277 Suicide and Life-Threatening Behavior 35(3) June 2005  2005 The American Association of Suicidology Social and Psychiatric Influences on Urban–Rural Differentials in Australian Suicide Richard Taylor, MBBS, DTM&H, FAFPHM, PhD, Andrew Page, BA(Psyc)Hons, Stephen Morrell, BA, BSc, PhD, James Harrison, MBBS, MPH, FAFPHM, and Greg Carter, MBBS, FRANZCP The purpose of this study was to investigate urban–rural differentials in Australian suicide rates, and to examine influences that previously have remained largely speculative. Suicide rates for males (all ages and young adults) were signifi- cantly higher in rural areas compared to urban areas. Urban–rural suicide rate differences in males were rendered nonsignificant after adjustment for migrant and area socioeconomic status. Adjusting for mental disorder prevalence, in addi- tion to migrant status, reduced the excess suicide risk in rural areas; the excess was reduced further with addition of mental health service utilization. The impli- cations of this study are that socioeconomic circumstances in rural populations contribute to higher male suicide rates compared to urban areas, but these condi- tions may be partly mediated by mental disorder prevalence and mental health service utilization. Suicide has emerged as an increasing public between suicide and psychiatric disorder or personality characteristics may be influenced health problem in Australia over the last two decades, highlighted especially by the rise of or modified by social, cultural and economic circumstances (Morrell, Taylor, Quine, & Kerr, male youth suicide rates in rural areas (Dud- ley et al., 1997; Dudley, Kelk, Florio, How- 1993; Page, Morrell, & Taylor, 2002b; Taylor, Morrell, Slaytor, & Ford, 1998) which, in ard, & Waters, et al., 1998). Relationships turn, may be associated with or modified by urban or rural residence. Suicide across all Professor Richard Taylor, Andrew Page, ages has been associated with psychiatric or ad- and Stephen Morrell are with the School of dictive disorders (Clark & Fawcett, 1992; Mos- Public Health at the University of Sydney in Aus- cicki, 1995), including schizophrenia (Caldwell tralia. James Harrison is an Associate Professor at the Research Centre for Injury Studies, Flinders & Gottesman, 1990), depression (Clark & Faw- University. Dr. Greg Carter is with the Depart- cett, 1992), substance use disorders (Moscicki, ment of Consultation-Liaison Psychiatry, New- 1995), personality disorders (Brent, 1995), and castle Mater Hospital and the Faculty of Health, comorbid diagnoses (Moscicki, 1995). University of Newcastle, in Australia. Internationally, higher suicide rates in This study was funded by the National Health and Medical Research Council, Project rural compared to urban areas have been Grant No. 107322. noted for males in the United States (Singh Address correspondence to Professor Rich- & Siahpush, 2002), and both sexes in China ard Taylor, School of Public Health, Edward Ford (Phillips, Li, & Zhang, 2002), Japan (older Building, A27, University of Sydney, NSW, 2006, ages) (Watanabe, Hasegawa, & Yoshinaga, Australia; E-mail: richardt@health.usyd.edu.au.