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Soc Psychiatry Psychiatr Epidemiol. 2018 Nov 20. doi: 10.1007/s00127-018-1632-9. [Epub ahead of print]

Risk factors for suicide in rural Italy: a case-control study.

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Psychiatry Core Training, East London NHS Foundation Trust, London, UK.
Unità Funzionale di Igiene e Sanità Pubblica, Azienda USL Toscana Sud-Est, Arcidosso, Italy.
UNCEM (Unione Nazionale Comuni, Comunità, Enti Montani) della Toscana, Firenze, Italy.
Unità Operativa di Psichiatria di Grosseto, Azienda USL Toscana Sud-Est, Grosseto, Italy.



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.


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.


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).


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.


Case–control studies; Italy/epidemiology; Risk factors; Rural population/statistics numerical data; Suicide/statistics numerical data


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