title: Influence of social and material individual and area deprivation on suicide mortality among 2.7 million Canadians: a prospective study.
abstract: BACKGROUND
  Few studies have investigated how area-level deprivation influences the relationship between individual disadvantage and suicide mortality. The aim of this study was to examine individual measures of material and social disadvantage in relation to suicide mortality in Canada and to determine whether these relationships were modified by area deprivation.
  
  
  METHODS
  Using the 1991-2001 Canadian Census Mortality Follow-up Study cohort (N = 2,685,400), measures of individual social (civil status, family structure, living alone) and material (education, income, employment) disadvantage were entered into Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for male and female suicide mortality. Two indices of area deprivation were computed - one capturing social, and the other material, dimensions - and models were run separately for high versus low deprivation.
  
  
  RESULTS
  After accounting for individual and area characteristics, individual social and material disadvantage were associated with higher suicide mortality, especially for individuals not employed, not married, with low education and low income. Associations between social and material area deprivation and suicide mortality largely disappeared upon adjustment for individual-level disadvantage. In stratified analyses, suicide risk was greater for low income females in socially deprived areas and males living alone in materially deprived areas, and there was no evidence of other modifying effects of area deprivation.
  
  
  CONCLUSIONS
  Individual disadvantage was associated with suicide mortality, particularly for males. With some exceptions, there was little evidence that area deprivation modified the influence of individual disadvantage on suicide risk. Prevention strategies should primarily focus on individuals who are unemployed or out of the labour force, and have low education or income. Individuals with low income or who are living alone in deprived areas should also be targeted.
authors.affiliation: Centre de recherche du Centre hospitalier de l'Université de Montréal, 1301 rue Sherbrooke Est Montréal, Québec, H2L 1M3, Canada. burrows.stephanie@sympatico.ca
authors.forename: Stephanie
authors.initials: S
authors.lastname: Burrows
authors.forename: Nathalie
authors.initials: N
authors.lastname: Auger
authors.forename: Philippe
authors.initials: P
authors.lastname: Gamache
authors.forename: Danielle
authors.initials: D
authors.lastname: St-Laurent
authors.forename: Denis
authors.initials: D
authors.lastname: Hamel
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D019352:Censuses; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000523:psychology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013405:Suicide / Q000191:economics* / Q000523:psychology