Both population- and individual-level data were collected. Cases were identified using ICD-10 (International Statistical Classification of Diseases and Related Health Problems-Tenth Revision) cause of death codes for intentional self-harm as classified by the WHO, and calculated by postcode using Australian Statistical Geography Standard (ASGS) Remoteness Area Codes. This dataset was compiled by the Centre for Rural and Remote Mental Health, The University of Newcastle, Australia. These jurisdictions were chosen due to availability of data and time needed to obtain additional agreements and approvals from local research ethics committees to access data from Victoria and Western Australia. Research Questionsįrom November 2016 to June 2019, all closed cases of intentional self-harm deaths in regional and remote Australia across four jurisdictions (New South Wales, Queensland, South Australia, and Tasmania) for the period January 2010–October 2016 were extracted from the National Coronial Information System (NCIS) ( n = 3761). Research Design, Methodology, and Methods 2.1. Focusing attention on under-theorised and under-researched relationships between factors using an intersectionality informed mixed-method approach will address an important gap in evidence about the social determinants of suicide, and identify new intervention points to improve suicide prevention in rural Australia. Given the National Mental Health Commission’s aim of reducing suicide rates by 50% over the next decade and current moves to rebalance investment and identify medium-term change goals in national suicide prevention, a new approach is needed that examines the interrelationships between mental and physical health, social determinants, and suicide in rural areas. Health-supporting public policies that address the social determinants of suicide such as education, housing, vocational training, and employment indicate an aspiration on the part of governments to achieve integrated solutions across sectors. Without an understanding of the interrelatedness of individual and social risk factors for suicide, traditional specialist mental health models and the suicide prevention strategies that support them, including mental health education and gatekeeper training programs, may be culturally unresponsive. Societal and individual factors do not partition neatly across levels and, hence, suicide is irreducible to any one contributing factor-a common problem in biomedical and sociological approaches that presuppose a divide between proximal and distal factors. However, while age-, sex- and gender-based analyses and social determinants perspectives have been applied to research on suicide, these methods are limited by a lack of explicit theory for understanding the interrelatedness of diverse proximal (individual) and distal (social) factors. Suicide prevention experts have long recognised the need to move beyond decontextualised analyses of specific risk factors for suicide to understand how different but interdependent and reinforcing factors contribute to suicide. Related to this is the more general problem of conceptualising and measuring how mental and physical health, social determinants, and suicide in rural areas interact. Findings from Phase One and Two will then be integrated to identify key points in suicide prevention policy and practice where action can be initiated. Phase Two will analyse suicide prevention at three interrelated domains: policy, practice, and research, to examine alignment with evidence generated in Phase One. Phase One will extract, code, and analyse quantitative and qualitative data on suicide in regional and remote Australia from the National Coronial Information System (NCIS). The two-phased study will use a mixed-methods design informed by intersectionality theory. This paper presents a protocol for generating a comprehensive dataset of suicide deaths and factors related to suicide in rural Australia, and for building a program of research to improve suicide prevention policy and practice to better address the social determinants of suicide in non-indigenous populations. Advancement of this knowledge, however, remains hampered by a lack of adequate theory and methods to understand how these factors interact, and the translation of this knowledge into constructive strategies and solutions. The dynamic interrelationship between mental and physical health, social determinants, and suicide in rural Australia is widely acknowledged. Disproportionate rates of suicide in rural Australia in comparison to metropolitan areas pose a significant public health challenge.
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