently preventable deaths on the families and communities in which they occur. Recommendations for future research are suggested.
'Alive and Kicking Goals!': Preliminary findings from a Kimberley suicide prevention program
Suicide is an enormous problem in the Kimberley, a region in northern-Western Australia. An 18-year-old Indigenous male is seven-times more likely to die by suicide, compared to his non-Indigenous peers. 'Alive and Kicking Goals!' (AKG) was a pilot program that took an innovative approach to suicide prevention peer education. Players from the Broome Saints Football Club formed a youth sub-committee. Guided by a Project Mentor (PM), these young men undertook training in suicide prevention in order to become Peer Educators (PEs) for the Kimberley region. AKG created a safe space for healing which allowed these young men to come to terms with the 'cycle of grief' experienced in the region. AKG also tackled suicide stigma as the PEs, who were well-respected sportsmen, demonstrated that seeking help does not display weakness. At the conclusion of the pilot, 16 young men became PEs. They learned practical skills in suicide awareness and prevention which they can teach within and across the different communities within the Kimberley region. Preliminary results from this pilot have informed ways in which AKG can be developed for the future. Further research can indicate to long-term positive impacts.
'I'm going to kill myself if you don't ...': contextual aspects of suicide in Australian Aboriginal communities
Aboriginal suicidal behaviours in remote Australia present as very different phenomena to suicidal behaviours in mainstream Australian society. Multiple suicide threats and behaviours often appear to express ways of executing violence or retaliation, rather than the immediate wish to die. This may be a response to the lack of choices in the face of an historical context of intergenerational trauma, grief and loss. Aboriginal youth are grasping the possibility of death, and the threat of dying, as a violent means to gain control over their lives. This enactment of agency can give instant 'power' to those violent and vulnerable enough to use it. Using examples of such a suicidal crisis common within these communities, this paper argues that those who work within Australian Aboriginal communities need to better understand the continuing impacts of colonialism and inter-generational trauma and 'decolonisation'. Further, the approach taken in providing services to communities may need to be adapted from the more orthodox approach of linear referral pathways. Understanding the importance of cultural context and place allows for a more dynamic and beneficial therapeutic relationship to be formed. It may also help to more effectively facilitate support for healthcare workers.
Suicide prevention initiatives in rural and remote areas of Australia
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.
Individual-level factors related to suicide in rural and remote areas of Queensland
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.
Hungry, Angry Ghosts: A Construction of Female Suicide in Traditional China
Suicide has long been constructed as a monstrous death within many societies. Its very existence challenges the social norms the majority of people presume to be acceptable; it leaves behind people questioning the reasons behind the choice. In this way, those who choose suicide have also been branded monsters - the most common of which is the belief that ghosts can arise from these deaths. Traditional Chinese stories of female suicide-related ghosts seemed to follow a distinct narrative trope involving rational, heroic men and irrational, villainous women. The ways in which stories of hungry ghosts were told speaks to the ways in which female suicide was understood and rationalised within traditional Chinese society. It also provides a demonstration of suicide prevention based within supernatural encounters. While the seriousness in which these stories were held is uncertain, they remain a colourful and potent source of suicide story-telling. By seeking to understand this mythology, we also begin to better understand the stigma and stereotypes that continue to attach to female suicide in modern rural China.