title: Spatial suicide clusters in Australia between 2010 and 2012: a comparison of cluster and non-cluster among young people and adults.
abstract: BACKGROUND
  A suicide cluster has been defined as a group of suicides that occur closer together in time and space than would normally be expected. We aimed to examine the extent to which suicide clusters exist among young people and adults in Australia and to determine whether differences exist between cluster and non-cluster suicides.
  
  
  METHODS
  Suicide data were obtained from the National Coronial Information System for the period 2010 and 2012. Data on date of death, postcode, age at the time of death, sex, suicide method, ICD-10 code for cause of death, marital status, employment status, and aboriginality were retrieved. We examined the presence of spatial clusters separately for youth suicides and adult suicides using the Scan statistic. Pearson's chi-square was used to compare the characteristics of cluster suicides with non-cluster suicides.
  
  
  RESULTS
  We identified 12 spatial clusters between 2010 and 2012. Five occurred among young people (n = 53, representing 5.6% [53/940] of youth suicides) and seven occurred among adults (n = 137, representing 2.3% [137/5939] of adult suicides). Clusters ranged in size from three to 21 for youth and from three to 31 for adults. When compared to adults, suicides by young people were significantly more likely to occur as part of a cluster (difference = 3.3%, 95% confidence interval [CI] = 1.8 to 4.8, p < 0.0001). Suicides by people with an Indigenous background were also significantly more likely to occur in a cluster than suicide by non-Indigenous people and this was the case among both young people and adults.
  
  
  CONCLUSIONS
  Suicide clusters have a significant negative impact on the communities in which they occur. As a result it is important to find effective ways of managing and containing suicide clusters. To date there is limited evidence for the effectiveness of those strategies typically employed, in particular in Indigenous settings, and developing this evidence base needs to be a future priority. Future research that examines in more depth the socio-demographic and clinical factors associated with suicide clusters is also warranted in order that appropriate interventions can be developed.
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, VIC, 3052, Australia. jo.robinson@orygen.org.au.
authors.forename: Jo
authors.initials: J
authors.lastname: Robinson
authors.affiliation: Melbourne School of Population and Global Health, Level 5, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
authors.forename: Lay San
authors.initials: LS
authors.lastname: Too
authors.affiliation: Melbourne School of Population and Global Health, Level 5, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Pirkis
authors.affiliation: Melbourne School of Population and Global Health, Level 5, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Spittal
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001315:Australia; D016000:Cluster Analysis; D016208:Databases, Factual; D005260:Female; D062306:Geography, Medical; D006801:Humans; D008297:Male; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Australia; Indigenous; Scan statistic; Spatial suicide cluster; Youth