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    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Björkenstam, Emma Dalman, Christina Vinnerljung, Bo Weitoft, Gunilla Ringbäck Walder, Deborah J and Burström, Bo 2016. Childhood household dysfunction, school performance and psychiatric care utilisation in young adults: a register study of 96 399 individuals in Stockholm County. Journal of Epidemiology and Community Health, Vol. 70, Issue. 5, p. 473.

    O’Farrell, IB Corcoran, P and Perry, IJ 2016. The area level association between suicide, deprivation, social fragmentation and population density in the Republic of Ireland: a national study. Social Psychiatry and Psychiatric Epidemiology, Vol. 51, Issue. 6, p. 839.


Individual- and area-level influence on suicide risk: a multilevel longitudinal study of Swedish schoolchildren

  • S. Zammit (a1) (a2), D. Gunnell (a2), G. Lewis (a2), G. Leckie (a3), C. Dalman (a4) and P. Allebeck (a4)
  • DOI:
  • Published online: 24 April 2013

Characteristics related to the areas where people live have been associated with suicide risk, although these might reflect aggregation into these communities of individuals with mental health or social problems. No studies have examined whether area characteristics during childhood are associated with subsequent suicide, or whether risk associated with individual characteristics varies according to childhood neighbourhood context.


We conducted a longitudinal study of 204 323 individuals born in Sweden in 1972 and 1977 with childhood data linked to suicide (n = 314; 0.15%) up to age 26–31 years. Multilevel modelling was used to examine: (i) whether school-, municipality- or county-level characteristics during childhood are associated with later suicide, independently of individual effects, and (ii) whether associations between individual characteristics and suicide vary according to school context (reflecting both peer group and neighbourhood effects).


Associations between suicide and most contextual measures, except for school-level gender composition, were explained by individual characteristics. There was some evidence of cross-level effects of individual- and school-level markers of ethnicity and deprivation on suicide risk, with qualitative interaction patterns. For example, having foreign-born parents increased the risk for individuals raised in areas where they were in a relative minority, but protected against suicide in areas where larger proportions of the population had foreign-born parents.


Characteristics that define individuals as being different from most people in their local environment as they grow up may increase suicide risk. If robustly replicated, these findings have potentially important implications for understanding the aetiology of suicide and informing social policy.

Corresponding author
*Address for correspondence: Dr S. Zammit, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Heath Park, Cardiff CF14 4XN, Wales, UK. (Email:
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