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Purpose: Transition from work to retirement may be associated with poor mental health outcomes in older-age groups, especially among those of lower socio-economic position (SEP). This study investigates the association between low educational achievement and mental health status, and the mediating role of employment status and income level among older-age Australians. Methods: This study was based on the '45 and Up Study', a prospective cohort study of participants from New South Wales (Australia) aged 45 years and older (N = 267,153), followed-up over the period 2006–2018. A causal mediation analysis was used to assess the total causal effect (TCE) of educational achievement level on psychological distress, and the extent of mediation by employment status and income level. Results: Lower educational achievement was associated with subsequent psychological distress, with a stronger TCE among those with low educational achievement (OR = 1.46, 95% CI 1.25–1.72), followed by those with intermediate educational achievement (OR = 1.26, 95% CI 1.07–1.48), compared to those with high educational achievement. In models investigating mediation by employment status and income level, 44.7%, (95% CI 34.2–55.3) of the association was mediated by employment status and income level, with a stronger mediating effect evident for income level. Conclusion: Findings suggest that employment status and income level changes at older age are more strongly associated with poorer mental health among those of lower SEP. Poor mental health associated with lower SEP may be ameliorated particularly by changes to income level, but also how people transition from employment to retirement. [ABSTRACT FROM AUTHOR]

Purpose: Rail level crossing removals to improve transport performance across metropolitan Melbourne (state of Victoria) resulted in new rail fencing and grade-separation of tracks from the surrounding environment at several sites. These design changes restricted pedestrian access to the rail tracks, which is a countermeasure known to prevent railway suicide in other settings. We examined whether any such suicide prevention effect followed the removals. Methods: We used a multiple-arm pre-post design to test whether a decrease in monthly frequency of railway suicides occurred at level crossing removal sites (intervention sites), compared to randomly matched sites where level crossings had not yet been removed (control sites). We used data available in the Victorian Suicide Register covering the period 1st January 2008 to 30th June 2021. Results: The mean monthly number of railway suicides decreased by 68% within a 500 m radius of intervention sites (RR: 0.32; CI 95% 0.11–0.74) and by 61% within a 1000 m radius of intervention sites (RR: 0.39; CI 95% 0.21–0.68). There was no evidence that the mean monthly number of railway suicides changed at the control sites, either within a 500 m radius (RR: 0.88; CI 95% 0.47–1.56) or a 1000 m radius (RR: 0.82; CI 95% 0.52–1.26). Conclusion: The reduction in railway suicides at locations where level crossings were removed, demonstrates the suicide prevention benefits that can be derived from a major infrastructure project even if not initially intended. Planning for major infrastructure projects should include consideration of these benefits, with designs incorporating features to maximise suicide prevention impact. [ABSTRACT FROM AUTHOR]

Purpose: Transition from employment to retirement may be detrimental to mental health, and associated with suicidal behaviour. This study investigated the association between employment and retirement status and suicidal behaviour among older aged Australians. Methods: This study was based on the '45 and Up Study', a large prospective cohort study of participants from New South Wales (Australia) aged 45 years and older (N = 267,153), followed up over the period 2006–2018. The risk of attempted suicide and suicide was compared between categories of employment and retirement status in a series of recurrent event survival analysis models adjusting for identified time variant and invariant confounders. Results: Compared to those who were employed, the risk of attempted suicide was higher among those who were not in the labour force and not retired (predominantly those who were sick or disabled, or carers) (HR = 1.97–95% CI 1.49–2.62), those who retired involuntarily (HR = 1.35–95% CI 1.03–1.77), and to a lesser extent those unemployed (HR = 1.31–95% CI 0.89–1.92). Risk of attempted suicide among those who retired voluntarily was similar to those who remained employed (HR = 1.09–95% CI 0.82–1.45). A similar pattern was evident for suicide, with a higher risk of suicide among those who were not in the labour force or retired, and those who retired involuntarily, compared to those who remained employed; however, these differences were not statistically significant. Conclusion: Transition from employment to retirement may be an important precipitating factor for suicidal behaviour, affected by current and previous mental health status. Services and programs facilitating continued or re-employment in older age, and adjustment to the transition from employment to retirement may prevent suicidal behaviour. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate trends in socioeconomic inequalities of suicide from 1979 to 2013 for Australian males and females aged 15-34 years and 35-64 years.Methods: Data on suicides and population were obtained from national registries. An area-based measure of socioeconomic status (SES) was used, and categorized into low, middle, and high SES areas. Suicide rates for each SES groups were estimated using a negative binomial regression model, adjusted for confounders. Socioeconomic inequalities in suicide were assessed using absolute and relative risk of low-to-high SES areas. Secular changes in socioeconomic inequalities were assessed using trend tests for relative risk.Results: For young males, there was an increase in socioeconomic inequality driven by a significant decrease in suicide rates in high SES areas. For older males, inequality in suicide increased by 29%, which was related to a marked increase in suicide rates in low SES areas. Inequalities in both young and older female suicides also increased. These increases occurred when corresponding suicide rates in high SES areas decreased.Conclusions: Recent widening socioeconomic inequalities in Australian suicide have been primarily associated with declines in suicide rates in high SES areas. However, an increasing inequality in older male suicide is linked with low SES. Efforts targeting people from poor areas, especially older males, should be considered when developing suicide prevention strategy. [ABSTRACT FROM AUTHOR]

Objective: Incarcerated adults are at high risk of self-harm and suicide and remain so after release into the community. The aims of this study were to estimate the number of ambulance attendances due to self-harm in adults following release from prison, and to identify factors predictive of such attendances.Methods: Baseline surveys with 1309 adults within 6 weeks of expected release from prison between 2008 and 2010 were linked prospectively with state-wide correctional, ambulance, emergency department, hospital and death records in Queensland, Australia. Associations between baseline demographic, criminal justice and mental health-related factors, and subsequent ambulance attendances resulting from self-harm, were investigated using negative binomial regression.Results: During 4691 person-years of follow-up (median 3.86 years per participant), there were 2892 ambulance attendances in the community, of which 120 (3.9%) were due to self-harm. In multivariable analyses, being Indigenous [incidence rate ratio (IRR): 2.10 (95% CI 1.14-3.86)], having previously been hospitalised for psychiatric treatment [IRR: 2.65 (95% CI 1.44-4.87)], being identified by prison staff as being at risk of self-harm whilst incarcerated [IRR: 2.12 (95% CI 1.11-4.06)] and having a prior ambulance attendance due to self-harm [IRR: 3.16 (95% CI 1.31-7.61)] were associated with self-harm attendances.Conclusions: Ambulance attendances resulting from self-harm following release from prison are common and represent an opportunity for tertiary intervention for self-harm. The high prevalence of such attendances, in conjunction with the strong association with prior psychiatric problems, reinforces the importance of providing appropriate ambulance staff training in the assessment and management of self-harm, and mental health problems more broadly, in this vulnerable population. [ABSTRACT FROM AUTHOR]

Purpose: Males feature prominently in suicide statistics, but relatively little work has been done to date to explore whether endorsement of dominant masculinity norms heightens the risk of or is protective against suicidal thinking. This paper aimed to further knowledge in this area.Methods: We used baseline data from 13,884 men (aged 18-55) in the Australian Longitudinal Study on Male Health (Ten to Men) cohort. These men filled in self-complete questionnaires in 2013/14 which covered a range of topics, including conformity to dominant masculinity norms and suicidal thinking. We conducted logistic regression analyses to estimate the strength of association between these two variables.Results: After controlling for other key predictors of suicidal thinking, one characteristic of dominant masculinity-self-reliance-stood out as a risk factor for suicidal thinking (AOR 1.33; 95% CI 1.25-1.42).Conclusions: It suggests that one particular element of dominant masculinity-being self-reliant-may place men at increased risk of suicidal thinking. This finding resonates with current theories of how suicidal thinking develops and leads to action. It also has implications for the full gamut of suicide prevention approaches that target males in clinical settings and in the general population, and for our broader society. Further work is needed, however, to confirm the direction of the relationship between self-reliance and suicidality, and to unpack the means through which self-reliance may exert an influence. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to simultaneously examine individual- and community-level factors associated with railway suicide.Methods: We performed a case-control study in Victoria, Australia between 2001 and 2012. Data on cases of railway suicide were obtained from the National Coronial Information System (a database of coronial investigations). Controls were living individuals randomly selected from the Household, Income and Labour Dynamics in Australia study, matching to cases on age groups, sex and year of exposures. A conditional logistic regression model was used to assess the individual-level and community-level influences on individual odds of railway suicide, controlling for socioeconomic status.Results: Individual-level diagnosed mental illness increased railway suicide odds by six times [95 % confidence interval (CI) 4.5, 9.2]. Community-level factors such as living in an area with a presence of railway tracks [odds ratio (OR) 1.8, 95 % CI 1.2, 2.8], within a city (OR 3.2, 95 % CI 1.9, 5.4), and with a higher overall suicide rate (OR 1.02, 95 % CI 1.01, 1.04) were independently associated with greater individual odds of railway suicide compared to living in an area without a presence of railway tracks, outside a city, and with a relatively lower overall suicide rate.Conclusions: The effects of mental illness and high incidence of overall suicides are prominent, but not specific on railway suicide. The effects of presence of railway tracks and city residence suggest the importance of accessibility to the railways for individual risk of railway suicide. Prevention efforts should focus on vulnerable people live in areas with easy access to the railways. [ABSTRACT FROM AUTHOR]

In the original publication there was an error in the calculation of scores for a number of the CMNI subscales and consequently the overall scale score. Recalculating the scores did not alter the substantive finding, and largely resulted in only small adjustments to estimates. Tables 1 and 2 are revised to show the corrected values, and revisions to the text reflecting these changes are noted. [ABSTRACT FROM AUTHOR]