Preliminary spatiotemporal analysis of the association between socio-environmental factors and suicide
© Qi et al; licensee BioMed Central Ltd. 2009
Received: 12 June 2009
Accepted: 1 October 2009
Published: 1 October 2009
The seasonality of suicide has long been recognised. However, little is known about the relative importance of socio-environmental factors in the occurrence of suicide in different geographical areas. This study examined the association of climate, socioeconomic and demographic factors with suicide in Queensland, Australia, using a spatiotemporal approach.
Seasonal data on suicide, demographic variables and socioeconomic indexes for areas in each Local Government Area (LGA) between 1999 and 2003 were acquired from the Australian Bureau of Statistics. Climate data were supplied by the Australian Bureau of Meteorology. A multivariable generalized estimating equation model was used to examine the impact of socio-environmental factors on suicide.
The preliminary data analyses show that far north Queensland had the highest suicide incidence (e.g., Cook and Mornington Shires), while the south-western areas had the lowest incidence (e.g., Barcoo and Bauhinia Shires) in all the seasons. Maximum temperature, unemployment rate, the proportion of Indigenous population and the proportion of population with low individual income were statistically significantly and positively associated with suicide. There were weaker but not significant associations for other variables.
Maximum temperature, the proportion of Indigenous population and unemployment rate appeared to be major determinants of suicide at a LGA level in Queensland.
Suicide is one of the major causes of mortality around the world with about 877,000 suicide deaths each year globally . Socio-environmental impacts on mental health, including suicide, have drawn increasing research attention, especially in recent years as global socio-environmental conditions change rapidly [2, 3].
A number of studies have examined the impact of meteorological factors on suicide and found that lower suicide rates were associated with increased rainfall , decreased temperature , decreased humidity , and increased sunshine . Additionally, some studies indicated that suicide rates varied with season [8, 9]. Socioeconomic status [10, 11], unemployment rate [12–14], country of birth [15, 16], governmental policy [17, 18] and intervention [19, 20] were also associated with suicide in different countries and areas.
Most of the previous suicide studies have focused on either meteorological or socioeconomic factors alone, and none has examined their combined effect. As all these factors can influence suicide in different aspects, the impact of these factors on suicide, thus, should be studied in a systematic way, to help formulating effective suicide prevention strategies. In addition, few of the previous studies have applied geographical information system (GIS) and or spatial analysis approaches to assess the geographical difference of suicide, and the socio-environmental impact on suicide [21, 22].
Spatiotemporal analysis of the impact of socio-environmental factors on suicide is critical because the distribution of suicide deaths and its determinants may vary with time and place, especially in Queensland, a large state with a wide range of climatic conditions and socioeconomic positions. The study consisted of four phases: data collection, data linkage and management, descriptive analyses, bivariable and multivariable analyses.
The meteorological data, including monthly rainfall (RF), maximum temperature (MaxT) and minimum temperature (MinT) were supplied by the Australian Bureau of Meteorology. Suicide, socioeconomic and demographic data were obtained from the Australian Bureau of Statistics (ABS).
The suicide data, covering a five-year period (1999-2003), included information on age, sex, year and month of suicide and Statistical Local Area (SLA) code. There are 125 Local Government Areas (LGAs) in Queensland in 2001 and each LGA has one or more SLAs. Suicide data were transferred into the LGA-based data, using the LGA codes from Australian Standard Geographical Classification (ASGC) . Average suicide counts in total and by gender were calculated for each season at the LGA level (September, October and November for spring; December, January and February for summer; March, April and May for autumn; and June, July and August for winter).
The meteorological database was composed of monthly grid (0.25°*0.25°, longitude and latitude; equivalent to the area of about 25 km*25 km) data. We used Vertical Mapper, a GIS tool, to transfer the meteorological data into the LGA data. Vertical Mapper was incorporated into the MapInfo, which was then used as a platform to perform the data link, data transfer and spatial display. After primary data retrieving and transferring, the structure of monthly meteorological data at the LGA level was established. The means of seasonal meteorological data at LGA level were calculated from monthly data.
Socio-economic Indexes for Area (SEIFA) and demographic data at the LGA level were based on CDATA 2001 of ABS, a database which provides information of 2001 Australian Census of Population and Housing, digital statistical boundaries, base map data and socio-economic data. We directly applied SEIFA and demographic data from the CDATA in the analysis.
SEIFA included four indices: the Index of Relative Socio-economic Advantage and Disadvantage (i.e., IRSAD, the higher IRSAD index, the higher socioeconomic position), the Index of Relative Socio-economic Disadvantage (i.e., IRSD, reflecting disadvantage such as low income and education level, high unemployment and unskilled occupations), the Index of Economic Resources (i.e., IER, reflecting the general level of availability to economic resources of residents and households) and the Index of Education and Occupation (i.e., IEO, reflecting the general educational level and occupational skills of people). All these indices were obtained from CDATA 2001.
Demographic variables included population, Indigenous population, unemployed population, population with low individual income (below AU$ 200 per week) and low education level (Year 9 and below). Using these numbers the following statistics were calculated: the proportion of Indigenous population (PIP), unemployment rate (UER), proportion of population with low individual income (PPLII) and proportion of population with low education level (PPLEL).
A series of GIS and statistical methods were used to analyse these data. MapInfo (including Vertical Mapper incorporated) was used to explore the spatial patterns of socio-environmental variables and suicide.
Univariable analysis was applied to describe characteristics of each variable (suicide and socio-environmental factors). This step is important because it can show the pattern of distribution of each variable, and then select appropriate approaches for bivariable and multivariable analysis. Pearson correlations were applied for bivariable analysis after some non-normally-distributed data (suicide mortality rate, rainfall, IRSD, PIP and UER) were transformed into approximately normally-distributed values by logarithm transformation. The multicollinearity was tested for selecting variables for the multivariable modelling process. The multivariable generalized estimating equation (GEE) regression models with a Poisson link were developed to assess the possible impact of socio-environmental factors on suicide, after adjustment for the effects of potential confounders. The GEE model is well suited to analyse the repeated longitudinal data (e.g., climate data) . This approach has also been used in other studies [28, 29]. Spatial autocorrelation is defined as an auto-correlated association of a certain spatial variable with its spatial location, which means observations have similar values if they are close to each other in geographical aspect . In this study, spatial autocorrelation test was applied to examine the variation of suicide between small areas. Semivariogram analysis was used to explore the spatial structure and spatial autocorrelation of suicide mortalities in Queensland, where semivariogram values were calculated on the basis of residuals. If there is spatial autocorrelation in model residuals, values are typically low and the semivariance increases with separation distance [30, 31]. Statistical Package for the Social Sciences (SPSS) and S+ SpatialStats software were used for data analysis.
Suicide counts by year and month for both male (upper value) and females (lower value, italics)*
In the population of the whole Queensland, 36.4% of males and 34.4% of females were 24-year age and below. 29.5% of males and 30.1% of females aged between 25 and 44. 23.5% of male population and 22.9% of female population were between 45 and 64-year-age. Other people aged at 65-year and above. In the age structure of suicides, 16.4% of males and 15.2% females were adolescents and youth (aged at 24-year or below). 46.9% of males and 48.6% of females aged between 25 and 44-year. 24.6% of male suicides and 25.8% of female suicides were between 45 and 64-year age. 12.1% of males and 10.4% of females were older-aged adults (65 and over).
Characteristics of suicide mortality, socio-demographic and environmental factors*
Total mortality (per 100,000)
Male ASM rate (per 100,000)
Female ASM rate (per 100,000)
Total PIP (%)
Male PIP (%)
Female PIP (%)
Total UER (%)
Male UER (%)
Female UER (%)
Total PPLII (%)
Male PPLII (%)
Female PPLII (%)
Total PPLEL (%)
Male PPLEL (%)
Female PPLEL (%)
In general, male suicides were recorded in the most LGAs, except for the southwest and some part of the central areas. Only 17 LGAs (13.6% of total) had no suicide recorded in the whole study period. Most female suicides occurred in the southeast, coastal and far north areas. There were very few female suicides in the majority of inland areas Queensland. Almost half (61 of 125) of total LGAs had no female suicide between 1999 and 2003.
Pearson correlations between socio-environmental factors and suicide for both male (upper value) and females (lower value, italics)§
In the assessment of multicollinearity between socio-environmental variables, we found that some SEIFA indexes (e.g., IRSAD and IER) were highly correlated (r = 0.90). Thus, IRSD index was used to represent SEIFA in this study because of its strongest association with suicide across four SEIFA indexes. In addition, MinT and MaxT were also highly correlated (r = 0.85), and therefore, we use MaxT and MinT in separate models.
Regression of socio-environmental determinants of suicide for both male (upper value) and females (lower value, italics)*
RR (95% CI)
1.09 (0.95 -- 1.26)
1.12(0.63 -- 1.98)
1.24 (1.04 -- 1.47)
0.93(0.57 -- 1.51)
0.98 (0.94 -- 1.03)
1.05 (0.88 -- 1.26)
1.07 (1.01 -- 1.13)
1.23 (1.03 -- 1.48)
1.08 (0.89 -- 1.32)
1.09 (1.01 -- 1.18)
1.45 (1.23 -- 1.72)
0.84 (0.64 -- 1.10)
0.87 (0.69 -- 1.09)
1.18 (0.96 -- 1.46)
This study examined the relationship between socio-environmental factors and suicide using GIS and spatiotemporal analysis approaches. A range of climate, socioeconomic and demographic determinants were included in this quantitative analysis.
The results of this study indicate some key socio-environmental predictors of suicide at the LGA level. The preliminary spatiotemporal analyses show that far north Queensland had the highest suicide mortality, while the south-western areas had the lowest mortality rate in all the seasons. MaxT, PPLII and PIP were positively associated with total and male suicide. UER had a positive association with total and female suicide. RF had a significant and positive association with total suicide only. However, no significant association was found for SEIFA and PPLEL.
Some of the previous studies found that rainfall was negatively associated with suicide [4, 32], while some other studies showed that this association was very weak [33, 34]. Persistent rainfall deficiency results in drought, which causes reduction of crops in rural areas and adds financial burden to local residents, especially farmers [32, 35]. In rural areas, farmers and other residents usually have less social support than urban residents, and this situation can get worse due to drought . All these add stress, anxiety and mental health problems among the rural population which will eventually lead to suicidal behaviours and even suicide. However, this study only covered 5-year rainfall and suicide data, so it is difficult to determine the long term effect of rainfall on suicide. Another explanation for this discrepancy is that Queensland is in tropical and subtropical areas with much rainfall in general, especially in coastal areas. Even during drought periods, rainfall in Queensland is still much higher than other states in Australia.
In this study, higher MaxT was accompanied with increased suicide mortality at a LGA level. This finding corroborates previous reports [6, 37, 38]. For instance, some studies discovered that higher temperature can lead to decreased availability of tryptophan in human body, one of the 20 standard amino acids, then the volume of 5-Hydroxyindoleacetic acid (5-HIAA) synthesized from tryptophan greatly reduced . As 5-HIAA can reduce depression among humans , therefore, the reduced 5-HIAA indirectly caused by high temperature leads to more depression and other mental health problems among population, even suicidal behaviours. We also examined the association between minimum temperature and suicide in the GEE model, but the association was very weak.
This study demonstrates a general trend that LGAs with higher PIP had higher rates of suicide. As most of the Indigenous population are located in rural areas, these communities often have lower SES and less opportunities of healthcare, including mental health services. The rapid social change in Australia may also affect the Indigenous communities, with more unhealthy behaviours such as excessive alcohol use and family violence . The environmental injustice in this study should not be ignored. Some activities (e.g., construction of water systems, land use, and management of organizations) may cause cultural, environmental and economic risks and hazards among the local communities, especially in the areas with low SES and high proportion of Indigenous population [42, 43]. The above factors contribute to the higher suicide occurrence and deaths in communities with a high proportion of Aboriginal and Torres Strait Islanders in Queensland . Other studies in the United States also indicate that suicide mortality rates were higher in the areas with higher proportion of Indigenous population than in the other areas [45–47]. These studies also discovered that suicide is associated with harsh environmental and social conditions.
Increased unemployment rate directly reduces individual and family income, and thus can cause the financial burden and result in anxiety and stress among family members, especially for a less skilled population. These may increase the risk of mental health problems and suicidal behaviours. This can explain why unemployment had an adverse impact on suicide. Previous studies also discovered that higher unemployment rate can enhance the risk of suicide behaviour and suicide [48–50]. In this study, unemployment had more significant impact on female suicide than male suicide. In recent years, more females participated in labour force than before, thus more females would experience unemployment as a consequence . A study in Portugal also indicated that female suicide increased, as women play more important roles in the socioeconomic status and the stress of unemployment on them was more prominent than before .
Previous studies have indicated that higher socioeconomic status (SES) areas usually have lower suicide mortality [10, 11], as high SES areas usually have higher employment rates, increased income and more accesses to training and education, compared with low SES areas . In this study, we did not find a significant association between SEIFA and suicide, which may be due to a short time series dataset (5 years) and the use of a snapshot measure of SEIFA (i.e., disadvantage index in 2001).
Some studies indicate that the population with low income had higher suicide rate [54, 55]. Generally, rural areas have higher proportion of population with low income, while healthcare (including mental health care) facilities are less developed and less accessible than urban areas. This can lead to increased mental health problems, even suicidal behaviours, among the local population. The results of this study are consistent with previous studies.
Some studies conducted in temperate areas like Brazil  and Italy  observed a peak of suicide in late spring and early summer. In this study, there were suicide peaks in August and October between 1999 and 2003. More suicides occurred in summer than other seasons. The results in this study were not completely consistent with previous studies, partly because all the LGAs of Queensland are in tropical and subtropical zones, and the four seasons are not evident in many places, especially in the north Queensland.
This study has several strengths. Firstly, this is the first study to examine an association between a wide range of socio-environmental factors and suicide at a LGA level in Queensland. Secondly, this study used a comprehensive spatial dataset, GIS and a range of quantitative analytical methods to compare the differences of socio-environmental impact on suicide over time and space. Thirdly, this study examined how socio-environmental factors influence the likelihood of suicide after taking into account a range of confounding factors, including gender, population size and SEIFA at the LGA level. Finally, the results of this study may have implications in public health policy making and implementation of suicide prevention intervention.
The limitations of this study should also be acknowledged. Firstly, the time series data set for analysis is short, compared with other studies [32, 37, 57]. Secondly, climate condition varies in different zones within each LGA, especially those covering large areas. So it is difficult to actually determine the climate condition in the geographical spot of each suicide death. Thirdly, the SEIFA index and demographic data at the LGA level were only based on 2001 Population Census, so it cannot reflect any changes in socioeconomic and demographic features during the whole study period. Thus the results of this study should be interpreted cautiously. Finally, this study only included several socio-environmental variables (i.e., rainfall, temperature, SEIFA, demographic variables), while other factors like personal and family history of mental health and psychiatric problems [58, 59], local health service facilities , nutrition [61, 62], religion [63, 64], alcohol and drug use [65–67] may also influence mental health status and suicidal behaviours. However, the information on these variables was unavailable in this study.
The impact of socio-environmental change on mental health has drawn much attention. On the one hand, the current global financial crisis is likely to deepen, and it will almost certainly have negative effects on the trend of suicide. On the other hand, as climate change continues, the frequency, intensity and duration of weather extremes (e.g., flood, drought and cyclone) are likely to increase in the coming decade, it may also lead to the increase in suicide. Thus it is vital to strengthen surveillance system on weather extremes (e.g., high temperature) and social changes (e.g., unemployment) as well as the impacts of these changes on mental health [68–70]. Governmental officials, epidemiologists, psychiatrists, environmental health workers, economists, meteorologists and community leaders should work together to design, develop and implement effective suicide prevention and control strategies through an integrated and systematic approach.
In this study, we discovered that suicide ASM varied between LGAs by gender. Maximum temperature, the proportion of Indigenous population and unemployment rate appeared to be major determinants of suicide at a LGA level in Queensland. Other factors, such as rainfall, education and income level, had no significant association with suicide at a LGA level, during the period 1999-2003. These findings may have implications in planning and implementing population-based suicide interventions.
List of abbreviations
(Australian Bureau of Statistics)
(age-adjusted standardized mortality)
(geographical information system)
(generalized estimating equation)
(Index of Relative Socio-economic Advantage and Disadvantage)
(Index of Relative Socio-economic Advantage and Disadvantage)
(Index of Education and Occupation)
(Index of Economic Resources)
(Local Governmental area)
(proportion of Indigenous population)
(proportion of population with low individual income)
(proportion of population with low educational level)
(Socioeconomic Indexes for Areas)
(statistical local area)
We owe much to Dr. Andrew Page of the University of Queensland, for providing the suicide data, Dr. Aaron Walker and Mr. Hang Jin from Queensland University of Technology (QUT) for valuable support in linking and arranging the climate data, and Dr. Adrian Barnett from QUT for contributing to data analysis and modeling.
- World Health Organization: The world health report: shaping the future. 2003, Geneva, SwitzerlandGoogle Scholar
- Kefi S, van Baalen M, Rietkerk M, Loreau M: Evolution of local facilitation in arid ecosystems. American Naturalist. 2008, 172: E1-17. 10.1086/588066.View ArticleGoogle Scholar
- McCoy B: Suicide and desert men: the power and protection of kanyirninpa (holding). Australasian Psychiatry. 2007, 15 (Suppl): 63-67. 10.1080/10398560701701221.View ArticleGoogle Scholar
- Preti A, Miottob P: Seasonality in suicides: the influence of suicide method, gender and age on suicide distribution in Italy. Psychiatry Research. 1998, 81: 219-231. 10.1016/S0165-1781(98)00099-7.View ArticleGoogle Scholar
- Lin HC, Chen CS, Xirasagar S, Lee HC: Seasonality and climatic associations with violent and nonviolent suicide: a population-based study. Neuropsychobiology. 2008, 57: 32-37. 10.1159/000129664.View ArticleGoogle Scholar
- Deisenhammer EA, Kemmler G, Parson P: Association of meteorological factors with suicide. Acta Psychiatrica Scandinavica. 2003, 108: 455-459. 10.1046/j.0001-690X.2003.00219.x.View ArticleGoogle Scholar
- Linkowski P, Martin F, De Maertelaer V: Effect of some climatic factors on violent and non-violent suicides in Belgium. Journal of Affective Disorders. 1992, 25: 161-166. 10.1016/0165-0327(92)90001-M.View ArticleGoogle Scholar
- Burns A, Goodall E, Moore T: A study of suicides in Londonderry, Northern Ireland, for the year period spanning 2000-2005. Journal of Forensic & Legal Medicine. 2008, 15: 148-157.View ArticleGoogle Scholar
- Rocchi MB, Sisti D, Miotto P, Preti A: Seasonality of suicide: relationship with the reason for suicide. Neuropsychobiology. 2007, 56: 86-92. 10.1159/000111538.View ArticleGoogle Scholar
- Page A, Morrell S, Taylor R, Carter G, Dudley M: Divergent trends in suicide by socio-economic status in Australia. Social Psychiatry & Psychiatric Epidemiology. 2006, 41: 911-917.View ArticleGoogle Scholar
- Taylor R, Page A, Morrell S, Harrisonb J, Carterc G: Mental health and socioeconomic variations in Australian suicide. Social Science & Medicine. 2005, 61: 1551-1559.View ArticleGoogle Scholar
- Morrell S, Taylor R, Kerr C: Unemployment and young people's health. Medical Journal of Australia. 1998, 168: 236-240.Google Scholar
- Inoue K, Tanii H, Kaiya H, Abe S, Nishimura Y, Masaki M, Okazaki Y, Nata M, Fukunaga T: The correlation between unemployment and suicide rates in Japan between 1978 and 2004. Legal Medicine. 2007, 9: 139-142. 10.1016/j.legalmed.2006.11.004.View ArticleGoogle Scholar
- Iverson L, Andersen O, Andersen PK, Christoffersen K, Keiding N: Unemployment and mortality in Denmark, 1970-80. British Medical Journal. 1987, 295: 879-884. 10.1136/bmj.295.6603.879.View ArticleGoogle Scholar
- Burvill PW: Migrant suicide rates in Australia and in country of birth. Psychological Medicine. 1998, 28: 201-208. 10.1017/S0033291797005850.View ArticleGoogle Scholar
- Westman J, Sundquist J, Johansson LM, Johansson SE, Sundquist K: Country of birth and suicide: a follow-up study of a national cohort in Sweden. Archives of Suicide Research. 2006, 10: 239-248. 10.1080/13811110600582471.View ArticleGoogle Scholar
- Page A, Morrell S, Taylor R: Suicide and political regime in New South Wales and Australia during the 20th century. Journal of Epidemiology & Community Health. 2002, 56: 766-772.View ArticleGoogle Scholar
- Shaw M, Dorling D, Smith GD: Mortality and political climate: how suicide rates have risen during periods of Conservative government, 1901-2000. Journal of Epidemiology & Community Health. 2002, 56: 723-725.View ArticleGoogle Scholar
- Oravecz R, Czigler BA, Moore M: The transformation of suicide fluctuation in Slovenia. Archives of Suicide Research. 2006, 10: 69-76. 10.1080/13811110500318471.View ArticleGoogle Scholar
- Hall WD, Mant A, Mitchell PB, Rendle VA, Hickie IB, McManus P: Association between antidepressant prescribing and suicide in Australia, 1991-2000: trend analysis. British Medical Journal. 2003, 326: 1008-10.1136/bmj.326.7397.1008.View ArticleGoogle Scholar
- Middleton N, Sterne J, Gunnell DJ: An atlas of suicide mortality: England and Wales, 1988-1994. Health & Place. 2008, 14: 492-506.View ArticleGoogle Scholar
- Saunderson TR, Langford IH: A study of the geographical distribution of suicide rates in England and Wales 1989-92 using empirical Bayes estimates. Social Science & Medicine. 1996, 43: 489-502.View ArticleGoogle Scholar
- Australian Bureau of Statistics: Regional Population Growth, Australia and New Zealand, 1991 to 2001. 2002, Cat. No.3218.0. Canberra, AustraliaGoogle Scholar
- Australian Bureau of Meteorology: Australian climatic zones (based on temperature and humidity). [http://www.bom.gov.au/cgi-bin/climate/cgi_bin_scripts/clim_classification.cgi]
- Queensland Government Treasury: 2007-08 Annual Economic Report on the Queensland economy - year ended 30 June 2008. Brisbane, Australia. 2008Google Scholar
- Australian Bureau of Statistics: Australian Standard Geographical Classification (ASGC) 2001. 2001, Cat. No.1216.0. Canberra, AustraliaGoogle Scholar
- Hanley JA, Negassa A, Edwardes MD, Forrester JE: Statistical analysis of correlated data using generalized estimating equations: An orientation. American Journal of Epidemiology. 2003, 157: 364-375. 10.1093/aje/kwf215.View ArticleGoogle Scholar
- Brooker S, Beasley M, Ndinaromtan M, Madjiouroum EM, Baboguel M, Djenguinabe E, Hay SI, Bundy DA: Use of remote sensing and a geographical information system in a national helminth control programme in Chad. Bulletin World Health Organization. 2002, 80: 783-789.Google Scholar
- Chen XK, Yang Q, Smith G, Krewski D, Walker M, Wen SW: Environmental lead level and pregnancy-induced hypertension. Environmental Research. 2006, 100: 424-430. 10.1016/j.envres.2005.07.006.View ArticleGoogle Scholar
- Carl G, Kühn I: Analyzing spatial autocorrelation in species distribution using Gaussian and logit models. Ecological modelling. 2007, 207: 159-170. 10.1016/j.ecolmodel.2007.04.024.View ArticleGoogle Scholar
- Bell N, Schuurman N, Hameed SM: Are injuries spatially related? Join-count spatial autocorrelation for small-area injury analysis. Injury Prevention. 2008, 14: 346-353. 10.1136/ip.2008.018903.View ArticleGoogle Scholar
- Nicholls N, Butler CD, Hanigan I: Inter-annual rainfall variations and suicide in New South Wales, Australia, 1964-2001. International Journal of Biometeorology. 2006, 50: 139-143. 10.1007/s00484-005-0002-y.View ArticleGoogle Scholar
- Deisenhammer EA, Kemmler G, Parson P: Association of meteorological factors with suicide. Acta Psychiatrica Scandinavica. 2003, 108: 455-459. 10.1046/j.0001-690X.2003.00219.x.View ArticleGoogle Scholar
- Preti A: The influence of climate on suicidal behaviour in Italy. Psychiatry Research. 1998, 78: 9-19. 10.1016/S0165-1781(97)00154-6.View ArticleGoogle Scholar
- Sartore G: Drought and its effect on mental health--how GPs can help. Australian Family Physician. 2007, 36: 990-993.Google Scholar
- Fuller J, Kelly B, Sartore G, Fragar L, Tonna A, Pollard G, Hazell T: Use of social network analysis to describe service links for farmers' mental health. Australian Journal of Rural Health. 2007, 15: 99-106. 10.1111/j.1440-1584.2007.00861.x.View ArticleGoogle Scholar
- Ajdacic-Gross V, Lauber C, Sansossio R, Bopp M, Eich D, Gostynski M, Gutzwiller F, Rossler W: Seasonal Associations between Weather Conditions and Suicide-Evidence against a Classic Hypothesis. American Journal of Epidemiology. 2007, 165: 561-569. 10.1093/aje/kwk034.View ArticleGoogle Scholar
- Vandentorren S, Bretin P, Zeghnoun A, Mandereau-Bruno L, Croisier A, Cochet C, Ribéron J, Siberan I, Declercq B, Ledrans M: August 2003 heat wave in France: risk factors for death of elderly people living at home. European Journal of Public Health. 2006, 16: 583-591. 10.1093/eurpub/ckl063.View ArticleGoogle Scholar
- Maes M, De Meyer F, Thompson P, Peeters D, Cosyns P: Synchronised annual rhythm in violent suicide rate, ambient temperature and light-dark span. Acta Psychiatrica Scandinavica. 1994, 90: 191-196.Google Scholar
- Bell C, Abrams J, Nutt D: Tryptophan depletion and its implication for psychiatry. British Journal Psychiatry. 2001, 178: 399-405. 10.1192/bjp.178.5.399.View ArticleGoogle Scholar
- Measey MA, Li SQ, Parker R, Wang Z: Suicide in the Northern Territory, 1981-2002. Medical Journal of Australia. 2006, 185: 315-319.Google Scholar
- Hillman M: Environmental justice: a crucial link between environmentalism and community development?. Community Development Journal. 2002, 37: 349-360. 10.1093/cdj/37.4.349.View ArticleGoogle Scholar
- Hillman M: Situated justice in environmental decision-making: Lessons from river management in Southeastern Australia. Geoforum. 2006, 37: 695-707. 10.1016/j.geoforum.2005.11.009.View ArticleGoogle Scholar
- Hunter E, Milroy H: Aboriginal and Torres Strait islander suicide in context. Archives of Suicide. 2006, 10: 141-147. 10.1080/13811110600556889.View ArticleGoogle Scholar
- Else IR, Andrade NN, Nahulu LB: Suicide and suicidal-related behaviors among indigenous Pacific Islanders in the United States. Death Studies. 2007, 31: 479-501. 10.1080/07481180701244595.View ArticleGoogle Scholar
- Seale JP, Shellenberger S, Spence J: Alcohol problems in Alaska Natives: lessons from the Inuit. American Indian & Alaska Native Mental Health Research. 2006, 13: 1-31.View ArticleGoogle Scholar
- Wexler L, Hill R, Bertone-Johnson E, Fenaughty A: Correlates of Alaska Native fatal and nonfatal suicidal behaviors 1990-2001. Suicide & Life Threat Behavior. 2008, 38: 311-320.View ArticleGoogle Scholar
- Chan WS, Yip PS, Wong PW, Chen EY: Suicide and unemployment: what are the missing links?. Archives of Suicide Research. 2007, 11: 327-335. 10.1080/13811110701541905.View ArticleGoogle Scholar
- Fergusson DM, Boden JM, Horwood LJ: Recurrence of major depression in adolescence and early adulthood, and later mental health, educational and economic outcomes. British Journal of Psychiatry. 2007, 191: 335-342. 10.1192/bjp.bp.107.036079.View ArticleGoogle Scholar
- Yasan A, Danis R, Tamam L, Ozmen S, Ozkan M: Socio-cultural features and sex profile of the individuals with serious suicide attempts in southeastern Turkey: a one-year survey. Suicide & Life Threat Behavior. 2008, 38: 467-480.View ArticleGoogle Scholar
- Stack S: Suicide: a 15 year review of the sociological literature: Part I: Cultural and economic factors. Suicide and Life Threatening Behavior. 2000, 30: 163-176.Google Scholar
- De Castro EF, Pimenta I, Martins I: Female independence in Portugal: effect on suicide rates. Acta Psychiatrica Scandinavica. 1988, 78: 147-155. 10.1111/j.1600-0447.1988.tb06314.x.View ArticleGoogle Scholar
- Australian Bureau of Statistics: Measures of Australia's progress: summary indicators, 2005. Cat No. 1383.0.55.001. Canberra, Australia. 2005Google Scholar
- Huisman M, Oldehinkel AJ: Income inequality, social capital and self-inflicted injury and violence-related mortality. Journal of Epidemiology & Community Health. 2009, 63: 31-37.View ArticleGoogle Scholar
- Kalist DE, Molinari NA, Siahaan F: Income, employment and suicidal behavior. Journal of Mental Health Policy & Economics. 2007, 10: 177-187.Google Scholar
- Benedito-Silva AB, Nogueira Pires ML, Calil HM: Seasonal variation of suicide in Brazil. Chronobiology International. 2007, 24: 727-737. 10.1080/07420520701535795.View ArticleGoogle Scholar
- Preti A, Lentini G, Maugeri M: Global warming possibly linked to an enhanced risk of suicide: Data from Italy, 1974-2003. Journal of Affective Disorders. 2007, 102: 19-25. 10.1016/j.jad.2006.12.003.View ArticleGoogle Scholar
- Kalmar S, Szanto K, Rihmer Z, Mazumdar S, Harrison K, Mann JJ: Antidepressant prescription and suicide rates: effect of age and gender. Suicide & Life Threatening Behavior. 2008, 38: 363-374.View ArticleGoogle Scholar
- Landberg J: Alcohol and suicide in Eastern Europe. Drug & Alcohol Review. 2008, 27: 361-373.View ArticleGoogle Scholar
- Pirkola S, Sund R, Sailas E, Wahlbeck K: Community mental-health services and suicide rate in Finland: a nationwide small-area analysis. Lancet. 2009, 373: 147-153. 10.1016/S0140-6736(08)61848-6.View ArticleGoogle Scholar
- Lakhan SE, Vieira KF: Nutritional therapies for mental disorders. Nutrition Journal. 2008, 7: 2-10.1186/1475-2891-7-2.View ArticleGoogle Scholar
- Li Y, Zhang J, McKeown RE: Cross-sectional assessment of diet quality in individuals with a lifetime history of attempted suicide. Psychiatry Research. 2009, 165: 111-119. 10.1016/j.psychres.2007.09.004.View ArticleGoogle Scholar
- Rasic DT, Belik SL, Elias B, Katz LY, Enns M, Sareen JZ: Spirituality, religion and suicidal behavior in a nationally representative sample. Journal of Affective Disorders. 2009, 114: 32-40. 10.1016/j.jad.2008.08.007.View ArticleGoogle Scholar
- Dervic K, Oquendo MA, Grunebaum MF, Ellis S, Burke AK, John Mann J: Religious affiliation and suicide attempt. American Journal of Psychiatry. 2004, 161: 2303-2308. 10.1176/appi.ajp.161.12.2303.View ArticleGoogle Scholar
- Evren C, Sar V, Evren B, Dalbudak E: Self-mutilation among male patients with alcohol dependency: the role of dissociation. Comprehensive Psychiatry. 2008, 49: 489-495. 10.1016/j.comppsych.2008.02.006.View ArticleGoogle Scholar
- Wang AG, Stórá T: Core features of suicide, gender, age, alcohol and other putative risk factors in a low-incidence population. Nordic Journal of Psychiatry. 2008, 63: 154-159. 10.1080/08039480802429458.View ArticleGoogle Scholar
- Wojnar M, Ilgen MA, Czyz E, Strobbe S, Klimkiewicz A, Jakubczyk A, Glass J, Brower KJ: Impulsive and non-impulsive suicide attempts in patients treated for alcohol dependence. Journal of Affective Disorders. 2008, 115: 131-139. 10.1016/j.jad.2008.09.001.View ArticleGoogle Scholar
- Abaurrea J, Cebrián AC: Drought analysis based on a cluster Poisson model: distribution of the most severe drought. Climate Research. 2002, 22: 227-235. 10.3354/cr022227.View ArticleGoogle Scholar
- Diaz JH: The influence of global warming on natural disasters and their public health outcomes. American Journal of Disaster Medicine. 2007, 2: 33-42.Google Scholar
- Hoffpauir SA, Woodruff LA: Effective mental health response to catastrophic events: lessons learned from Hurricane Katrina. Family & Community Health. 2008, 31: 17-22.View ArticleGoogle Scholar
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