title: Youth suicide in New South Wales: urban-rural trends.
abstract: OBJECTIVE
  The study tested the hypotheses that (i) the rate of suicide by firearms among youth (aged 10-19 years) is increasing at a greater rate than rates of suicide by other methods; (ii) the rate of youth suicide in rural New South Wales is significantly higher than those in urban areas; and (iii) the increase in youth suicide by means of firearms is occurring at a greater rate in rural males aged 15-19 years than in other groups.
  
  
  METHODS
  Data were obtained from the NSW Office of the Australian Bureau of Statistics concerning 735 youth suicides in NSW between 1964 and 1988. These were reviewed for information concerning residential area and method of death. Five five-year periods were used, and rates were calculated with population figures obtained in the census years for the same age and sex group.
  
  
  RESULTS
  From 1964 to 1988, suicide by firearms has risen most substantially, from 3.4 to 5.6 per 100,000 per year in 15-19-year-old males. There has also been a substantial increase in 15-19-year-old male suicides by hanging (0.7 to 3.4 per 100,000 per year). Poisoning suicides have declined among females and males in the past 15 years. Suicide rates in Sydney, Newcastle and Wollongong have remained stable. In rural cities, they have increased from 1.5 to 4.7 per 100,000 per year (F = 4.9, P less than 0.02) while in rural municipalities and shires they have increased from 1.3 to 6.4 (F = 14.6, P less than 0.0001). The suicide rate of 15-19-year-old males has shown a modest increase in Sydney and no change in Newcastle or Wollongong, but the rate for 15-19-year-old males in rural cities has more than doubled, from 5.1 to 12.5 (F = 7.7, P less than 0.003), while in rural municipalities and shires, the rate has increased more than fivefold, from 3.9 to 20.7 (F = 9.3, P less than 0.001). There has been no significant change in the suicide rates of 15-19-year-old females, or in 10-14-year-olds. The rate of suicide by firearms among 15-19-year-old males has not risen significantly in rural cities, but in rural municipalities and shires the rates have risen fivefold from 2.8 to 14.8 (F = 5.6, P less than 0.01).
  
  
  CONCLUSIONS
  Each hypothesis was confirmed. An increase of this magnitude is not an artefact of coroners' verdicts. The findings are believed to be due to ready access to firearms, the use of alcohol and drugs (particularly in firearms suicides) and increasing socioeconomic, health, and identity problems for rural youth, especially males.
authors.affiliation: Avoca Clinic, Department of Child and Adolescent Psychiatry, Prince of Wales Children's Hospital, Randwick, NSW.
authors.forename: M
authors.initials: M
authors.lastname: Dudley
authors.forename: B
authors.initials: B
authors.lastname: Waters
authors.forename: N
authors.initials: N
authors.lastname: Kelk
authors.forename: J
authors.initials: J
authors.lastname: Howard
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D005389:Firearms; D006801:Humans; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D012424:Rural Population; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data* / Q000639:trends; D014505:Urban Population