title: Individual- and area-level influence on suicide risk: a multilevel longitudinal study of Swedish schoolchildren.
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.
  
  
  METHODS
  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.
authors.affiliation: MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK.
authors.forename: S
authors.initials: S
authors.lastname: Zammit
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK.
authors.forename: D
authors.initials: D
authors.lastname: Gunnell
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK.
authors.forename: G
authors.initials: G
authors.lastname: Lewis
authors.affiliation: Centre for Multilevel Modelling, University of Bristol, UK.
authors.forename: G
authors.initials: G
authors.lastname: Leckie
authors.affiliation: Department of Public Health Sciences, Karolinska Institute, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Dalman
authors.affiliation: Department of Public Health Sciences, Karolinska Institute, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Allebeck
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004777:Environment; D005260:Female; D006801:Humans; D007206:Individuality; D008137:Longitudinal Studies; D008297:Male; D015233:Models, Statistical; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012574:Schools / Q000706:statistics & numerical data; D013405:Suicide / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult