Friday, 18 March 2016

Rural suicide rates: research reveals role of place

Newly published research around alarming suicide rates in regional areas provides an important insight into the issue.

The research team from Monash Rural Health studied four Victorian communities to look for common links. It found there were several common factors in towns with lower suicide rates including seeking out help and positive attitudes to mental illness.

While the disproportionate rate between suicides in country and city is well documented, this latest research, published in Qualitative Health Research, looked at the reasons why.

Social cohesion and a focus on youth are among the factors associated with lower rates of suicide in small rural towns.


Comparing four rural towns

The study chose four small rural towns with populations under 4000 – two with high suicide rates and two with lower rates. Scoping research found suicide rates in rural areas have increased up to 12-fold in some demographics over a 30-year period in towns of this size.

The research formed part of Dr Jessica Collins’ doctoral studies with Monash Rural Health. According to Dr Collins, although the patterns and mechanisms of rural suicide were well documented, they remained “poorly understood”. She interviewed psychologists, GPs and other health professionals in the four towns.

What's the role of "place"?

Research colleague and Monash Rural Health Senior Research Fellow, Dr Bernadette Ward, said the research found there were several factors associated with lower suicide rates in the towns, including positive attitudes to mental illness and seeking help.

“High perceptions of community safety were also important,” she said. “Also the ability of town residents to work together in difficult times, and to change and accept the values and goals of young people, particularly when there were high levels of social support and attendance at community events.

“This is not to say that residents within low suicide towns didn’t experience difference but instead their perceptions of community were much stronger than those seen in towns with higher suicide rates.”

Dr Ward said the findings of this study supported previous findings that physical environment, climate, housing and employment influenced wellbeing.

“But we wanted to explore the role of ‘place’ in contributing to suicide rates in rural communities,” she said. “This is very different to ‘location’ because it takes into account the sense of connection rural town residents have with each other and how social cohesion, support, community values and attitudes to mental health influence this sense of connection.”

Differences between towns matter

Dr Collins said it was the first time this research ‘model’ had been tested in an in-depth way.  “A great deal of reporting around rural suicide puts all rural communities into one bucket when they are all very different,” she said. “While access to health and mental health services in particular is very important in promoting mental wellbeing, understanding the differences rather than the similarities provided insights to what drives the disproportionately high rates of suicide and poor mental health outcomes.”

Dr Collins said one of the “really interesting” aspects of the findings was that while there were lots of similarities between the four towns, there were also many differences. She said access to mental health services and social cohesion were significantly different between the towns with high and low suicide rates.

“One of our findings was that even the type of drugs these communities get greater access to seems, in some instances, to impact on mental health outcomes,” she said.

“Integration of services was working well in towns with a low rate. The absence or presence of social cohesion was consistently talked about as was perceptions of safety and attitudes towards mental illness.”

Importance of a focus on youth

One of the things Dr Collins found in the two towns with the lowest suicide rates was that they had created facilities and activities for youth. “One town had a particularly high suicide rate and made targeted interventions in the community and brought that rate down,” she said. “One town even created a youth cafĂ©. These things made a difference.”

Dr Collins said the results showed that suicide in rural areas remained a complicated issue needing continued and close research. “The issue remains complicated…but the underlying mechanism of connectedness was important. We must keep validating and sharpening the pencils so we can potentially point to things we can do to intervene.”

Compositional, Contextual and Collective Community Factors in Mental Health and Wellbeing in Australian Communities is an open access article, published in Qualitative Health Research, February 2016.



Wednesday, 9 March 2016

Melbourne to host World Congress of Nephrology 2019

Melbourne has won the bid to host the International Society of Nephrology’s biennial World Congress of Nephrology (WCN), the premiere event in nephrology education and research.

Led by Professor Peter Kerr, Monash University and recently appointed Head of Rural Health at Monash University Professor Robyn Langham, a group of Melbourne nephrologists bid for the 2019 congress.

Win: Professor Peter Kerr (above) and Professor Robyn Langham headed a successful bid to host the World Congress of Nephrology in 2019.

“In the same way as cities bid to host the Olympics or World Cup, Melbourne competed against other Australian and international cities to host this high profile event,” said Professor Kerr, who is also Director of Nephrology at Monash Health and Editor in Chief of Nephrology.

Last held in Australia (in Sydney) in 1998, recent congresses have been in Cape Town, Hong Kong and Vancouver with up to 6000 conference participants.

“In choosing Melbourne, the International Society of Nephrology (ISN) cited the city’s excellent facilities, well located hotels and public transport, along with the high profile of Australian nephrology clinical practice, education and research.”

“Australian nephrology has always held a prominent position internationally and this congress will further cement our place,” added Professor Kerr.

“Over the next 3 years we intend to put together a strong program, not only showcasing nephrology but also Melbourne.”

While a forum to advance physician education and support the development of clinical research into kidney disease, the WCN is also an ideal opportunity to increase public awareness of kidney health.

Wednesday, 2 March 2016

A chance to tell your 'story of illness'


FreeImages.com/Andrew Richards
It's an interesting phenomenon that when we are ill we often resort to military terms to describe our experience.

This observation has, in part, motivated Monash Rural Health researcher Dr Marg Simmons to embark on a research project which will explore stories of illness from patients or health professionals. She hopes her work will help to provide an opportunity for them to make sense of their own stories, in their own way.

As part of the research she is asking for anyone who feels they have an illness story to share, to consider participating in an anonymous survey which will explore their story.

Dr Simmons, who is based at the Monash Rural Health Churchill teaching site, teaches Monash medical students about the social and community aspects of health. In April she will present at a conference at the Monash Prato Centre in Italy, focusing on the ‘illness narrative’ – how these stories are told, what language is used and how various stories of illness overlap or differ.

“I think when we are ill it can be difficult to tell our illness story,” Dr Simmons said. “We tend to tell it in certain ways, for example using military metaphors like ‘the battle’ or ‘we are targeting this’ or ‘we will win this fight.’”

The local researcher believes that while this sort of commonly accepted language might be readily available for health professionals and patients, it could potentially alienate those experiencing illness, leaving them feeling like they are “somehow ‘losing the battle’ or ‘not fighting the good fight’.”

“I am interested in providing people who may not feel like they have had the space to tell their story, in their own way, a chance to express that,” Dr Simmons explained.

“I want to hear about how people cope with changes to their bodies, how  they create a new story about themselves, what language they use,” she said, adding “I want to provide people with an opportunity to tell a story they may not have been able to tell others.”

Referring to the cultural narratives that often “shape us” in the face of illness, Dr Simmons said adopting certain narratives can also “limit us and there may be other more useful forms of language through which we tell our stories that can be explored”.

Dr Simmons hopes her research and the qualitative data collected through her survey – open to anyone who has an experience of illness whether they are a patient or professional – will help to better inform health professionals about the use of language around illness.

“I hope this work will add to the body of knowledge which can help with translating the illness experience into important stories that highlight the connections and similarities in those stories as well as the challenges and disruptions that illness brings to people’s lived experience to hopefully make a difference for patients” The Prato conference theme is ‘Broken Narratives and the Lived Body’. Its focus on the disruption that illness always imposes on someone’s personal story was one of particular interest to Dr Simmons.

Anyone interested in participating in a survey as part of Dr Simmons’ research is asked to go to the online survey. The survey takes about 30 minutes to complete.

For those who would prefer to tell their story to Dr Simmons – or for anyone seeking more information – please phone (03) 5122 7527 or email margaret.simmons@monash.edu