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Individual- and area-level influence on suicide risk: a multilevel longitudinal study of Swedish schoolchildren

Published online by Cambridge University Press:  24 April 2013

S. Zammit ,
D. Gunnell ,
G. Lewis ,
G. Leckie ,
C. Dalman  and
P. Allebeck
S. Zammit*
Affiliation:
MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK School of Social and Community Medicine, University of Bristol, UK
D. Gunnell
Affiliation:
School of Social and Community Medicine, University of Bristol, UK
G. Lewis
Affiliation:
School of Social and Community Medicine, University of Bristol, UK
G. Leckie
Affiliation:
Centre for Multilevel Modelling, University of Bristol, UK
C. Dalman
Affiliation:
Department of Public Health Sciences, Karolinska Institute, Sweden
P. Allebeck
Affiliation:
Department of Public Health Sciences, Karolinska Institute, Sweden
*
*Address for correspondence: Dr S. Zammit, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Heath Park, Cardiff CF14 4XN, Wales, UK. (Email: [email protected])
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Abstract

Background

Characteristics related to the areas where people live have been associated with suicide risk, although these might reflect aggregation into these communities of individuals with mental health or social problems. No studies have examined whether area characteristics during childhood are associated with subsequent suicide, or whether risk associated with individual characteristics varies according to childhood neighbourhood context.

Method

We conducted a longitudinal study of 204 323 individuals born in Sweden in 1972 and 1977 with childhood data linked to suicide (n = 314; 0.15%) up to age 26–31 years. Multilevel modelling was used to examine: (i) whether school-, municipality- or county-level characteristics during childhood are associated with later suicide, independently of individual effects, and (ii) whether associations between individual characteristics and suicide vary according to school context (reflecting both peer group and neighbourhood effects).

Results

Associations between suicide and most contextual measures, except for school-level gender composition, were explained by individual characteristics. There was some evidence of cross-level effects of individual- and school-level markers of ethnicity and deprivation on suicide risk, with qualitative interaction patterns. For example, having foreign-born parents increased the risk for individuals raised in areas where they were in a relative minority, but protected against suicide in areas where larger proportions of the population had foreign-born parents.

Conclusions

Characteristics that define individuals as being different from most people in their local environment as they grow up may increase suicide risk. If robustly replicated, these findings have potentially important implications for understanding the aetiology of suicide and informing social policy.

Keywords

Contextualepidemiologymultilevel modelneighbourhoodsuicide
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 2 , January 2014 , pp. 267 - 277
Copyright
Copyright © Cambridge University Press 2013 

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References

Agerbo, E, Sterne, JA, Gunnell, DJ (2007). Combining individual and ecological data to determine compositional and contextual socio-economic risk factors for suicide. Social Science and Medicine 64, 451–461.Google Scholar
Allebeck, P, Allgulander, C, Henningsohn, L, Jakobsson, SW (1991). Causes of death in a cohort of 50,465 young men – validity of recorded suicide as underlying cause of death. Scandinavian Journal of Social Medicine 19, 242–247.Google Scholar
Boydell, J, van Os, J, McKenzie, K, Allardyce, J, Goel, R, McCreadie, RG, Murray, RM (2001). Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. British Medical Journal 323, 1336–1338.Google Scholar
Browne, WJ (2009). MCMC Estimation in MLwiN, v2.13. Centre for Multilevel Modelling, University of Bristol: Bristol, UK.Google Scholar
Chandola, T, Bartley, M, Wiggins, R, Schofield, P (2003). Social inequalities in health by individual and household measures of social position in a cohort of healthy people. Journal of Epidemiology and Community Health 57, 56–62.Google Scholar
Collings, S, Ivory, V, Blakely, T, Atkinson, J (2009). Are neighbourhood social fragmentation and suicide associated in New Zealand? A national multilevel cohort study. Journal of Epidemiology and Community Health 63, 1035–1042.Google Scholar
Congdon, P (1996). Suicide and para-suicide in London: a small area study. Urban Studies 33, 137–158.Google Scholar
Crawford, MJ, Kuforiji, B, Ghosh, P (2010). The impact of social context on socio-demographic risk factors for suicide: a synthesis of data from case-control studies. Journal of Epidemiology and Community Health 64, 530–534.Google Scholar
Cubbin, C, LeClere, FB, Smith, GS (2000). Socioeconomic status and injury mortality: individual and neighbourhood determinants. Journal of Epidemiology and Community Health 54, 517–524.Google Scholar
De Silva, MJ, McKenzie, K, Harpham, T, Huttly, SR (2005). Social capital and mental illness: a systematic review. Journal of Epidemiology and Community Health 59, 619–627.CrossRefGoogle ScholarPubMed
Duncan, C, Jones, K, Moon, G (1995). Psychiatric morbidity: a multilevel approach to regional variations in the UK. Journal of Epidemiology and Community Health 49, 290–295.Google Scholar
Durkheim, E (1951). Suicide: A Study in Sociology. The Free Press: New York.Google Scholar
Evans, J, Heron, J, Lewis, G, Araya, R, Wolke, D (2005). Negative self-schemas and the onset of depression in women: longitudinal study. British Journal of Psychiatry 186, 302–307.Google Scholar
Fone, D, Dunstan, F, Williams, G, Lloyd, K, Palmer, S (2007). Places, people and mental health: a multilevel analysis of economic inactivity. Social Science and Medicine 64, 633–545.Google Scholar
Galea, S, Ahern, J, Vlahov, D, Coffin, PO, Fuller, C, Leon, AC, Tardiff, K (2003). Income distribution and risk of fatal drug overdose in New York City neighborhoods. Drug and Alcohol Dependence 70, 139–148.Google Scholar
Goldstein, H (2010). Multilevel Statistical Models. Wiley: Chichester.Google Scholar
Goodyer, IM (2002). Social adversity and mental functions in adolescents at high risk of psychopathology. Position paper and suggested framework for future research. British Journal of Psychiatry 181, 383–386.Google Scholar
Gunnell, DJ, Peters, TJ, Kammerling, RM, Brooks, J (1995). Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation. British Medical Journal 311, 226–230.Google Scholar
Hart, D, Atkins, R, Matsuba, MK (2008). The association of neighborhood poverty with personality change in childhood. Journal of Personality and Social Psychology 94, 1048–1061.Google Scholar
Kapur, S (2003). Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry 160, 13–23.Google Scholar
Kawachi, I, Kennedy, BP (1997). Health and social cohesion: why care about income inequality? British Medical Journal 314, 1037–1040.Google Scholar
Kirkbride, JB, Boydell, J, Ploubidis, GB, Morgan, C, Dazzan, P, McKenzie, K, Murray, RM, Jones, PB (2008). Testing the association between the incidence of schizophrenia and social capital in an urban area. Psychological Medicine 38, 1083–1094.Google Scholar
Kirkbride, JB, Morgan, C, Fearon, P, Dazzan, P, Murray, RM, Jones, PB (2007). Neighbourhood-level effects on psychoses: re-examining the role of context. Psychological Medicine 37, 1413–1425.Google Scholar
Labonte, B, Turecki, G (2012). Epigenetic effects of childhood adversity in the brain and suicide risk. In The Neurobiological Basis of Suicide (ed. Dwivedi, Y.), chapter 13. CRC Press: Boca Raton, FL (http://www.ncbi.nlm.nih.gov/books/NBK107193/).Google Scholar
Laruelle, M (2000). The role of endogenous sensitization in the pathophysiology of schizophrenia: implications from recent brain imaging studies. Brain Research Reviews 31, 371–384.Google Scholar
Leckie, G, Charlton, C (2011). runmlwin: Stata module for fitting multilevel models in the MLwiN software package. Centre for Multilevel Modelling, University of Bristol: Bristol, UK.Google Scholar
Leventhal, T, Brooks-Gunn, J (2003). Moving to opportunity: an experimental study of neighborhood effects on mental health. American Journal of Public Health 93, 1576–1582.Google Scholar
Lewis, G, David, A, Andreasson, S, Allebeck, P (1992). Schizophrenia and city life. Lancet 340, 137–140.Google Scholar
Li, Z, Page, A, Martin, G, Taylor, R (2011). Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: a systematic review. Social Science and Medicine 72, 608–616.Google Scholar
Linsley, KR, Schapira, K, Kelly, TP (2001). Open verdict v. suicide – importance to research. British Journal of Psychiatry 178, 465–468.Google Scholar
Martikainen, P, Maki, N, Blomgren, J (2004). The effects of area and individual social characteristics on suicide risk: a multilevel study of relative contribution and effect modification. Social Psychiatry and Psychiatric Epidemiology 20, 323–350.Google Scholar
McKenzie, K, Whitley, R, Weich, S (2002). Social capital and mental health. British Journal of Psychiatry 181, 280–283.Google Scholar
Neeleman, J, Wessely, S (1999). Ethnic minority suicide: a small area geographical study in south London. Psychological Medicine 29, 429–436.Google Scholar
O'Reilly, D, Rosato, M, Connolly, S, Cardwell, C (2008). Area factors and suicide: 5-year follow-up of the Northern Ireland population. British Journal of Psychiatry 192, 106–111.Google Scholar
Pedersen, CB, Mortensen, PB (2001). Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Archives of General Psychiatry 58, 1039–1046.Google Scholar
Rasbash, J, Charlton, C, Browne, WJ, Healy, M, Cameron, B (2009). MLwiN Version 2.1. Centre for Multilevel Modelling, University of Bristol: Bristol, UK.Google Scholar
Rehkopf, DH, Buka, SL (2006). The association between suicide and the socio-economic characteristics of geographical areas: a systematic review. Psychological Medicine 36, 145–157.Google Scholar
Selten, JP, Cantor-Graae, E (2005). Social defeat: risk factor for schizophrenia? British Journal of Psychiatry 187, 101–102.Google Scholar
Skapinakis, P, Lewis, G, Araya, R, Jones, K, Williams, G (2005). Mental health inequalities in Wales, UK: multi-level investigation of the effect of area deprivation. British Journal of Psychiatry 186, 417–422.Google Scholar
Thomas, H, Weaver, N, Patterson, J, Jones, P, Bell, T, Playle, R, Dunstan, F, Palmer, S, Lewis, G, Araya, R (2007). Mental health and quality of residential environment. British Journal of Psychiatry 191, 500–505.Google Scholar
Veling, W, Susser, E, van Os, J, Mackenbach, JP, Selten, JP, Hoek, HW (2008). Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants. American Journal of Psychiatry 165, 66–73.Google Scholar
Wainwright, NW, Surtees, PG (2004). Area and individual circumstances and mood disorder prevalence. British Journal of Psychiatry 185, 227–232.Google Scholar
Weich, S, Holt, G, Twigg, L, Jones, K, Lewis, G (2003). Geographic variation in the prevalence of common mental disorders in Britain: a multilevel investigation. American Journal of Epidemiology 157, 730–737.Google Scholar
Whitley, E, Gunnell, D, Dorling, D, Smith, GD (1999). Ecological study of social fragmentation, poverty, and suicide. British Medical Journal 319, 1034–1037.Google Scholar
Winsper, C, Lereya, T, Zanarini, M, Wolke, D (2012). Involvement in bullying and suicide-related behavior at 11 years: a prospective birth cohort study. Journal of the American Academy of Child and Adolescent Psychiatry 51, 271–282.e3.Google Scholar
Xue, Y, Leventhal, T, Brooks-Gunn, J, Earls, FJ (2005). Neighborhood residence and mental health problems of 5- to 11-year-olds. Archives of General Psychiatry 62, 554–563.Google Scholar
Yoshimasu, K, Kiyohara, C, Miyashita, K (2008). Suicidal risk factors and completed suicide: meta-analyses based on psychological autopsy studies. Environmental Health and Preventive Medicine 13, 243–256.Google Scholar
Zammit, S, Lewis, G, Rasbash, J, Dalman, C, Gustafsson, JE, Allebeck, P (2010). Individuals, schools, and neighborhood: a multilevel longitudinal study of variation in incidence of psychotic disorders. Archives of General Psychiatry 67, 914–922.Google Scholar
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