Rethinking suicide in urban and rural areas. A critical approach to research of suicide in Castellon

Dear Editor,

I read with interest the research study entitled “Suicide in Castellon, 2009–2015: Do sociodemographic and psychiatric factors help understand urban-rural differences?”.¹ The critical position I wish to argue regards the epistemological stance of which the aforementioned research study is an expression, and therefore, an example.

According to the interests to understand declared by the authors, I believe that the principal limitation of the study was to classify the differences in suicides in both areas, without discussing rural and urban areas as part of the problem itself. I have no doubt that the statistical method used by the authors was consistent with their design logic. However my critical stance as an investigator of the subject comes into play when I’m asked about the explanations that are being left out, and the scope of current results in preventing suicide taking rurality or urbanity into account. This letter is an attempt to respond to these 2 questions.

There is a long epistemological tradition in health research which has fragmented understanding of social matters by factors that are more or less relevant, for which there is growing evidence. The abovementioned research study focuses on these types of approach.

According to the study data we know that of the total sample there was a higher suicide rate among males, and from the rural environment. We know that they use more lethal methods. Consequently a prevention strategy could target males as the group at greatest risk. However, we could limit ourselves to regulating the methods that they use in their suicide attempts, or ask ourselves what it means to be male in either environment. The same applies to females.

The answer to this question implies exploring, for example, how attempts by males are sanctioned in a patriarchal society, which expects emotional repression, success and optimisation of the male body. In rural contexts these expectations are reinforced by a traditional division in gender roles, as part of the production activities that are traditionally undertaken by men.

Various research studies^2–4 on the phenomenon of suicide in rural and urban contexts support the need to understand how emotions are experienced and expressed in both spaces, through the ways that families are organised, how responsibilities and free time are distributed, and access to education and employment. Added to this are current phenomena such as the impact of neoliberal policies in reorganising families, migration and the rupture of emotional ties between their members, as well as precarious work conditions, which have a differential impact on men and women.^5,6

We can continue to discuss results with the support of literature references that are statistically consistent with the findings, but the urban and the rural are not universal categories. In a comprehensive approach to culturally unique contexts, equal suicide rates could be explained by completely different processes.

One way of complementing or looking beyond a factorialist and historical view of social spaces, in this case urban and rural, is to understand the study aim as a network that expresses a social context. Based on that logic, either space could be studied as relatively stable ways of social organisation that regulate and express the different ways of being of human individuals and groups. We must remember that mental health is not only a field and category of study, but also how lives are lived on a daily basis.

These types of viewpoints involve an inter- and trans-disciplinary effort. This is why my critical stance is directed not so much at the aforementioned research study, which is over, but towards what it could have been, and towards those yet to be undertaken. The utility of science depends on the answers as well as the possibility of changing the questions.

Funding

This paper was financed with the support of a national grant awarded by the Mexican National Council on Sciences and Technology.