Suicide and mental health in rural, remote and metropolitan areas in Australia.

OBJECTIVES To compare the prevalence of mental health disorders and the use of professional help by area of residence, age and sex; and to determine whether the differences parallel differences in suicide rates. DESIGN Retrospective cross-sectional analysis of Australian national mortality data (1997-2000) and the National Survey of Mental Health and Wellbeing (1997), using broad area-of-residence classifications based on the Rural, Remote and Metropolitan Area (RRMA) index. MAIN OUTCOME MEASURES (a) Suicide rates; (b) prevalence of depression, anxiety and substance-use disorders; and (c) use of health professionals for mental health problems - by age, sex and area of residence. RESULTS Higher suicide rates were evident for men, particularly young men in rural (40.4 per 100 000; z, 3.2) and remote (51.7 per 100 000; z, 7.2) populations compared with metropolitan (31.8 per 100 000) populations. Although the proportion of young men reporting mental health disorders did not differ significantly between rural (23.5%; z, -0.5) and remote (18.8%; z, -1.6) areas compared with metropolitan (25.6%) areas, young men with a mental health disorder from non-metropolitan areas were significantly less likely than those from metropolitan areas to seek professional help for a mental health disorder (11.4% v 25.2%; z, -2.2). CONCLUSIONS There is a need to investigate why young men in non-metropolitan areas, the population with the greatest suicide risk, do and do not engage with mental health services.