11
Social Science & Medicine 57 (2003) 2355–2365 Toward understanding youth suicide in an Australian rural community Lisa Bourke* School of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, P.O. Box 6500 Shepparton VIC 3632, Australia Abstract Australia has one of the highest rates of youth suicide in the western world, especially among rural men. This paper discusses the social construction of this issue in Australia and explores the issue through interviews with 30 young people and 12 key informants from a rural town in NSW. Findings suggest that young people struggle to deal with conflict in social relationships, that community discourses shape young people’s understandings and that suicide is talked about in reference to depression. Implications for youth suicide prevention in Australian rural communities are discussed. r 2003 Elsevier Ltd. All rights reserved. Keywords: Youth suicide; Rural community; Australia Introduction Until a decade ago, Australia witnessed a rise in youth suicide for over 25 years, especially among young men and Indigenous Australians (Beautrais, 2000; Cantor, Neulinger, & De Leo, 1999; Hassan, 1995; Hunter, 1991; Lynskey, Degenhardt, & Hall, 2000). Rates remained high for young men aged between 15 and 24 through most of the 1990s (ABS, 2002; Mitchell, 2000), began to decline in 1999 and have continued to decline (ABS, 2002). 1 Rates have been much lower and stable for young women over this time (ABS, 2002; Mitchell, 2000). However, rates of attempts have been similar for men and women (Davis, 1992; de Vaus, 1996; Kelk, 1995) suggesting that suicide is an issue explored by young women. 2 Further, in 1997, 18–24-year-olds were found to have the highest occurrence of mental disorders (Eckersley, 1999). Rates of suicide for young males were consistently higher in small country towns than in metropolitan areas (Baume & Clinton, 1997; Dudley, Kelk, Florio, Howard, & Waters, 1998; Wilkinson & Gunnell, 2000), especially in towns with populations under 4000 (Kelk, ARTICLE IN PRESS *Tel.: +61-3-5823-4519; fax: +61-3-5823-4555. E-mail address: [email protected] (L. Bourke). 1 Suicide rates for young men rose dramatically from 1968 to 1992, more than doubling (Hassan, 1995). Some of this rise has been attributed to more deaths being counted as suicides by coroners (see Kosky, 1992). Suicide rates for young men aged 15–24 were 25–27 per 100,000 in the 1990s, peaking at 31 in 1997, dropping to 27 in 1998, 23 in 1999 and 19 per 100,000 in 2000. These rates have been consistently higher than rates for men of all ages, which were around 21 per 100,000 throughout the 1990s and 19 per 100,000 in 2000. Rates for young women aged 15–24 have remained around 4–6 per 100,000, similar to the rates for women of all ages (ABS, 2002). 2 While suicide rates among 15–24 year old women are consistently around 4 per 100,000 in both rural and urban areas (de Vaus, 1996; Kelk, 1995), for every male suicide, there are 15 more attempts by men and for every female suicide, there are 100 attempts by young women (Davis, 1992). Therefore, including para-suicides suggests that this is a major issue facing young women. Some argue that the gender issue is largely the result of method; men are more likely to use lethal methods (hanging and shooting) than women (poisonous substances) (Baume and Clinton, 1997; Hassan, 1995; McKillop, 1992). In recent years, female rates of attempts have declined (Mitchell, 2000) although rates of attempts are, and always have been, difficult to ascertain (Hassan, 1995; Kosky, 1992; Mitchell, 2000). 0277-9536/03/$ - see front matter r 2003 Elsevier Ltd. All rights reserved. doi:10.1016/S0277-9536(03)00069-8

Toward understanding youth suicide in an Australian rural community

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Social Science & Medicine 57 (2003) 2355–2365

Toward understanding youth suicide in an Australianrural community

Lisa Bourke*

School of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne,

P.O. Box 6500 Shepparton VIC 3632, Australia

Abstract

Australia has one of the highest rates of youth suicide in the western world, especially among rural men. This paper

discusses the social construction of this issue in Australia and explores the issue through interviews with 30 young

people and 12 key informants from a rural town in NSW. Findings suggest that young people struggle to deal with

conflict in social relationships, that community discourses shape young people’s understandings and that suicide is

talked about in reference to depression. Implications for youth suicide prevention in Australian rural communities are

discussed.

r 2003 Elsevier Ltd. All rights reserved.

Keywords: Youth suicide; Rural community; Australia

Introduction

Until a decade ago, Australia witnessed a rise in youth

suicide for over 25 years, especially among young men

and Indigenous Australians (Beautrais, 2000; Cantor,

Neulinger, & De Leo, 1999; Hassan, 1995; Hunter, 1991;

Lynskey, Degenhardt, & Hall, 2000). Rates remained

high for young men aged between 15 and 24 through

most of the 1990s (ABS, 2002; Mitchell, 2000), began to

decline in 1999 and have continued to decline (ABS,

2002).1 Rates have been much lower and stable for

young women over this time (ABS, 2002; Mitchell,

2000). However, rates of attempts have been similar for

men and women (Davis, 1992; de Vaus, 1996; Kelk,

1995) suggesting that suicide is an issue explored by

young women.2 Further, in 1997, 18–24-year-olds were

found to have the highest occurrence of mental disorders

(Eckersley, 1999).

Rates of suicide for young males were consistently

higher in small country towns than in metropolitan

areas (Baume & Clinton, 1997; Dudley, Kelk, Florio,

Howard, & Waters, 1998; Wilkinson & Gunnell, 2000),

especially in towns with populations under 4000 (Kelk,

ARTICLE IN PRESS

*Tel.: +61-3-5823-4519; fax: +61-3-5823-4555.

E-mail address: [email protected] (L. Bourke).1Suicide rates for young men rose dramatically from 1968 to

1992, more than doubling (Hassan, 1995). Some of this rise has

been attributed to more deaths being counted as suicides by

coroners (see Kosky, 1992). Suicide rates for young men aged

15–24 were 25–27 per 100,000 in the 1990s, peaking at 31 in

1997, dropping to 27 in 1998, 23 in 1999 and 19 per 100,000 in

2000. These rates have been consistently higher than rates for

men of all ages, which were around 21 per 100,000 throughout

the 1990s and 19 per 100,000 in 2000. Rates for young women

aged 15–24 have remained around 4–6 per 100,000, similar to

the rates for women of all ages (ABS, 2002).

2While suicide rates among 15–24 year old women are

consistently around 4 per 100,000 in both rural and urban areas

(de Vaus, 1996; Kelk, 1995), for every male suicide, there are 15

more attempts by men and for every female suicide, there are

100 attempts by young women (Davis, 1992). Therefore,

including para-suicides suggests that this is a major issue facing

young women. Some argue that the gender issue is largely the

result of method; men are more likely to use lethal methods

(hanging and shooting) than women (poisonous substances)

(Baume and Clinton, 1997; Hassan, 1995; McKillop, 1992). In

recent years, female rates of attempts have declined (Mitchell,

2000) although rates of attempts are, and always have been,

difficult to ascertain (Hassan, 1995; Kosky, 1992; Mitchell,

2000).

0277-9536/03/$ - see front matter r 2003 Elsevier Ltd. All rights reserved.

doi:10.1016/S0277-9536(03)00069-8

1995).3 In the late 1980s and early 1990s, suicide was the

leading cause of death for 15–19-year-old rural males

(Bush, 1990; Dudley, Waters, Kelk, & Howard, 1992;

Hassan, 1995). It must be acknowledged that there is

much variation across rural areas, with some commu-

nities having higher rates and rates changing from year

to year (Cantor & Slater, 1997; Hassan, 1995).4 While

declining, suicide rates remain unacceptably high in

rural Australia.

This paper investigates young, rural residents’ under-

standings of suicide with particular attention to their

social environment. It is argued that the construction of

youth suicide in Australia is related to claims and

discourses surrounding youth suicide and also to the

social context in which young people undertake such

behaviour—contextual constructionism (see Best, 1993).

Within the social context of Australian rural commu-

nities, the lived experiences of young rural residents and

their interpretations of claims about youth suicide are

important. The aim is not to identify the historical and

cultural processes of constructing young people’s knowl-

edges, but to examine how suicide is understood by

young people in rural communities and how their

knowledges can assist in improving suicide prevention

and policy. Currently, there is little published literature

on young rural residents’ understandings of mental

health issues and suicide. This paper contributes to this

dearth by providing an exploratory analysis of young

people’s perceptions of their social environment gen-

erally and rural youth suicide specifically.

The construction of rural youth suicide in Australia

An individual’s problem

Research on youth suicide has identified two con-

sistently recurring correlates with youth suicide, a

previous suicide attempt and depression (Baume &

Clinton 1997; DHFS, 1997a; McKillop, 1992). The

strong relationship between suicide and depression

means that suicide carries the stigma of mental health

(de Vaus, 1996; also see Baume & Clinton, 1997;

Hassan, 1995). Further analysis identified a range of

correlates whose relationships are significant but less

clear, including (1) psychological characteristics, such as

a mental illness, psychiatric/psychological disorders and

depression, (2) personal/family experiences, including

physical, sexual and emotional abuse, being raised in a

dysfunctional family, or parents who were divorced,

unemployed or low income, and (3) individual char-

acteristics, such as being male, rural, unemployed, an

ethnic minority, HIV positive, having low self-esteem or

recently experiencing a relationship breakup (Baume,

1995; Beautrais, 2000; Beautrais, Joyce & Mulder, 1996;

Burnley, 1995; Bush, 1990; Cantor & Slater, 1997;

DHFS, 1997a; DHSH, 1995; Emslie, 1996; Fergusson &

Lynskey, 1995; Hassan, 1995; King, 1994; Kosky, 1992;

McKillop, 1992; Morrell, 1995).

Such research has assisted in targeting ‘at risk youth,’

however, as Davis (1992, pp. 99) noted: ‘‘most of the risk

factors identified are common in the community and,

even combining the factors to create a risk profile,

identified a large number of people, most of whom will

never suicide or attempt suicide’’. Further, such a focus

is aimed at the individual level, suggesting the individual

and not the social context is responsible. Eckersley

(1993, 1998) argued that western cultures are failing to

provide a sense of meaning and belonging for young

people and these and other contextual issues, including

well-being, are related to the increase of social problems,

including youth suicide.

The construction of ‘youth’ in Australia

Included in the social context are the ways in which

young Australians are viewed by others. Both histori-

cally and currently, young people in Australia have

tended to be constructed ‘negatively’. The term youth

has been associated with disruption, rebellion, irrespon-

sibility, dependency and other negative and dismissive

terms (White, 1993, 1994; Gaines, 1991). Tait (1993, pp.

40) argued that ‘‘the concept of ‘youth’ is best under-

stood as an example of the governmental formation of a

specific type of person’’ while White (1994) suggested

that the category ‘youth’ was used to identify a

normative transition into adulthood embedded with

‘problems’. Constructing ‘youth’ in this way means that

we look for the problems associated with young people,

we view them differently and we can justify giving them

fewer rights or less respect than older people. Young

Australians are paid less than their adult counterparts,

have very high unemployment rates (up to 40% in some

rural areas) and struggle to maintain rights previously

taken for granted (e.g., recent introductions of both

compulsory work-for-the-dole (unemployment benefits)

schemes and university fees) (Irving, Maunders &

Sherington, 1995; White, 1994; Wyn & White, 1997).

Many also note the homogenisation of all young people

into this category of ‘youth’ that is clearly diverse (Wyn

& White, 1997). The diversity of young people who

ARTICLE IN PRESS

3 In 1995–97 rates for 15–24-year-old males rates were 25 per

100,000 and for rural males of the same age, rates were as high

as 38 per 100,000 (Baume & Clinton, 1997; Wilkinson &

Gunnell, 2000). Kelk (1995) found that in towns less than 4000,

male suicide rates were 53 for 15–19-year-olds and 72 for 20–24-

year-olds.4Because suicide rates are calculated per 100,000, rates in

small towns can change dramatically. This is exacerbated when

a suicide is followed by others, raising the rate dramatically in a

short time.

L. Bourke / Social Science & Medicine 57 (2003) 2355–23652356

cope, remain cynical, lack connectedness and/or experi-

ence significant social and emotional issues is not well

understood (Eckersley, 2002).

Applying these negative constructions to this issue of

suicide in the US, Gaines identified young people living

in a culture and context that labels, oppresses and

degrades. In this environment, suicide is constructed as

attention seeking, not being of ‘the right mind’, being

impulsive and as ‘not real’ for young people while the

individuals are constructed as powerless, immature and

in need of help (Gaines, 1991). Eckersley (2002) argued

that increasing individualism, consumerism, economism

and lack of social connectedness have impacted young

people’s health and well-being in Australia; the former

related to suicide rates among young men. These

destructive constructions of young people, youth cul-

tures and youth suicide are critical to the social context

of youth suicide and the ways young people understand

their social world.

The social context of rural youth suicide in Australia

Rural areas are marked by high rates of stress,

unemployment, underemployment and lower levels of

education (Cheers, 1998; Craig, 1994; Dawson, 1994;

Sher & Rowe Sher, 1994). Rural communities have

fewer services, particularly health, social and youth

services, to address such issues and under current

policies these services are declining (Cheers, 1998;

Lawrence & Share, 1993). Difficulties for young rural

residents in many Australian communities surround

work and income, services and transportation (Croce,

1994). However, discussions of rural youth suicide have

given little attention to social and economic circum-

stances, despite their importance in the daily lives of

rural residents.5

Social, cultural, economic and political consequences

of rurality are also embedded in the social context in

which rural residents grow up. Rurality depresses

opportunities for, and the diversity of, social interac-

tions resulting in a lack of anonymity, fewer contacts

and greater likelihood of social isolation (Wilkinson &

Israel, 1984).6 Young residents are aware of the rapid

flow of information and the stigmas associated with

defying community norms (Wilkinson, 1991); under-

standings are constructed around community dis-

courses. Young people have witnessed marginalisation

from the community and understand the consequences

rejecting locally accepted attitudes, behaviours and/or

actions. While some will choose to reject them, these

choices are made in the context of community reactions.

While social relations in rural communities are dynamic,

there are labels attributed to young people who leave

and those who stay, those who are partnered and those

who are not, those who work and those who do not, and

many of these labels are gendered (Jones, 2000).

Gender relations are often good examples of hier-

archical social relations in a rural community (Alston,

1997). A dominant hegemonic masculinity tends to

pervade cultures of many rural communities in Aus-

tralia, which promotes the tough, independent male who

plays football, drinks beer and accepts violence (Demp-

sey, 1992). For young men who are gay, unathletic or

who do not fit the traditional male mold, development

of identity/ies is confusing and marginalising (Connell,

1995; Green (1997); Lockie & Bourke, 2001). Further,

non-local challenges to the traditional construction of

masculinity by media, women and contemporary issues

contributes to the negotiations of masculinities. In

addition, there is still strong reinforcement of traditional

feminine discourses in many rural communities which

promote women undertaking domestic duties, being

wives and mothers, supporting families and being more

passive and private (Rawsthorne, 2000). However,

women working, leaving rural communities to pursue

a career/education and changes in families are challen-

ging traditional femininities and raising multiple ex-

pectations of younger women. Therefore, young people

are making choices based on varied understandings of

gender and their interpretations of gender relations are

not constant or consistent but impact their friendships,

lifestyles and choices (Jones, 2000; Rawsthorne, 2000).

Rural communities also have other power hierarchies,

such as those based on town-land distinctions, length of

residence, community participation and ethnicity (Lock-

ie & Bourke, 2001). Of course, these vary among

communities but the negotiation of these power

relations can be very difficult for young people, not

only because they are often less firm in their convictions

and identities, but also because their negotiations are

observed by the community. Addressing the rural, social

context in which young people grow up and develop

their understandings and identities is needed to explain

understandings of youth suicide.

Therefore, efforts to understand rural youth suicide in

Australia must incorporate the stigma associated with

suicide, the social relations, poor economies and few

services in rural communities and the stereotypes made

about ‘youth’. Still, this does not explain how young

people understand suicide. This study is a preliminary

search for these understandings so as to work with

ARTICLE IN PRESS

5There are some exceptions, see Graham (1994) and Morrell

(1995).6While rural and urban people have similar numbers of

strong ties, rural residents have fewer weak ties, or acquain-

tances (Wilkinson, 1991; see also Granovetter, 1973). Such

intensity of relationships in rural areas results in less

anonymity, which can be the source of incredible stigma and

marginalisation (Wilkinson, 1984, 1991), and increases the

severity of social disruption, resulting in high rates of violence,

homicide and suicide (Wilkinson, 1984).

L. Bourke / Social Science & Medicine 57 (2003) 2355–2365 2357

young people to reconsider their choices and provide a

better social environment in which their choices are

made.

Methods

This study explores young, rural residents’ percep-

tions and understandings of, as well as negotiation

through, their social environments. It is an attempt to

view young people constructively; rather than focus on

young people as suicidal, struggling and not coping, this

study investigated how young people understand the

social contexts they live in. Because this project is an

exploratory investigation, a case study was conducted.

Hometown (a pseudonym) is a small town in NSW,

selected due to its small population and, for practical

reasons, within a day’s drive from the researcher in

Sydney.

Hometown

The 1996 census recorded approximately 2000 resi-

dents in Hometown and just over 4000 residents in the

shire.7 It is a farming region although the town is a small

service centre for the shire: 14% of the labour force in

the town and 45% of the shire’s labour force were

employed in the primary industries, while 64% of the

town and 30% of the shire’s workers were employed in

service industries. Hometown is located 45 km from a

regional centre with over 20,000 residents and many

more services. The economy of Hometown is not strong

with empty shop fronts, talk of farming difficulties and

many high school students receiving government assis-

tance (AUStudy). The census recorded an unemploy-

ment rate of 7% in the town and 6% in the shire, which

were below state and national averages (around 9%).

For those aged 15–24, unemployment was recorded as

10%, which, like the overall unemployment rate, was

higher for males. The median weekly income was not

high, $275 for individuals and approximately $400 for

households. The majority of hometown residents were

Australian born (93%) and only 1% identified as

indigenous. Most residents affiliated themselves with

the catholic, anglican or uniting churches while few had

tertiary education (ABS, 1996).

The town has several caf!e/restaurants, hotels, petrol

stations, a hospital, fire station, police station, neigh-

bourhood centre and a youth centre. There is a primary

and secondary school and the latter had approximately

270 students enrolled at the time of the study (NSW

Department of School Education, 1997). Of specific

importance to this study is the target population; in 1996

a total of 213 residents were aged between 16 and 20 in

the Hometown area, comprising of 116 males and 97

females (ABS, 1996). A 12-month review of Home-

town’s paper (June 1997–June 1998) found that 254

articles had been written about young people. Almost

half, 44%, were sporting results, just over a quarter

discussed achievements by young residents, 13% were

about the school and only 4% targeted issues such as

health and employment. Therefore, local media dis-

cussed young people in mostly positive ways but gave

little attention to non-traditional activities (e.g., the arts,

etc.) or to issues that would challenge them.

Data collection

Young people’s stories about their experiences,

problems and lifestyles from interviews provide some

understanding of the ways in which young people

construct, understand and negotiate their social world.

Young people’s language, attitudes and knowledges are

representative of their understandings, constructions

and experiences and thus serve as the basis of this

analysis (Healy & Mulholland, 1998). Such information

contributes to understanding young people’s perspec-

tives of their social world, including suicide, and

provides a voice for young people in prevention.

Subsequently, 30 interviews were conducted with

young Hometown residents in May, June and July,

1998. The young residents were sampled via a random

sample of 30 of the 68 students in Years 11 and 12 at

Hometown High School. Twenty of the 30 selected

agreed to be interviewed and provided written consent

by themselves and a parent. Most of the refusals were

young men resulting in only four high school males

being interviewed. Using snowball sampling, where

community members and other interviewees referred

potential interviewees, 16 non-students between the ages

of 16 and 20 were asked to be interviewed of which 10

agreed and provided written consent. Among these 10

respondents, most worked, some were unemployed and

a few were parents. All interviews discussed an array of

topics, including attitudes towards living in Hometown,

issues facing young people, problems and difficulties

experienced by respondents, coping strategies and

perceptions of their future. The interviews were semi-

structured so that while these issues were addressed in

every interview, any other issues raised were also

discussed. For ethical reasons, suicide was never asked

about and only discussed if first mentioned by the

respondent. Not asking about suicide was also metho-

dologically intentional, so that interviewees were not led;

however, the study investigated if and how the concept

was discussed. Interviews with young residents finished

on a positive note and interviewees were offered a list of

accessible counseling and social services.

ARTICLE IN PRESS

7As suicide rates are highest in rural communities with a

population of less than 4000 (Kelk, 1995), the size of the town

was appropriate for a case study.

L. Bourke / Social Science & Medicine 57 (2003) 2355–23652358

In addition to interviews with young people, a set of

12 key informants were interviewed about issues facing,

and coping strategies of, young residents of hometown.

These respondents were purposively selected because of

their position in the community or involvement in youth

issues.8 A total of five teachers were selected, the

principal, vice-principal, school counselor and the

advisors for years 11 and 12. A further seven community

members were interviewed including members of the

local council, police, health care providers, and those

involved in both the neighbourhood centre and the

hometown youth centre. These interviews were also

semi-structured, asking about the major issues facing

young people, their coping strategies, how young people

were perceived in the community and what helped and

hindered young people’s well-being. The 42 interviews

were recorded via notes and, if permission was obtained,

audiotapes. They were transcribed and, with the

assistance of the NUD-IST software package, analysed

to gain an understanding of how young people

experience their social world while, at the same time,

preserving their voices (see Denzin & Lincoln, 1994).

Findings are presented which capture common themes

among all interviewees and the statements by a few who

mentioned suicide. For ethical reasons this was not

asked about or discussed in any way detrimental to the

young people.

Findings

Young people’s perceptions of living in hometown

Generally, young interviewees were open, honest and

optimistic. The majority of young respondents expressed

both positive and negative views about Hometown. The

positive comments were about people and the friendli-

ness, support and closeness of the community—‘‘it’s a

good place to live’’ and ‘‘everyone knows everybody’’.

Most also talked about the town as ‘‘boring’’ or that

‘‘there is nothing to do here’’ but some said they ‘‘find

things to do’’. Most specifically mentioned that they

would not like to live in a city.

Life in Hometown varied among the young people but

some common themes were evident. Almost all young

people identified friends and/or family as the most

important sources of support, but confidentiality was

key to seeking support. Sports and drinking were central

activities in the community, both for young people and

other residents: ‘‘the only things you can do around here

is play sport or go to the pub’’. Sport was a particularly

important activity in terms of social acceptance and

many students played numerous (sometimes 6 or 8)

sports. School provided social interaction; those in

school reported that the social aspect was more

important than the education while non-students spoke

about missing the social setting that school provided.

Some mentioned the lack of choice of friends: ‘‘Like this

school doesn’t interest me much because I like a lot, you

know, a lot more different people and a bigger sort of

variety of people, everyone’s just the same around here’’.

Eight mentioned the youth centre in hometown but only

one indicated that he/she was currently involved. It was

clear that each respondent was aware that the town is

small, that ‘‘people talk’’ and there were clear bound-

aries of acceptable behaviours. They took these ser-

iously, being very concerned about stigmas associated

with drug use, unemployment, single parenthood as a

young person and having a ‘‘bad reputation’’. Many

concerns among key informants were about young

people engaging in behaviours that adults engage in,

especially alcohol use.

Social relations in a small town

Young people spoke at length about current issues in

their lives. While issues about their choices and futures

were discussed as concerns, their stories of current

experiences elicited the most detail, the most emotion

and the most frustration. These issues ranged from

abusive and dysfunctional families to disagreements

with friends, family members and choices of behaviours,

but tended to centre around interpersonal relationships.

Relationships with friends, family and other members

of the community were very important to almost all

young respondents. Some praised their friends and more

than 90% emphasised the importance of their family.

While relationships were extremely important to young

interviewees and sources of emotional support, strained

relationships with parents and friends were very difficult

and serious issues for young people. These became very

difficult to deal with if they escalated into town or school

gossip. When asked about their most recent experience

of being down, one third responded strained relation-

ships in one’s family and another six indicated problems

among friends. Young men seemed unable to manage

relationship breakups, one stating ‘‘you can’t deal with

that’’. For many, (both young men and women), it was

also very difficult to articulate their hurt over relation-

ship problems. In contrast, most of the key informants

were not sympathetic toward their relationship pro-

blems, suggesting that young people ‘‘blow these issues

all out of proportion’’.

However, it was clear that young people wanted older

people and authority figures to believe in them and often

interpreted seemingly supportive suggestions from

adults as expecting them to fail. For example, when a

teacher suggested that Greg should attend school part

ARTICLE IN PRESS

8Bourke and Luloff (1995) found this to be a valid form of

sampling to gain a cross-section of perspectives about key

community issues.

L. Bourke / Social Science & Medicine 57 (2003) 2355–2365 2359

time due to illness, Greg believed that the teacher

thought he could not handle school and resented the

teacher’s lack of support and confidence in him.

Important for students was to be able to talk to others

confidentially. They resented personal information

becoming town gossip. Another student with a mental

illness went to great lengths to hide her illness for fear of

stigma which also meant that her support networks were

limited. In the words of one student: ‘‘say hello to

someone one day and by the next day you’re sleeping

with them’’.

It was evident, particularly among the students, that

there were hierarchical social groups into which some

people ‘fit’ while others did not. Those who ‘‘fit in’’

appeared to be more social in their daily lives, confided

in friends and tended to play sport and go to parties.

Some resisted or accepted these social hierarchies

actively while others were more passive. Regardless,

most, if not all, were aware of the normative power of

‘acceptable’ versus ‘unacceptable’ behaviours. For ex-

ample, some retreated from the social expectations,

some actively negotiated their way through these social

hierarchies while others actively challenged the moral

hierarchy: ‘‘I don’t care what people think about me

[living with my boyfriend]’’. The stigmas attached to

these behaviours seemed more important than any

moral objections to the behaviours.

Employment and income

Despite the fact that most young interviewees liked

living in hometown, they realised that they would have

to leave hometown in the future for employment or

tertiary education. Half, more often those still in school,

looked forward to moving, while a third accepted they

would ‘‘just have to’’. For many, the type of job was not

important and career goals were very modest, based on

realistic terms; most wanted semi-skilled jobs and

careers such as being a cook, day care provider or

gaining an apprenticeship.

All interviewees mentioned un/employment and key

informants suggested that it was the major issue facing

young people. Young respondents, especially men, were

particularly worried about finding work: ‘‘As long as

I’m in a joby’’ Some feared being out of work because

of their understanding of the impact of unemployment,

usually through a family member. The two unemployed

men stated that there were ‘‘no jobs around.’’ Both

wanted jobs that suited them and believed they would

have to leave to find work. However, for many other

young people unemployment was identified as an issue

facing young people and/or local residents generally and

they moved on to discuss other personal issues in greater

detail.

The importance of work was reinforced in that young

interviewees who were working were less likely to have

experienced depression (as self reported) and had the

most positive attitudes towards their life than those who

were students or not working (unemployed and parents).

Work seemed to give a young person independence and

a sense of worth. The social lives of the two unemployed

men revolved around alcohol, drugs, sex and violence

for reasons of ‘‘boredom’’ and gratification. One of the

two did not receive unemployment benefits because of

the stigma to both himself and his family, which plagued

his social conscience:

What I would like most is to wake up to myself

ygive up the piss, the dope and the smokesy My

father is fifty and has always been an alcoholic and I

don’t want to be that way (at this point fighting

tears).

Gender

Gender differences were difficult to discern, partly due

to the few young male students agreeing to be

interviewed. This itself attests to the finding that young

men were less willing to talk about personal issues and

their difficulties. However, some women were also not

willing to discuss personal or problematic issues

indicating that this is not only a gender issue. Clearly,

certain expectations were associated with each gender,

including the importance of men playing sports and

women being more caring. Young people indicated that

gender roles were different from their parents’ genera-

tion, including the expectation for women to work,

acceptance of pursuing a career and men having to

respect young women’s choices and wishes. Drinking,

sports and cars were central to young men’s narratives,

especially those no longer in school. Male sports were

important throughout the whole community and many

young women spent their Saturdays watching men’s

sports. Those in the pubs were mostly men and a central

social field for most non-student males who were

interviewed. Many young women were aware of some

of the double standards that plagued gender relations,

including sexuality, careers and different rules for

brothers and sisters, but tended to dismiss their mothers

work or talked about ‘‘Mumyshe’s just a housewife’’.

When a young man’s girlfriend ‘slept with’ his ‘mate’, he

blamed the young male (resolved through a physical

fight) and not the young woman.

Some young people did experience conflicts between

gender expectations, especially those who were students

or parents. One young man wrote poetry and was fearful

about what his fellow students might say if they knew.

Young women were especially torn between encourage-

ment to pursue an education/career and pressure to stay

near their families. It seemed that young women were

more troubled by the competing gender expectations

than young men. However, young women seemed more

ARTICLE IN PRESSL. Bourke / Social Science & Medicine 57 (2003) 2355–23652360

directed, goal oriented and reflective in terms of their

future.

Suicide

Of the 30 young people, only five mentioned the word

suicide. In most cases, suicide was mentioned when

talking about being down or depressed: ‘‘Its not as if I’m

going to commit suicide or anything’’. These young

people discussed suicide generically, distancing them-

selves and rationally claiming that it was not personal.

In fact, when discussing suicide, young rural residents

downplayed its importance, suggesting they would never

take their own lives as if there was a stigma associated

with it. Their responses were almost prescribed, suggest-

ing that young people are aware of the implications of

discussing the topic and how adults would respond.

Some of the comments imply that suicide is at the end of

a continuum of depression: ‘‘I don’t get too depressed,

not too bad. I’d say about half way between suicide and

alright.’’

However, one young man did discuss being suicidal.

Fieldnotes recorded the following:

Last time he was really down was about a year ago. It

was really late at night and while in the kitchen ‘‘I

wondered what that kitchen knife would look like

hanging out of my arm’’. He felt because he had no

one to talk to (parents in bed, girlfriend in Canberra)

an overwhelming sense of loneliness.

How did he deal with it that night?

He reminded himself of his family and that he had

a good girlfriend and that they would be really hurt if

something happened to him. When asked if he thinks

many kids think about suicide he replied ‘‘no’’. He

rarely thinks about death, and when he does usually

its in a ‘‘positive way’’ because of the nature of life

and death on the farm, lambs being borny

Another admitted that she had seriously contemplated

suicide in the past but, like the student above, would

never consider suicide now. The tone of these two young

people suggested that suicide is wrong and now, in a

rational frame of mind, was not an option. There was

little discussion of how to deal with these thoughts and

little recognition that suicidal thoughts might reoccur.

Certainly, none of those who had considered suicide had

discussed it with anyone, either at the time or later,

which the prevention literature advocates. And they all

confidently affirmed that they would not become

suicidal again.

Some young people talked in stories about specific

aspects of their lives which had been difficult. Not

framed in terms of suicide, these stories reflected difficult

situations which a young person struggled to work

through each day. There was a lack of analysis for many

and they were not sure how they had coped. Some of

these were serious situations involving caring for siblings

because parents did not assume their role, or dealing

with parents who were alcoholics and/or violent. Some

rebelled against community or parental expectations,

such as staying out overnight despite reactions of

parents. In these situations, support from friends or

other family members made the situation bearable. For

a 17-year-old mother, the social isolation made her

question ‘‘have I ruined my life?’’ Many of the young

men used violence to resolve conflicts with other men,

including physical fights with male friends and fathers

which sometimes resulted in broken bones. This was

accepted as ‘‘the way it is’’. Is it any wonder, then, that

when the problem is the self, resolution is via self-harm.

For the most part, teachers did not want to be

counselors and indicated that it was problematic to

know about a student’s problems while also being a

local resident and perhaps a friend of the young person’s

parents. All the teachers interviewed indicated that they

would not ignore a student who came to them for

support or advice but they were reluctant to confront

students for a range of reasons.

Almost half, five, of the key informants mentioned

suicide. It was discussed in terms of Australia’s high

suicide rates or in reference to a publicised suicide in the

nearest regional centre. Most suggested that ‘‘it is

definitely not a problem here, noy’’. Only two key

informants discussed the issue to any length, one

highlighting the negative discussions of youth and

challenging the assumption that it would not happen

here:

The media are telling kids that times are tough which

may be necessary. This makes kids see themselves in

a negative light. I think they need positive reinforce-

ment and positive message and that educators need

to think about it. I don’t really have any solution.

When there is a suicide in [the nearest regional

center], it strikes close to home because there is an

attitude that these things happen in Sydney and

Canberra and they don’t happen here. Suddenly, a

youth suicide in [the nearest regional center], in the

last two years has been on the grow. A recent suicide

in [the nearest regional center] was children of well

known families and that makes everything a bit more

personal. If these things are happening then we’re not

doing enough to address problems.

The other key informant to discuss suicide was a

teacher who was troubled by her lack of understanding

of it:

One girl last year, it seemed ridiculous to me, wanted

to suicide because she was fighting with some girls.

She came from a good functional family and these

girls were teasing her to the point where she wanted

ARTICLE IN PRESSL. Bourke / Social Science & Medicine 57 (2003) 2355–2365 2361

to suicide. You know, if someone said their mother

had suicided I could understand but to me, it seemed

to me, to be such a trivial reason to do it. Perhaps

there is a lack of understanding of the reality of what

suicide was about. It seemed like a lack of maturity.

That really struck me, you know, people in deep

depression, yes I can see that, but a girl who has been

excluded by a group of girls, that was her reaction.

She was genuine.

The tone of the teacher was not a lack of belief in the

student’s seriousness about being suicidal but bewilder-

ment that a student, without any evident triggers or

major causes, would feel this way over such a ‘‘trivial’’

issue. The teacher’s reaction assumes that there are

issues which may warrant depression and suicide and

those which do not.

Discussion

This analysis raises some interesting issues about life

in an Australian rural community and its relationship to

young people’s understandings of suicide. After discuss-

ing the social construction of youth suicide, interviews

with young residents of a small rural community

revealed some interesting ideas about their understand-

ings of social life and their interpretations of the

problem of youth suicide. Social relationships, a poor

economy and constructions of youth, community and

gender were related to the experiences of young people

and their sources of depressive moods. As a small case

study with fewer male interviewees, the study is limited,

but it raises questions about youth suicide prevention.

Interpersonal relationships were perhaps the issue

young people struggled with most. While young people

are surrounded by cultural representations implicating

relationships as central to social life, their own relation-

ship difficulties were trivialised as little fights and

gossips. Young people may well be less experienced

with conflict, break-ups and interpersonal tensions, and

these experiences were the most difficult for young

people to resolve or manage (see Bourke, 2002). For

teachers, parents and older community residents to

trivialise such relationship difficulties may well limit

young people’s search for support, advice and encour-

agement.

Young people negotiated their way through gendered

social hierarchies in the local community. Young men

hid anything associated with femininity, such as poetry

writing, and used masculine behaviours to be accepted,

including sport, farming and drinking. Young women

struggled with the double standards that plagued gender

relations, the expectations to live locally and develop

their own career, and the difficulties of conflict. Local

understandings of gender shaped young peoples choices,

behaviours and decisions about their future (Jones,

2000; Rawsthorne, 2000).

As getting along with others (both peers and

community members) was important, local norms,

expectations and cultures shaped young people’s mean-

ings and knowledge. Young residents tended to embrace

normalised discourses of their local community, includ-

ing acceptable behaviours, constructions of masculi-

nities and femininities, and stigmas associated with

unemployment, single motherhood and suicide. Some

used the interview process to discuss their ‘secrets’ and

reveal identities not acceptable in Hometown. Others

spoke about the frustration of living in a community

that is unsupportive of their goals or lacking the social

support networks for who they want to be. Young rural

residents made choices about the extent to which they

will fit in, work with or reject existing social hierarchies.

Therefore, young people’s understandings of social life,

interpersonal relationships and suicide were strongly

shaped by the local community. Consequently, chal-

lenges to some of the dominant discourses in small,

agricultural communities like Hometown, including the

acceptance of violence among men and marginalisation

of those not ‘mainstream’, could assist in improving the

social context for young rural residents generally and

addressing youth suicide specifically. This highlights the

need for community development, community capacity

building and primary prevention programs tailored to

the local community (Davis, 1992; de Vaus, 1996;

Graham, 1994; Mitchell, 2000; Taylor, 1999).

Rurality was not implicated as problematic or a

barrier to coping. However, the lack of confidentiality,

anonymity and choice of friends were important issues

in the daily lives of these young residents (see Wilkinson,

1991). Further, the poor local economy was not only a

concern they were well aware of, it shaped their choices,

opportunities and futures. Clearly, the awareness of

unemployment, modest career aspirations and inability

to travel/relocate due to cost demonstrated how a poor

economy shaped choices and understandings of young

people. Therefore, living in a rural community is not in

itself a problem for young people but the current social

and economic circumstances of rural communities,

whereby local norms are rigid and poor economies

prevent young people working or leaving, make rural

life problematic. This suggests that rural communities

with good economies and social norms that are more

accepting of difference would provide young people with

more opportunities and choices, more varied under-

standings of the social world and greater ability to

develop their identities that may help develop a more

constructive perspective of how to negotiate their social

world.

Findings about suicide are preliminary here because it

was not discussed frequently. However, most young

respondents removed suicide from a personal perspec-

ARTICLE IN PRESSL. Bourke / Social Science & Medicine 57 (2003) 2355–23652362

tive. Further, the finding that two of 30 young people in

the community discussed having contemplated suicide

identifies it as an issue facing many young residents.9

The importance of confidentiality for young people

living in a rural community questions the effectiveness of

prevention strategies encouraging young people to tell

someone. Other respondents indicated that young

people ‘know’ they are not supposed to admit to suicidal

thoughts and are reluctant to explore or discuss them.

Clearly, there is a stigma surrounding suicide; young

people are aware of it and not willing to confide in

others at the time. Stigmas also surround mental health

with one student going to extreme lengths to hide her

illness. An association between suicide and mental

illness was implied through suicide being discussed when

asked about depression and often linked to depression in

specific statements.

Interestingly, contemplations of suicide were dis-

cussed in the past tense, as something that happened

before and would not happen again. When discussed,

suicide was rationalised as behaviour respondents would

not currently undertake. This is problematic considering

that suicide has a strong correlation with mental illness

and depression that do reoccur. This questions whether

young people are able to discuss suicidal or depressive

thoughts, why they have a tendency to dismiss the

emotional trauma of contemplation and why they think

they will not feel suicidal again.

Youth suicide seemed to be understood differently by

young people and key informants. While adults men-

tioned suicide as an isolated, disturbing issue, young

people spoke of it in terms of a response. This supports

Taylor’s (1999) insight that young people view suicide as

a solution rather than a problem. Further, it questions

whether or not prevention strategies are targeted to

young people’s or older people’s understandings of

suicide. This highlights the need to include the perspec-

tives, understandings and voices of young people in

youth suicide prevention.

In conclusion, this study reinforces the need for

primary prevention for rural young people based on the

social contexts in which these young people learn

communication and coping skills. In particular, it

supports strategies aimed to assist young people

negotiate social relations, increase tolerance of differ-

ence and urges adults to take young people’s concerns

seriously. Further, it encourages employment programs,

including apprenticeship programs, job creation

schemes, relocation assistance for young people who

want to move from rural areas for employment and/or

education (Graham, 1994). Finally, it proposes that

rethinking rural youth suicide, to incorporate the social

context, dominant discourses and sources of young

people’s knowledges, may well improve the wellbeing of

young residents in Australian rural communities.

Acknowledgements

The author thank all those who shared their stories,

experiences and personal journey with the researchers as

well as Jonathan Hulme for his assistance and skill in

collecting data and working with the young people of

Hometown.

References

ABS. (1996). Census of population and housing. Canberra:

Australian Bureau of Statistics.

ABS. (2002). Australian social trends 2002: Health—national

summary tables. http://www.abs.gov.au/socialtrends/health/

nationalsummary: ABS (Retreived 23/12/02).

Alston, M. (1997). Women in rural Australia: A case for

cultural misogyny. In P. Share (Ed.), Communication and

culture in rural areas (pp. 87–96). Wagga Wagga: Centre for

Rural Social Research Charles Sturt University.

Baume, P. J. M. (1995). Developing a national suicide strategy

for Australia. In: Suicide prevention: Public health signifi-

cance of suicide prevention strategies (pp. 59–68). Canberra:

Public Health Association of Australia.

Baume, P. J. M., & Clinton, M. E. (1997). Social and cultural

patterns of suicide in young people in rural Australia.

Australian Journal of Rural Health, 5, 115–120.

Beautrais, A. L. (2000). Risk factors for suicide and attempted

suicide among young people. Australian and New Zealand

Journal of Psychiatry, 34(3), 420–436.

Beautrais, A. L., Joyce, P. R., & Mulder, R. T. (1996). Risk

factors for serious suicide attempts among youths aged 13

through 24 years. Journal of the American Academy of Child

and Adolescent Psychiatry, 35(9), 1174–1182.

Best, J. (1993). But seriously folks: The limitations of the strict

constructionist interpretation of social problems. In J. A.

Holstein, & G. Miller (Eds.), Reconsidering social construc-

tionism: Debates in social problems theory (pp. 212–226).

New York: de Gruyter.

Bourke, L. (2002). How can you deal with that? Coping

strategies among young residents of a rural community in

New South Wales. Journal of Family Studies, 8(2), 197–212.

Bourke, L., & Luloff, A. E. (1995). Leaders’ perspectives on

rural tourism: Case studies in Pennsylvania. Journal of the

Community Development Society, 26(2), 224–239.

Burnley, I. H. (1995). Socioeconomic and spatial differentials in

mortality and means of committing suicide in New South

Wales, Australia, 1985–91. Social Science & Medicine, 41(5),

687–698.

Bush, R. (1990). Rural youth suicide. Rural Welfare Research

Bulletin, 6(December), 25–27.

Cantor, C. H., & Slater, P. J. (1997). A regional profile of

suicide in Queensland. Australian and New Zealand Journal

of Public Health, 21(2), 181–186.

ARTICLE IN PRESS

9This also suggests that suicide research involving the general

public and not just those ‘at risk’ is also insightful.

L. Bourke / Social Science & Medicine 57 (2003) 2355–2365 2363

Cantor, C. H., Neulinger, K., & De Leo, D. (1999). Australian

suicide trends 1964–1997: Youth and beyond? Medical

Journal of Australia, 171(3), 137–141.

Cheers, B. (1998). Welfare bushed. London: Ashgate.

Connell, R. W. (1995). Masculinities. Sydney: Allen & Unwin.

Craig, D. (1994). Nature of educational disadvantage in

country schools: A South Australian perspective. In D.

McSwan, & M. McShane (Eds.), Issues affecting rural

communities (pp. 247–251). Townsville: Rural Education

Centre, James Cook University.

Croce, C. (1994). Towards a national rural youth policy. Rural

Society, 4(1), 15–20.

Davis, A. (1992). Suicidal behaviour among adolescents: Its

nature and prevention. In . R. Kosky (Ed.), Breaking out:

Challenges in adolescent mental health. Canberra: AGPS.

Dawson, B. (1994). Rural employment in Australia. Rural

Society, 4(2), 14–21.

Dempsey, K. (1992). A man’s town. Melbourne: Oxford

University Press.

Denzin, N., Lincoln, Y. (Eds.). (1994). Handbook of qualitative

research. Thousand Oaks: Sage.

de Vaus, D. (1996). Suicide among young Australians. Family

Matters, 44(winter), 42–45.

DHSH (Commonwealth Department of Human Services and

Health, Mental Health Branch). (1995). Here for life: A

national plan for youth in distress. Canberra: Mental Health

Branch, Commonwealth Department of Human Services

and Health.

DHFS (Commonwealth Department of Health and Family

Services). (1997a). Youth suicide in Australia: A background

monograph (2nd ed). Canberra: AGPS.

Dudley, M., Kelk, N., Florio, T. M., Howard, J., & Waters, B.

(1998). Suicide among young Australians, 1964–1993—an

interstate comparison of metropolitan and rural trends.

Medical Journal of Australia, 169(2), 77–80.

Dudley, M., Waters, B., Kelk, N., & Howard, J. (1992). Youth

suicide in NSW: Urban–rural trends. Medical Journal of

Australia, 156, 83–88.

Eckersley, R. (1993). Failing a generation: The impact of

culture on the health and well-being of youth. Journal of

Paediatric and Child Health, 29(Suppl 1), S16–S19.

Eckersley, R. (1998). Rising psychosocial problems among

young people. Family Matters, 50(Winter), 50–52.

Eckersley, R. (1999). What the !#&* have values got to do with

anything! Young people, youth culture and well-being. In R.

White (Ed.), Australian youth subcultures, on the margins and

in the mainstream (pp. 209–221). Hobart: ACYS.

Eckersley, R. (2002). Taking the prize or paying the price

Young people and progress. In R. Rowling, G. Martin, & L.

Walker (Eds.), Mental health promotion and young people

concepts and practice (pp. 70–83). Sydney: McGraw-Hill.

Emslie, M. (1996). Ignored to death: Representation of

young, gay men, lesbians and bisexuals in Australian youth

suicide policy and programs. Youth Studies Australia, 15(4),

38–42.

Fergusson, D. M., & Lynskey, M. T. (1995). Childhood

circumstances, adolescent adjustment and suicide attempts

in a New Zealand birth cohort. Journal of the American

Academy of Child Adolescent Psychiatry, 34(5), 612–622.

Gaines, D. (1991). Teenage wasteland: Suburbia’s deadend kids.

New York: Harper Collins.

Graham, D. (1994). Adolescent suicide in the Australian rural

recession. Australian Journal of Social Issues, 29(4),

407–411.

Granovetter, M. (1973). The strength of weak ties. American

Journal of Sociology, 78(6), 1360–1380.

Green, E. (1997). Youth suicide in the bush: he was the type of

guy you wouldn’t expect to be gay. Paper presented at the

Rural Australia: Towards 2000 Conference, Wagga Wagga,

July 2–4.

Hassan, R. (1995). Suicide explained, the Australian experience.

Melbourne: Melbourne University Press.

Healy, K., & Mulholland, J. (1998). Discourse analysis

and activist social work: Investigating practice pro-

cesses. Journal of Sociology and Social Welfare, XXV(3),

3–27.

Hunter, E. (1991). Out of sight, out of mind—Emergent

patterns of self-harm among Aborigines of remote Aus-

tralia. Social Science & Medicine, 33(6), 655–659.

Irving, T., Maunders, D., & Sherington, G. (1995). Youth in

Australia. Melbourne: Macmillan.

Jones, G. W. (2000). Babes in the bush: Youth, gender and

identity among young rural women. Unpublished Ph.D.

thesis, University of Melbourne.

Kelk, N. (1995). The suicide of young men: Causation,

understanding and prevention. In the Proceedings from the

The National Men’s Health Conference. Canberra: AGPS.

King, R. (1994). Suicide prevention: Dilemmas and some

solutions. Rural Society, 4(3/4), 2–6.

Kosky, R. (Ed.). (1992). Breaking out: Challenges in adolescent

mental health. Canberra: AGPS.

Lawrence, G., & Share, P. (1993). Rural Australia: Current

problems and policy directions. Regional Journal of Social

Issues, 27, 3–9.

Lockie, S., Bourke, L. (Eds.). (2001). Rurality bites: The social

and environmental transformation of rural Australia. Sydney:

Pluto Press.

Lynskey, M., Degenhardt, L., & Hall, W. (2000). Cohort trends

in youth suicide in Australia 1964–1997. Australian and New

Zealand Journal of Psychiatry, 34(3), 408–412.

McKillop, S. (Ed.). (1992). Preventing youth suicide

conference proceedings. Canberra: Australian Institute of

Criminology.

Mitchell, P. (2000). Valuing young lives: Evaluation of the

national suicide prevention strategy. Melbourne: Australian

Institute of Family Studies.

Morrell, S. (1995). Suicide: A historical perspective with some

implications for research and prevention. In Suicide preven-

tion: Public health significance of suicide—prevention strate-

gies (pp. 34–46). Canberra: Public Health Association of

Australia.

NSW Department of School Education. (1997). Directory of

government schools in New South Wales. Sydney: NSW

Department of School Education.

Rawsthorne, M. (2000). Complex negotiations: Discourses that

shape rural young people’s understandings and experience of

sexuality and sexual violence. Unpublished Ph. D. thesis,

University of Sydney.

Sher, J., & Rowe Sher, K. (1994). Beyond the conventional

wisdom: Rural development as if Australia’s rural people

really mattered. In D. McSwan, & M. McShane (Eds.),

Issues affecting rural communities (pp. 1–14). Townsville:

ARTICLE IN PRESSL. Bourke / Social Science & Medicine 57 (2003) 2355–23652364

The Rural Education Research and Development Centre,

James Cook University.

Tait, G. (1993). Youth, personhood and practices of the self:

Some new directions for youth research. Australian and New

Zealand Journal of Sociology, 29(1), 40–54.

Taylor, B. (1999). Young people and youth suicide. Keynote

address to communities helping young people conference.

Hervey Bay, May.

White, R. (1993). Young people and the policing of community

space. Australian and New Zealand Journal of Criminology,

26(December), 207–218.

White, R. (1994). The problem of theory in Australian youth

studies. Discourse, 14(2), 79–91.

Wilkinson, K. P. (1984). Rurality and patterns of social

disruption. Rural Sociology, 49(1), 23–36.

Wilkinson, K. P. (1991). The community in rural America. New

York: Greenwood Press.

Wilkinson, D., & Gunnell, D. (2000). Youth suicide trends in

Australian metropolitan and non-metropolitan areas 1988–

1997. Australian and New Zealand Journal of Psychiatry,

34(5), 822–828.

Wilkinson, K. P., & Israel, G. D. (1984). Suicide and rurality in

urban society. Suicide and Life Threatening Behavior, 14(3),

187–200.

Wyn, J., & White, R. (1997). Rethinking youth. Sydney: Allen &

Unwin.

ARTICLE IN PRESSL. Bourke / Social Science & Medicine 57 (2003) 2355–2365 2365