Risk factors for suicide in rural Italy: a case-control study.
PURPOSE
Increased frequency of suicide in rural areas of Tuscany has been described since the 1970s. A case-control study was conducted in 2014 and 2015. The objective of this study was to identify major individual risk factors related to suicides in six rural districts of Tuscany.


METHODS
Cases were identified as all 128 suicides occurred in six rural districts between 2009 and 2013. Controls (three for each case) were matched for age, sex, and general practice. Information was collected from GPs using a structured questionnaire. Univariate and multivariate analyses were carried out to investigate the association between individual risk factors and suicide.


RESULTS
Informants for 91 cases of the 128 identified cases were successfully interviewed (response rate 71.1%). About 40.5-65.9% suicide cases and 11.4-20.0% of controls had some psychiatric pathology, accordingly to different definitions. Univariate conditional regression analysis showed that living in isolated houses (OR 2.48), living alone (OR 2.97), not being married (OR 2.63), low income (OR 2.73), psychiatric pathology (OR 9.70), psychotropic medication (OR 5.58), problems with relatives (OR 14.78), psychiatric family history (OR 5.67), and suicidal ideation (OR 15.61) were all risk factors. Practising religion (OR 0.27) was the only protective factor identified. Multivariate regression identified two independently and significantly associated variables namely, psychiatric pathology (OR 8.87) and living alone (OR 2.30).


CONCLUSIONS
Results of this study showed, similarly to recent research, that not all suicide events are the results of psychiatric pathology. Prevention strategies should, therefore, target both socio-economic and clinical risk factors.
['Martiello|Michele Arcangelo|MA|http://orcid.org/0000-0002-5390-9512', 'Boncompagni|Giuseppe|G|', 'Lacangellera|Davide|D|', 'Corlito|Giuseppe|G|']
D000328:Adult D016022:Case-Control Studies D005260:Female D006801:Humans D007182:Income D007558:Italy D008297:Male D017533:Marital Status D008875:Middle Aged D015999:Multivariate Analysis D011619:Psychotropic Drugs D012044:Regression Analysis D012307:Risk Factors D012424:Rural Population D059020:Suicidal Ideation D013405:Suicide D011795:Surveys and Questionnaires
Risk factors Case–control studies Italy/epidemiology Rural population/statistics numerical data Suicide/statistics numerical data