Suicide and Place: how do area characteristics affect suicidality? A Meta-ethnography

Suicidality affects individuals, social networks, and societies. Despite strong evidence for the social determinants of suicide, suicidality is typically treated as a private psychological issue with interventions at an individual or interpersonal level. With a sociological imagination, private troubles are public issues. Suicide has been consistently associated with local area characteristics (e.g. economic disadvantage, rurality, urbanicity, social isolation, built environment). With growth in qualitative and sociological research on suicide, there is space for a qualitative evidence synthesis aiming to explore potential mechanisms between suicidality and area characteristics. To develop conceptual findings, the synthesis method of meta-ethnography was chosen. A comprehensive search for qualitative research with participants affected by suicidality in a local-area context identified 2576 unique results. After title and abstract screening, 456 full texts were reviewed. This systematic review identifies 123 qualitative studies that report on area-level characteristics affecting suicidality. Purposively sampling for conceptually rich and relevant findings, 31 papers were translated into each other developing third-order constructs and lines of argument. Synthesising 31 articles, representing over 1200 participants affected by suicide, 3 potential mechanisms are identified between area characteristics and suicidality. In socially disadvantaged areas, Cumulative Disadvantage leads to Social Disempowerment. Areas with social isolation or incohesion influence Anomic Disaffection. In highly cohesive communities, Social Pressure affects a Contradictory Social Position. Area characteristics can affect suicidality through forms of alienation (material, social, and internal). These findings contribute to a social model of suicide, with implications for place-based suicide prevention starting before suicidality to build social meaning.