A tale of two cities: Suicide rates in Sydney and Melbourne are consistently lower than the rest of Australia

To the Editor

Recent data from the Australian Bureau of Statistics reveal higher suicide rates in rural areas, particularly among Aboriginal and Torres Strait Islander people. Such metropolitan/rural differences are well recognised internationally with cities over 1 million population having lower rates (Ivey-Stephenson et al., 2017). The ABS data for 2010/2018 also show a significant gap between the largest conurbations and the rest of the country: Sydney and Melbourne have the lowest suicide rates in Australia (Figure 1). The ‘Greater national cities total’ is an average for all state and territory capital cities, as well as the Australian Capital Territory (ACT), which has suicide rates that are relatively low but variable, overlapping the national average, given as ‘Australia total’. It is also notable that rural Victoria and rural New South Wales (NSW) rank below other rural areas and some capital cities. Overall, suicide rates are lower in the southeast corner of the country.

Figure 1.

Australian capital city and rural suicide rates from 2010 to 2018 (means and 95% confidence intervals).

Emile Durkheim observed, ‘every society is predisposed to supply a given number of voluntary deaths’ (Durkheim, 2006). While Sydney and Melbourne have many disadvantaged neighbourhoods, nevertheless there appear to be significant social benefits for people who live in these global cities, where migration and high population densities drive innovation, economic activity, employment, international universities, arts and culture, cutting edge architecture, huge sporting events, and more generally, city liveability. In 2019, the Economist Intelligence Unit ranked Melbourne as the second most liveable city in the world (after Vienna, Austria) and Sydney as the third most liveable city (https://www.eiu.com/topic/liveability). City liveability is a composite of various indicators, some of which are related to the sociology of suicide: these indicators include higher social cohesion, better employment, less income inequality, lower crime rates, ready availability of health and social services and educational opportunities (Badland et al., 2014).

Commenting on the 2019 ABS data, the Prime Minister’s National Suicide Prevention Advisor echoed Durkheim on the need to focus on the social determinants of suicide and highlighted the higher average suicide rates ‘among those who live outside our capital cities’. (https://www.health.gov.au/news/statement-from-the-prime-ministers-national-suicide-prevention-adviser-abs-causes-of-death-data) Our analysis of the ABS data reveals a more complex picture with overlapping suicide rates among the smaller capital cities and rural areas (Figure 1). Judging by the suicide data, there are two Australias: the south-eastern cities and the rest. Rather than just concentrating on the rural/metropolitan distinction, it may be important for suicide researchers and policy makers to emphasise that suicide rates tend to rise outside the global cities of the southeast. This may provide a more accurate description of the geography of suicide in Australia.