The relationship between rurality, travel time to care and death by suicide

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Rebecca Barry - , University of Toronto (Author)
  • Jürgen Rehm - , Chair of Behavioral Epidemiology, University of Toronto, Centre for Addiction and Mental Health (CAMH) (Author)
  • Claire de Oliveira - , University of Toronto, University of York (Author)
  • Peter Gozdyra - , Institute for Clinical Evaluative Sciences (Author)
  • Simon Chen - , Institute for Clinical Evaluative Sciences (Author)
  • Paul Kurdyak - , University of Toronto, Institute for Clinical Evaluative Sciences (Author)

Abstract

Background: We previously found an association between rurality and death by suicide, where those living in rural areas were more likely to die by suicide. One potential reason why this relationship exists might be travel time to care. This paper examines the relationship between travel time to both psychiatric and general hospitals and suicide, and then determine whether travel time to care mediates the relationship between rurality and suicide. Methods: This is a population-based nested case-control study. Data from 2007 to 2017 were obtained from administrative databases held at ICES, which capture all hospital and emergency department visits across Ontario. Suicides were captured using vital statistics. Travel time to care was calculated from the resident’s home to the nearest hospital based on the postal codes of both locations. Rurality was measured using Metropolitan Influence Zones. Results: For every hour in travel time a male resides from a general hospital, their risk of death by suicide doubles (AOR = 2.08, 95% CI = 1.61–2.69). Longer travel times to psychiatric hospitals also increases risk of suicide among males (AOR = 1.03, 95%CI = 1.02–1.05). Travel time to general hospitals is a significant mediator of the relationship between rurality and suicide among males, accounting for 6.52% of the relationship between rurality and increased risk of suicide. However, we also found that there is effect modification, where the relationship between travel time and suicide is only significant among males living in urban areas. Conclusions: Overall, these findings suggest that males who must travel longer to hospitals are at a greater risk of suicide compared to those who travel a shorter time. Furthermore, travel time to care is a mediator of the association between rurality and suicide among males.

Details

Original languageEnglish
Article number345
JournalBMC psychiatry
Volume23
Issue number1
Publication statusPublished - Dec 2023
Peer-reviewedYes

External IDs

PubMed 37198612

Keywords

Sustainable Development Goals

ASJC Scopus subject areas

Keywords

  • Healthcare access, Rurality, Suicide

Library keywords