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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