The International Handbook of Suicide Prevention: Research, Policy and Practice

By Rory C. O’Connor; Jane Pirkis | Go to book overview

33
Rurality and Suicide

Cameron R. Stark, Vincent Riordan,
and Nadine Dougall


Introduction

Any consideration of rural suicide first requires consideration of the nature of rurality. Intuitively, small populations and settlements, remoteness, and low population density are all features associated with rurality. As Hewitt (1989) pointed out, however, these characteristics change linearly, yet they are often categorized as dichotomous variables, that is, low versus high population density. She identified four main dimensions that are routinely considered in U.S. studies: population size, population density, adjacency to a metropolitan area, and urbanization (defined as the proportion of an area that is urban). Other authors have noted that sparsity may be misleading: although the overall population density may be low, people often live in small communities. Irving and Davidson (1973) suggested that social distance, or the degree of contact between individuals, might be a useful alternative way of considering social connectedness as a proxy for distance. Bibby and Shepherd (2004) described an English classification system that clusters areas by sparsity and then separates them by settlement type (small town and fringe, village, and hamlets or dispersed households). This allows areas to be both described geographically and set in a context.

There are enormous differences in the nature of rurality across the world. Distances between settlements in North America, Australia, Africa, and Asia dwarf distances in Europe. Communication infrastructure varies with level of economic development. Affluent European countries with centrally funded health-care systems can use differential investment to partially overcome distance (Grytten, Rongen, & Sorensen, 1995), but such options are not open to less affluent countries. Better health and better availability of health care, however, does not always follow increased societal affluence (Hsiao, 1995; Liu, Hsiaoa, & Eggleston, 1999; Zhang & Kanbur, 2003), and rural areas may be disadvantaged by urban models of investment, which often see efficiency as a key goal. In rural areas, with long distances and sparse populations, unit costs are usually higher, and so services may appear less efficient than urban counterparts.

The International Handbook of Suicide Prevention, Second Edition. Edited by Rory C. O’Connor and Jane Pirkis. © 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.

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