Compositional, contextual and collective community factors in mental health and wellbeing in Australian rural communities:perspectives from the front line

Rates of suicide in rural Australia are disproportionately high when compared with rates of suicide in urban Australia, and have seen alarming increases over the last half-century. Notwithstanding this, elevated rates of suicide are not consistent across all rural Australian areas, nor does mental health and wellbeing form a homogeneous picture across all rural communities. While there is an extensive body of research into risk factors for suicide, this literature is unable to provide a comprehensive account of why rates of suicide have been elevated in some small rural communities but not in others. Macintyre and colleagues (Macintyre, 1997; Macintyre, Ellaway, & Cummins, 2002) proposed that geographic variations in physical and mental health can be understood through the combination of compositional (the individuals), contextual (the physical environment) and collective (the local history and culture) factors pertaining to particular “places”. This qualitative study investigated this framework through an examination of potential “place” effects contributing to disparate rates of suicide between four small rural Victorian communities. The aims of this study were: (i) to gain an in-depth understanding of factors perceived by rural mental health professionals to be important to the mental health of local residents in four rural Victorian towns, two with “high” rates of suicide and two with “low” rates of suicide, in order to ascertain whether these identified factors could be conceptualised within the framework provided by Macintyre and colleagues, and (ii) to assess whether differences in perceived compositional, contextual and collective community factors between the four towns served to build an understanding of the differences in their recorded rates of suicide. Using a Grounded Theory approach (Glaser & Strauss, 1967) to the analysis of in-depth interviews with rural mental health professionals, the major compositional themes identified in this study were population make-up and demographics and mental health issues, the major contextual themes identified were physical environment and climate, employment opportunities, availability of housing, and mental health and other services, and the major collective themes identified were identity of the town and values and behaviours. Each of the thematic factors which emerged from analysis during this study were able to be adequately mapped under the broad constructs of compositional, contextual, and collective factors and as such could be successfully conceptualised within the framework proposed by Macintyre and colleagues. In the four rural towns included in this study, patterns of variation in both perceived contextual and collective community factors, though not compositional factors, offered insight into possible differences in the mental health and wellbeing of residents in these communities, and contributed important information towards building an understanding of differences in their rates of suicide. Finally, in considering a theoretical account for the data in this study, it is proposed that connectedness may be the underlying mechanism by which compositional, contextual, and collective factors influence mental health and wellbeing in small rural communities.