Psychological Medicine

Original Articles

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

S. Zammita1a2 c1, D. Gunnella2, G. Lewisa2, G. Leckiea3, C. Dalmana4 and P. Allebecka4

a1 MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK

a2 School of Social and Community Medicine, University of Bristol, UK

a3 Centre for Multilevel Modelling, University of Bristol, UK

a4 Department of Public Health Sciences, Karolinska Institute, Sweden

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.

(Received September 04 2012)

(Revised March 08 2013)

(Accepted March 08 2013)

(Online publication April 24 2013)

Key words

  • Contextual;
  • epidemiology;
  • multilevel model;
  • neighbourhood;
  • suicide

Correspondence

c1 Address for correspondence: Dr S. Zammit, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Heath Park, Cardiff CF14 4XN, Wales, UK. (Email: zammits@cardiff.ac.uk)

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