title: Neighborhood ethnic density and suicide risk among different migrant groups in the four big cities in the Netherlands.
abstract: OBJECTIVE
  Recent studies suggested a favorable association between the ethnic density of the neighborhood and the risk of psychotic disorders among ethnic minorities. In this study, it was investigated whether this so-called 'ethnic density hypothesis' is also relevant to suicide risk, which is not sensitive to bias associated with ethnic differences in access to health care and reflects a broad range of mental health problems.
  
  
  METHODS
  Suicides in the four big cities in the Netherlands during 2000-2011 were ascertained using the cause of death register of Statistics Netherlands and analyzed in a multilevel Poisson model in relation to individual- and neighborhood-level characteristics.
  
  
  RESULTS
  With increasing non-Western minority density, the adjusted rate ratio (RR) of suicide in non-Western immigrants compared to native Dutch persons decreased from 0.69 to 0.39 (P < 0.001). This was explained by higher suicide rates among Dutch persons (RR = 1.28, P = 0.048) and lower rates among non-Western persons (RR = 0.72, P = 0.004) in neighborhoods with high (>55.9 %) compared to neighborhoods with low non-Western minority density (<36.5 %). Similar results were found for Turkish, Moroccan, Surinamese/Antillean and other non-Western subgroups separately. Compared to personally matched controls, non-Western cases (i.e., those who committed suicide) more often moved house to own-group high-dense areas and less often to own-group low-dense areas in the 5 years prior to suicide.
  
  
  CONCLUSIONS
  Our findings support the beneficial influence of the presence of the own ethnic group in the neighborhood on suicide risk among non-Western minorities. As moving to minority more dense areas prior to suicide was observed, this influence of ethnic density as measured on population level may have been underestimated.
authors.affiliation: Public Health, Municipality of Utrecht, PO Box 2423, 3500 GK, Utrecht, The Netherlands, F.Termorshuizen@umcutrecht.nl.
authors.forename: Fabian
authors.initials: F
authors.lastname: Termorshuizen
authors.forename: Arjan W
authors.initials: AW
authors.lastname: Braam
authors.forename: Erik J C
authors.initials: EJ
authors.lastname: van Ameijden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002947:Cities; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D009426:Netherlands / Q000453:epidemiology; D011618:Psychotic Disorders / Q000208:ethnology; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012306:Risk; D013405:Suicide / Q000706:statistics & numerical data*; D014171:Transients and Migrants; D014421:Turkey / Q000208:ethnology; D055815:Young Adult