- Title
- Suicide in urban and rural Australia: determinants, moderators and treatment options for suicidal thoughts and behaviours
- Creator
- Handley, Tonelle
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2013
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- This thesis explores determinants and moderators of suicidal ideation in Australia in three higher-risk populations: rural and remote residents, older adults, and people with co-occurring depression and substance misuse. It consists of an Introduction, nine papers and a final chapter providing a synthesis of the results and conclusion. At the time of submission, seven of the nine papers have been accepted for publication in peer reviewed journals, with two currently submitted for peer review. The Introduction provides an overview of suicidal thoughts and behaviours in Australia, summarising the current body of literature and drawing particular attention to higher-risk groups, established risk factors, and current treatments. Limitations in existing research are summarised in Paper 1 (“Urban-rural influences on suicidality: Gaps in the existing literature and recommendations for future research”). This section leads into a justification for the aims of this thesis and an outline of how they will be addressed. Chapter 2, Paper 2 (“Contributors to suicidality in rural communities: Beyond the effects of depression”) explores the extent of the relationship between depression and suicidal thoughts and behaviours in rural areas, determining that although these concepts are highly related, they remain independent. The discussion of this Chapter emphasises the variance in suicidal ideation not accounted for by depression, indicating the potential for other factors to contribute. This information is used to direct the analyses in Chapter 3. Chapter 3 explores the long-term risk factors for suicidal ideation within each of the key groups of rural residents, older adults, and people with a mental illness. Informed by Chapter 2, the papers presented in Chapter 3 incorporate a focus on social as well as psychiatric factors, while aiming to address the identified lack of longitudinal research investigating suicidal ideation. Longitudinal associations with suicidal ideation are explored in rural residents in Paper 3 (“You’ve got to have friends: The predictive value of social integration and support in suicidal ideation among rural communities”) and Paper 4 (“Longitudinal course and predictors of suicidal ideation in a rural community sample”); in older adults in Paper 5 ("Predictors of suicidal ideation in older people. A decision-tree analysis"); and in people with comorbid mental illness and substance use problems in Paper 6 (“Longitudinal risk profiles for suicidal ideation in comorbid depression and substance misuse”). Finally, Chapter 4 evaluates potential treatment options for suicidal thoughts and behaviours in terms of their accessibility, appeal, and efficiency. Rural residents are the focus of Paper 7 (“Facilitators and barriers to treatment-seeking for people with mental health problems in rural areas”) and Paper 8 (“Feasibility of internet-delivered mental health treatments for rural populations”), older adults are explored in Chapter 4.3, while people with a comorbid mental illness provide the data presented in Paper 9 (“Incidental treatment effects of CBT on suicidal ideation and hopelessness”). While this Chapter identifies flexible treatment options that may increase the accessibility of services for people experiencing suicidal ideation, the importance of overcoming attitudinal barriers to help-seeking is emphasised; limitations in current clinical treatment approaches are also discussed. The Discussion section synthesises the findings of the nine papers presented in this thesis, with a focus on the implications and future directions indicated by this research. It outlines a proposed multi-tiered approach to suicide prevention, incorporating strategies ranging from epidemiological through to clinical treatment strategies. Future research directions are also suggested.
- Subject
- suicide; rural; urban; community; comorbidity; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1041746
- Identifier
- uon:13952
- Rights
- Copyright 2013 Tonelle Handley
- Language
- eng
- Full Text
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