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Many western countries have experienced increased rates of youth suicide over recent years. This has been an issue of particular concern in New Zealand, since it had the highest rate of youth suicide among OECD countries in the mid-1990s. However, while attention is drawn to the now declining youth suicide rate by politicians and policy-makers, what is obscured is a cohort effect. In this paper we will argue that a cohort effect is clearly visible; suicide rates among 15-24 year olds came to the fore in the mid-1980s, peaking 10 years later, and were displaced by that among 25-35 year olds by the late-1990s. Further, this century has been characterised by the rise of suicide rates among 35-44 year olds. This effect correlates with a dramatic downturn in the New Zealand economy in a five-year period bracketing 1970. We argue for an increased focus on social and economic factors underlying suicide. [ABSTRACT FROM AUTHOR]

Enrolled patients at the free clinic in Dunedin, New Zealand were not just financially poor, but also vulnerable. Large social inequalities are present in the United States and New Zealand. The literature on vulnerability originates predominantly from sociology and public health. This commentary discusses the concept of vulnerability within clinical practice, and makes a case for the improved recognition of patient vulnerability. Vulnerability arises from an individual's susceptibility to harm and their exposure to risks and negative events. Biographical factors commonly regarded as social vulnerability characteristics such as homelessness, teenage parenthood, and childhood abuse do not necessarily lead to negative health and other outcomes because of a direct, causal effect, but because they are indicative of more upstream adversities. Health professionals should address vulnerability not just during clinical encounters, but also at an institutional and policy level. [ABSTRACT FROM AUTHOR]