Significant Impacts of Built Environment on Public Housing Residents’ Suicide Rates: A 13-Year Natural Experiment

Abstract

Suicide is a global problem. It is known that socioeconomic and demographic factors influence suicide rates, but little is known about the impacts of built environment factors on suicide rates after controlling for self-selection bias. We explored this gap via a natural experiment conducted in 151 rent-only public housing communities in Hong Kong from 2005 to 2017, during which period there were 5,841 suicide deaths in these communities. The regulations of public-housing constituted a natural experiment with minimal self-selection bias. We conducted hierarchical regression analyses and found that built environment factors collectively have a significant association with suicide rates. Three significant environmental factors were identified: distance to the nearest urban center, distance to the nearest Mass Transit Railway station, and gross flat area per person. These findings demonstrate that the built environment plays a significant and independent role in predicting suicide rates. Environmental interventions to prevent suicide is necessary and pressing.