title: The area level association between suicide, deprivation, social fragmentation and population density in the Republic of Ireland: a national study.
abstract: Numerous studies have examined the ecological relationship between suicide and area level determinants such as deprivation and social fragmentation. In Ireland, there is considerable geographic variation in the rates of suicide. However, there is a dearth of Irish studies investigating the geographic variability of suicide.
  
  
  
  The Irish Central Statistics Office (CSO) provided data relating to all deaths by suicide and deaths of undetermined intent that occurred from 2009 to 2011. Negative binomial regression was used to examine the relationship between area level suicide rates and measures of deprivation, social fragmentation and population density that were taken from the 2011 National Census.
  
  
  
  Overall deprivation had the strongest independent effect on small-area rates of suicide, with the most deprived areas showing the greatest risk of suicide (risk ratio = 2.1; 95 % CI 1.70-2.52). Low population density (rurality) was associated with an increased risk suicide in males across both age groups and among females in the older 40-64-year age group. Conversely, a weak association between high population density (urbanicity) and increased suicide risk was found among females in the 15-39-year age group. Associations with social fragmentation only became apparent in the sub group analysis. Social fragmentation was associated with an elevated risk of suicide in the older 40-64 age group, with this effect being most pronounced among females.
  
  
  
  The findings of this study demonstrate marked geographical inequalities in the distribution of suicide in Ireland and highlight the importance of targeting suicide prevention resources in the most deprived areas.
authors.affiliation: Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Republic of Ireland. i.ofarrell@ucc.ie.
authors.forename: I B
authors.initials: IB
authors.lastname: O'Farrell
authors.affiliation: Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Republic of Ireland.|National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Republic of Ireland.|Department of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork, Republic of Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Corcoran
authors.affiliation: Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Republic of Ireland.
authors.forename: I J
authors.initials: IJ
authors.lastname: Perry
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011156:Population Density; D011610:Psychosocial Deprivation; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Area level determinants; Deprivation; Ecological study; Population density; Social fragmentation; Suicide