Academic journal article Advances in Mental Health

Suicide Bereavement and Stigma for Young People in Rural Australia: A Mixed Methods Study

Academic journal article Advances in Mental Health

Suicide Bereavement and Stigma for Young People in Rural Australia: A Mixed Methods Study

Article excerpt

Introduction

Suicide is the leading cause of death of young people in Australia. It accounts for about 28% of all deaths of males aged between 15 and 24 years, and up to 32% of all deaths of females aged between 15 and 24 years (Australian Bureau of Statistics, 2014). A disproportionately high number of young people die by suicide in rural areas with young males almost twice as likely to die by suicide than their urban counterparts (National Rural Health Alliance, 2009). The suicide death rate for people aged 15-24 years in remote and very remote areas of Australia is almost three times higher than that of major cities (Australian Institute of Health and Welfare, 2011).

The higher rural suicide rate for young people seems incongruent with the often idyllic picture painted of rural Australia used to lure city dwellers as part of a tree- or sea-change. Rural areas have much to offer young people but they can also present certain challenges that can exacerbate difficulties in relation to individual, family, and social circumstances; all factors associated with increased suicide risk (Australian Institute of Health and Welfare, 2007). Page, Morrell, Taylor, Dudley, & Carter (2007, p. 451) speculated that socio-economic status, migrant composition, gender differences, and changed economic conditions might be responsible for the difference in youth suicide rates between urban and rural areas with 'a diverging trend attributable to a continued increase in suicide in remote areas alongside a decline in suicide in large rural and metropolitan areas'.

There are a number of rationales proposed as to why rural areas have higher rates of youth suicide. One apparent anomaly is the relationship between mental health and suicide. Whilst not all young people who die by suicide have a mental health disorder, suicidal behaviour is indicative of psychological distress (Australian Institute of Health and Welfare, 2007). However, prevalence levels of psychological distress and mental disorders, especially in males, are not significantly different between those living in major cities and those living outside major cities (Australian Institute of Health and Welfare, 2012). That said, for many rural young people in need of help for mental health problems, there is often a lack of services and available information, particularly in remote areas (Suicide Prevention Australia, 2010b). Even if services are available, symptoms of mental distress may not be well-recognised as a problem, and specialist support not sought, such that ignorance about the role and value of mental health services can result in a lack of consultation (Judd, Cooper, Fraser, & Davis, 2006; McColl, 2007).

People living in rural communities can also be subject to the 'rural paradox of proximity and distance' (Boyd, Aisbett, Kelly, & Newnham, 2006, p. 3), and while many in the community share close relationships, intimate information is often not shared. This can result in silence about mental health difficulties and exclude people with a mental illness in more acute ways than in urban areas (Boyd et al., 2006). Young people are also particularly concerned about the confidentiality and anonymity of services (NSW Centre for the Advancement of Adolescent Health, 2005), and may resist attending services if they suspect that personal information about them might be disclosed (Boyd et al., 2006). These factors can all impact on rural young people and result in higher rates of suicide irrespective of similar rates of mental disorders. Many young people who suffer psychological distress fail to seek help, with research suggesting that the intention to seek help can decrease as the level of suicide ideation increases (Wilson, Deane, & Ciarrochi, 2005a).

Stigma associated with mental health problems and suicide is also a major issue that impacts the willingness and ability of people to seek help (Suicide Prevention Australia, 2010a) and is well documented in the literature (for example, Sudak, Maxim, & Carpenter, 2008). …

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