Suicide trends and geographical variations in the United Kingdom ...

Health Statistics Q u a r t e r l y 3 1

Autumn 2006

Suicide trends and geographical variations in the United Kingdom, 1991–2004 Anita Brock, Allan Baker and Clare Griffiths, Office for National Statistics; Graham Jackson, General Register Office for Scotland; Gillian Fegan and David Marshall, Northern Ireland Statistics and Research Agency

Introduction

Almost 6,000 people killed themselves in the UK in 2004. While suicide rates in the UK fell between 1991 and 2004 this decrease did not occur in all areas. Large disparities remain between suicide rates in the countries of the UK, and between regions and local areas. This article also presents inequalities in suicide rates by deprivation, and considers change over time, for men and women, and for different age groups.

There is a long tradition of the investigation of geographical differences in suicides. The Thirty-third Annual Report of the Registrar General, for example, reported how the 1,554 suicides in 1870 were distributed across the regions of England and Wales.1 Examining differences within the UK has traditionally been complicated by the fact that countries have different registration and coding systems for deaths from suicide. The most recent decennial supplement on geographical variations in mortality investigated the pattern of suicide at local authority level in the UK between 1991 and 1997, and examined differences between countries and English regions.2 It reported that the highest suicides rates were in Scotland for both sexes, while men in Wales also had rates which were significantly higher than the rate for the UK as a whole. Since these figures were published, population estimates for the UK have been revised to take into account results from the 2001 Census. For this article, rates were therefore calculated again for 1991 to 1997, but based on the most recent population estimates. Suicides have also been analysed for a subsequent seven year period from 1998 to 2004, to see if there have been changes over time in the geographical distribution of suicides in the UK. Previous studies have shown that there is a link between deprivation and suicide. In 1991–1993 men aged 15–64 who lived in the most deprived areas of Great Britain had suicide rates which were double those of men living in the least deprived areas.3 This article presents an analysis of the relationship between deprivation and suicide in England and Wales for 1999–2003 for men and women aged 15 and over.

Nationnaall SSttaatti isstti iccss Natio

H e a l t h S t a t i s t i c s Q u a r t e r l y 3 1

Methods

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Box two

Definitions In this article ‘suicide’ has been defined as deaths given an underlying cause of intentional self-harm or injury/poisoning of undetermined intent. In England and Wales, it has been customary to assume that most injuries and poisonings of undetermined intent are cases where the harm was selfinflicted but there was insufficient evidence to prove that the deceased deliberately intended to kill themselves.4 In this article, for comparability, this definition has been used across all countries of the UK and data were selected using the International Classification of Diseases (ICD) codes listed in Box One.

Box one ICD-9 and ICD-10 underlying cause codes used in this analysis ICD-10

ICD-9 Description

X60–X84 Y10–Y34*

E950–E959 Intentional self-harm E980–E989 † Injury/poisoning of undetermined intent

* Excluding Y33.9 where the coroner’s verdict was pending in England and Wales. † Excluding E988.8 for England and Wales. The ICD-10 definition excludes sequelae of intentional self harm (Y87.0) and sequelae of event of undetermined intent (Y87.2) although they are included within the ICD-9 definition. However, due to the very small numbers of deaths assigned to these codes the data remain comparable between the two ICD Revisions. Previous analyses5,6 found that the change from the Ninth (ICD-9) to the Tenth (ICD-10) Revision did not affect the numbers of suicides overall. This means that the figures used within this analysis are comparable across the period covered. ICD-10 was introduced in Scotland in 2000 and in England and Wales and Northern Ireland in 2001. Deaths of undetermined intent for children cannot be considered to be suicides in the same way that they have been for adults. This article therefore analyses data for adults aged 15 and over only. Wherever ‘allage’ rates or numbers are mentioned this refers to the number or rate for those aged 15 and over.

Mortality data Mortality data used in this article, which are collated from death certification and registration, are collected and processed by the Office for National Statistics (ONS) for England and Wales, the General Register Office for Scotland (GROS), and the General Register Office for Northern Ireland (GRONI), which is part of the Northern Ireland Statistics and Research Agency (NISRA). The countries of the UK have different registration and coding systems for deaths from suicide which may introduce misleading variations. These systems are described in Box Two.

Mortality analysis Suicide rates are reported for single years from 1991 to 2004 for the UK, in three-year moving averages for constituent countries and English regions, and in two seven-year periods for local areas. Rates for broad age bands are also reported for the same periods: 1991–1997 and 1998–2004.

Registration, coding and analysis of suicides in England and Wales, Scotland and Northern Ireland In England and Wales, by law, a death should be registered ‘before the expiration of five days from the date of the death.’ In the case of suspected violent deaths, however, where a coroner needs to hold an inquest before reaching a verdict, this is almost impossible as in most cases the death can only be registered after the inquest. An unpublished examination of registration delays for suicides occurring in 2001 has shown that fewer than half (41 per cent) of these deaths were registered within 3 months of the death occurring, but that 96 per cent were registered within 12 months. The data analysed in this article are based on deaths registered in each calendar year with the cut-off point for collecting late submissions of data from registrars to ONS being April the year following. Deaths assigned to code ICD-9 E988.8 and ICD-10 Y33.9 where the verdict was pending, are excluded, as these codes are used by ONS in cases where a coroner adjourns an inquest awaiting prosecution in a higher court. The coroner is able to register these deaths before legal proceedings have been completed (accelerated registration). As a large proportion of these cases are subsequently found to be homicides, these deaths are not included in this analysis as their inclusion would present a misleading picture of suicide mortality. In Scotland, there is no delay in the initial registration of suspected violent deaths. The deaths are registered using the doctor’s certificate of cause of death and GROS codes the deaths on a provisional basis using the information provided at that time. If the information available indicates that a death was due to intentional self-harm it will be so coded. If not, the death is coded as injury/poisoning of undetermined intent. At the time of registration, the certifying doctor, or the Registrar, reports all potential suicides to the Procurator Fiscal, who examines the case and prepares a report for the Crown Office. The Procurator Fiscal may provide GROS with more accurate information on the cause of death, but it is left to the Crown Office to inform GROS which deaths were considered to be suicides. GROS may receive further information on the cause of death from enquiries made to the certifying doctor/forensic pathologist. If necessary, the death will be recoded taking account of all the additional information received. However, no changes are made to the records after the end of June following the year of registration. In Northern Ireland, coroners do not record verdicts on violent deaths as they do in England and Wales. Instead, they forward a summary of ‘findings’ to the Registrar. From these ‘findings’ staff at GRONI consult with coroners where it is unclear whether the death was a suicide or not and then code the death accordingly. The figures in this article are based on deaths registered within each calendar year where the cause of deaths was classified as either ‘intentional self-harm’ or ‘injury/poisoning of undetermined intent.’ It is likely that, in England and Wales and Northern Ireland, some of these deaths will have occurred prior to the registration year because they have been referred to the coroner and thus have taken some time to be registered.

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The rates that appear in this article have been directly age-standardised. This makes allowances for differences in the age structure of populations which means that results can be compared over time and between areas and sexes. Rates were age-standardised using the European Standard Population and this was done for both suicides at all ages (15 and over) and within broad age groups (15–44, 45–74, and 75 and over). Within small populations, the number of deaths may be subject to random variation. Therefore, 95 per cent confidence intervals have been calculated for all rates presented in this article using standard methods.7 Suicide rates were calculated for the four countries of the UK, and Government Office Regions in England. The lowest geographical level used was Local and Unitary Authorities in England and Wales, Council Areas in Scotland, and Parliamentary Constituencies in Northern Ireland. These smaller areas are referred to throughout this article as ‘local areas.’ Deaths throughout the period 1991–2004 were assigned to current local area boundaries. Earlier analysis of suicides in Northern Ireland by ONS had considered deaths in District Council Areas (DCAs).2 In this article, however, Parliamentary Constituencies have been used in preference to DCAs in order to examine differences in suicide rates within the city of Belfast. Adult suicide rates were calculated for all local areas in the UK for the two periods 1991–1997 and 1998–2004. These rates are presented in the form of charts and maps in this report, however areas with fewer than ten suicides in each grouped period have been excluded to be consistent with previous analyses.2 The numbers of suicides and rates can be found on the National Statistics website at: www.statistics.gov.uk/CCI/nugget. asp?ID=1092 Suicide rates (with 95 per cent confidence intervals) for 1991–1997 and 1998–2004 for the local areas of the UK are presented in Figures 5 and 6, for men and women respectively. The UK rate is also shown, as are bands for 25 and 50 per cent higher and lower than this overall rate. Maps 1–4 indicate where suicide rates in local areas were above or below the UK rate, based on the ratios presented in bands (Box Three). The maps have coloured hues for higher ratios and grey hues for lower ratios – the depth of colour indicating the extent of the difference. The white areas are where the rate was up to 25 per cent higher or lower than the UK rate and the dotted areas are those where there were fewer than 10 deaths across each period and which were therefore excluded from the analysis.

Box three Maps Maps 1 to 4 show the ratio of the suicide rate to that for the United Kingdom by sex and time period for: l local/unitary authority area of England and Wales l Council Area of Scotland l Parliamentary Constituency of Northern Ireland The colouring is based on five intervals as defined by values of 25 per cent and 50 per cent or more above or below the UK rate as shown below: Legend label Colour

Min ratio Max ratio value value

1.50 -- 1.25 1.49 0.76 1.24 0.51 0.75 0.00 0.50

Nation a l S t a t i s t i c s

50 per cent or more higher 25–49 per cent higher Up to 25 per cent higher or lower 25–49 per cent lower 50 per cent or more lower Fewer than 10 deaths

Area of residence and non-residents The results for countries, regions and local areas are based on the area of usual residence of the deceased. This information is collected at death registration from the informant who registers the death. This means that if the deceased had more than one residence it is up to the informant to decide which was the ‘usual residence.’ For example, if the deceased was a student in Manchester and the parent who registered the death lived in London, the parent may say that the usual residence was the family home instead of the student accommodation. This could potentially introduce a mismatch between the number of suicides and the population estimate. Although the data in this article cover the UK as a whole, if a death was registered in one of the constituent countries of the UK but the deceased was resident in another of those countries, due to the individual death registration collection systems for each country, this death cannot be assigned to the country of residence but is instead treated as a nonresident death. For example, if a person who was resident in London committed suicide in Scotland, this death would be considered a nonresident death in Scotland, and therefore not included in the figures for Scotland or London. This does not apply to suicides of residents of England that occurred in Wales and vice versa, however, since England and Wales are covered by a single registration system. The overall suicide rates presented for the UK though do include deaths of non-residents which occurred in England, Wales, Scotland or Northern Ireland. Deaths occurring outside the UK are not included.

Population Estimates The mortality rates examined in this article were calculated using revised population estimates for the UK, based on results from the 2001 Census.8 In England and Wales these were estimates for 1991 published in spring 2003, revised mid-year population estimates for 1992–2002 published in autumn 2004, and estimates for 2003 and 2004 published in September 2004 and December 2005 respectively. In Scotland, these were revised population estimates for the years 1991–20009 and in Northern Ireland, revised population estimates for the years 1992–2000.10

Deprivation analysis To consider the relationship with deprivation, all suicides in England and Wales from 1999 to 2003 were allocated to the 2001 Census Standard Table ward of the deceased’s usual residence. Each ward was then assigned a deprivation score using the Carstairs and Morris index. These scores were calculated by ONS using data from the 2001 Census and were published on the National Statistics website in 2005.11 The calculation of the Carstairs scores is described in an article in this edition of Health Statistics Quarterly12 which also presents the geographical pattern of deprivation across England and Wales in 2001. Using the Carstairs scores, wards were divided into deprivation twentieths (5 per cent of the population) and fifths (20 per cent of the population). This was done using 2001 experimental ward population estimates which had also been published by ONS for 2001 Census wards. Wards were ranked by Carstairs score from least deprived to most deprived. Wards were divided into twentieths and fifths to give equal population size (rather than number of wards) in each. Quintile 5 therefore represents the fifth of the population of England and Wales living in the most deprived wards, while Quintile 1 represents the fifth of the population living in the least deprived areas. Suicide rates were calculated by aggregating deaths within wards to deprivation quintiles and twentieths. 2001 ward population estimates were similarly aggregated to provide denominators. In this article suicide rates for England and Wales are presented in twentieths while the rates for English regions and Wales are presented in quintiles. The quintiles


were assigned at a national level rather than for each region. Quintile 5 for a particular region does not therefore represent the most deprived fifth of the population within that area. Instead it represents the most deprived fifth of the population of England and Wales resident within that region. The proportions of the population in each deprivation quintile therefore vary across regions.12 The deprivation analysis was only carried out for England and Wales as deprivation scores produced on a comparable basis for all countries of the United Kingdom were not available. Deaths from 1999 to 2003 were selected to provide data two years either side of 2001 – the census year the Carstairs scores were based on and the first year ONS ward population estimates were available.

Figure 1

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Results Suicide trends in the UK, 1991–2004 There were 5,906 adult suicides in the UK in 2004, a fall of 7 per cent from the 1991 total of 6,366. In 2004, suicides represented 1 per cent of the total of all UK deaths. Almost three-quarters of suicides in 2004 were of men and this division between the sexes was broadly similar from 1991 onwards. Male suicide rates in the UK showed a downward trend during the 1990s until an increase in 1998 (Figure 1). Since this peak, the rate has again fallen and the rate in 2004 was the lowest throughout the period (18.1 suicides per 100,000 population). Suicide rates for women in the UK were lower than those seen in men throughout 1991 to 2004 at around six suicides per 100,000 population, and a slight downward trend was observed.

Age-standardised suicide rates by sex and age group, 1991–2004

United Kingdom Men

30

30 5

Rate per 100,000 population

5


Women

0 15 10

0 15 10 5

5 0

0

1991 199 1993 1994 1995 1996 1997 1998 1999 000 001 00 003 004

1991 199 1993 1994 1995 1996 1997 1998 1999 000 001 00 003 004

Year

Year All ages

Figure 2

15 − 44

45 − 74

75 and over

Age-standardised suicide rates for men and women by country of residence in the United Kingdom, three-year rolling averages 1991–1993 to 2002–2004

United Kingdom Men

35

30


30


Women

35

5 0 15 10 5

5 0 15 10 5

0

3

19

/9 91

4

19

/9 9

5

19

/9 93

6

19

/9 94

8

7

19

/9 95

19

/9 96

00

9

/9 97

19

99

0 8/

1

1

19

/0 99

3

/0 00

0

0

/0 01

4

0

/0 0

/93

91

0

19

/94

9

19

/95

93

19

/96

94

19

Year England

/97

95

19

/98

96

19

/99

97

19

1

00

/0

8 99

/01

99

19

Year Wales

Scotland

Northern Ireland

United Kingdom

National Statistics

/0

00

0

/03

01

0

/04

0

0

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The female suicide rate in Scotland remained relatively stable between 1991/93 and 2002/04 at around 10 deaths per 100,000 population, but this was consistently higher than the rates for the other countries. The difference was greatest in 2001/03 when the suicide rate for women in Scotland was almost double the rates for England and Wales (10.3 suicides per 100,000 population in Scotland, compared to 5.3 and 5.8 in England and Wales respectively) and was over twice that for Northern Ireland (4.8 per 100,000 population). In England a slight downward trend was observed across the period.

Men aged 15− 44

35


30 5 0 15 10 5

d ale No Sco s rth tla ern nd Ire lan d W

gla n

Ea

No

En

W idl es an tM d Ea idl s a st of nds En gla n Lo d nd So on uth So Eas uth t W es t

0

Y rth st th orks We e H hi st u re Ea mbe and st r M

For both men and women, Scotland had suicide rates which were consistently higher than the rates for the other constituent countries of the UK across the period 1991/93 to 2002/04 (Figure 2). For most of this period male suicide rates in Scotland were over 50 per cent higher than the overall UK rate and in 2000/02 were 67 per cent higher. The suicide rate for men in Wales was also higher than the overall UK rate across this period, as was that for Northern Ireland from 1999/2001 onwards. Male suicide rates in Scotland rose throughout the 1990s but have decreased in the most recent years. The trends for other countries of the UK followed a similar pattern of decreasing rates until the late 1990s when there was a marked increase, followed again by a fall in rates.

Age-standardised suicide rates for men by age group, for UK countries and Government Office Regions in England, 1991–1997 and 1998–2004

40

rth

Suicide rates in the countries of the UK and regions of England, 1991–2004

Figure 3

No

Different trends in suicide rates were observed by age group for each sex. Deaths were examined by three broad age bands: 15–44, 45–74 and 75 and over. During the first half of the 1990s, the highest UK rates were among those aged 75 and over for both men and women (Figure 1). Suicide rates for the oldest age group fell for both sexes across the period however. The rate for young men (15–44), after an initial stability from 1991, increased by over a fifth between 1997 and 1998 and it was this age group which had the highest male suicide rate from 1998 onwards. For women, up to the mid-1990s suicide rates decreased in older adults aged 45–74 and 75 and over and slightly increased in young adults (15–44). However, the rate has since stabilised in all age groups and older women aged 75 and over had the highest suicide rate across most of the period.

Men aged 45−74

40 35



30 5 0 15 10 5

Suicide rates by age in the countries of the UK and regions of England, 1991–1997 and 1998–2004 For men aged 15–44, although annual rates fluctuated between 1991 and 2004, the UK suicide rate remained the same between the two periods


10

Sc s rth otla ern nd Ire lan d

ale

W

nd gla

No

W

No

En

Ea


rth No

Men aged 75 and over 40


35 30 5 0 15 10 5

1991−1997

UK 1991−1997

1998−004

UK 1998−004

Sc s rth otla ern nd Ire lan d No

ale

W

nd gla En

W

No

rth

Ea


i es dlan t M ds Ea idl a st of nds En gla n Lo d nd So on uth So Eas uth t W es t

0

No

For women, the North West and London had suicide rates which tended to be higher than the overall UK rate across the period 1991/93 to 2002/04, although the trend for each region varied. During the early 1990s, London was the English region with the highest female suicide rates but from the mid-1990s onwards the North West tended to have higher rates than other regions. Rates in Yorkshire and the Humber, the East and West Midlands, and East of England were lower than elsewhere. By 2002/04 female suicide rates had fallen in all English regions when compared to 1991/93, except in the East Midlands where the rate remained stable.

i es dlan tM d Ea idl s a st of nds En gla n Lo d nd So on uth So Eas uth t W es t

0

Within England, the highest suicide rates were generally seen in the North East and North West for men and the North West and London for women (Appendix A). For men, the North West had higher suicide rates than the overall UK rate across the period 1991/93 to 2002/04 and the trend followed that for England with a peak during the late 1990s followed by a decrease in rates. The North East, however, saw suicide rates increase across the entire period and this region had the highest rate in England in 2002/04 (21.1 suicides per 100,000 population). This was the only English region where male suicide rates were higher in 2002/04 than in 1991/93. The lowest male suicide rates across the period 1991/93 to 2002/04 were in the East of England region.


Women aged 15−44

1 10 8 6 4

W

gla n

d ale No Sco s rth tla ern nd Ire lan d

No

En

s Ea


10 8 6 4

1

Sc s rth otla ern nd Ire lan d

ale

No

W

nd gla En

No rth No Ea Yo rth st th rks We e H hi st u re Ea mbe and st r M W idl es an t M ds Ea idl a st of nds En gla n Lo d nd So on uth So Eas uth t W es t

0

Women aged 75 and over

10 8 6 4

1991−1997

UK 1991−1997

1998−004

UK 1998−004

11

National Statistics

Sc rth otla ern nd Ire lan d No

ale s

W

nd

0

En gla

The overall suicide rate in women aged 75 and over fell 15 per cent between 1991–1997 and 1998–2004. Scotland had the highest rate in 1991–1997, slightly higher than the rate in London (9.9 and 9.6 suicides per 100,000 population, respectively). The rate in Scotland decreased by 30 per cent between 1991–1997 and 1998–2004. London therefore had the highest rate in the more recent time period (8.5 suicides per 100,000 population). London still had a higher rate than the overall UK rate in 1998–2004. Other areas with rates which were higher than the overall UK rate in both time periods were the South East, South West and East of England. As with men aged 75 and over, the lowest rates for both 1991–1997 and 1998–2004 were in Northern Ireland (2.7 and 2.0 suicides per 100,000 population, respectively).

No

rth

For women aged 45–74, Scotland also had the highest suicide rates in the UK in both 1991–1997 and 1998–2004 (10.4 and 10.0 suicides per 100,000, respectively). The South East had the second highest rate in 1991–1997 (7.8 suicides per 100,000 population) although this area experienced a decrease of almost a quarter – the largest decrease in rates – between the two time periods. Lower rates for both periods were seen in the East Midlands, West Midlands and East of England. The overall UK suicide rate decreased by 10 per cent.

Women aged 45−74

1


As with young men, women aged 15–44 in Scotland also had suicide rates which were considerably higher than the rates for the other countries of the UK in both 1991–1997 and 1998–2004 (Figure 4). In the more recent period, rates for young women in Scotland were more than double the rates in England (10.2 and 5.0 suicides per 100,000, respectively). The overall suicide rate in the UK for women aged 15–44 increased by 3 per cent between 1991-1997 and 1998-2004. As with young men, the lowest rates for both periods were in the East of England.

W idl es an tM d Ea idl s a st of nds En gla n Lo d nd So on uth So Eas uth t W es t

0

No rth No Ea Yo rth st th rks We e H hi st u re Ea mbe and st r M W idl es an t M ds Ea idl a st of nds En gla n Lo d nd So on uth So Eas uth t W es t

There was a more substantial fall in suicide rates between 1991–1997 and 1998–2004 for men aged 75 and over in the UK. The UK rate decreased from 22.2 to 18.1 suicides per 100,000 population, a fall of almost 20 per cent. The geographical pattern of suicide rates in the 75 and over age group was different from that seen in the other two age groups. In 1991–1997 the highest rate was in the East Midlands (26.5 per 100,000). The suicide rate in the East Midlands fell by over a third to 17.3 per 100,000 population in 1998–2004, however, which meant that Scotland had the highest rate in the latter period (21.4 per 100,000 population). The lowest suicide rates for both 1991–1997 and 1998–2004 were in Northern Ireland.

Age-standardised suicide rates for women by age group, for UK countries and Government Office Regions in England, 1991–1997 and 1998–2004

Y rth t th orks We e H hi st u re Ea mbe and st r M

For men aged 45–74 geographical variations in suicide rates were less marked than those for young men but the highest rates were still in Scotland for both time periods. The suicide rate in the UK among men aged 45–74 fell by 4 per cent between 1991–1997 and 1998–2004 (from 18.0 to 17.3 suicides per 100,000 population). The lowest suicide rates for both periods in this age group were in Northern Ireland.

Figure 4


at 21 deaths per 100,000 population (Figure 3). Scotland had the highest suicide rate for both periods. In 1998-2004 the suicide rate for young men in Scotland was almost double the rate in England (36.9 and 19.1 suicides per 100,000 population, respectively). Rates in Scotland also increased by 10 per cent between 1991–1997 and 1998–2004. Wales and the North West also had rates which were higher than the overall UK rate in both time periods. The lowest rates were in the East of England. The largest increases in rates between the two periods were in the North East (23 per cent) and Northern Ireland (22 per cent). This rise meant that in 1998-2004, both of these areas had suicide rates above the overall UK rate, whereas their rates were below the UK rate in 1991–1997. Suicide rates for young men also increased in the West Midlands. The largest fall in suicide rates for this age group was in London (9 per cent decrease).

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outer London, parts of the South East, West Midlands, eastern England and Northern Ireland.

Suicide rates in local areas of the UK, men Out of a total of 426 local areas in the UK, two areas with fewer than ten deaths were excluded in 1991–1997, and three were excluded in 1998–2004. Approximately 61 per cent of local areas had a suicide rate equal to or lower than the rate for the UK as a whole in both 1991–1997 and 1998–2004 (Figure 5). However, an increased number of local areas had a suicide rate 50 per cent or more higher than the overall UK rate, from 14 local areas in 1991–1997 to 26 local areas in 1998–2004, and an increased number also had a suicide rate 50 per cent or more lower than the overall UK rate, from two local areas in 1991–1997 to seven local areas in 1998–2004. As already noted, Scotland had the highest suicide rates in the UK during 1991–1997, and three-quarters of local areas in Scotland had suicide rates which were 25 per cent or more higher than the overall UK rate and over a third had rates which were 50 per cent or more higher (Map 1). Several rural councils were among the Scottish areas with particularly high rates. Denbighshire in Wales, and Manchester and Hastings in England also had rates that were 50 per cent or more higher than the overall UK rate. Rates which were at least 25 per cent higher than the UK rate were mostly found in parts of Wales, the North West, North East, and South West of England, inner London, and the south coast. Lower rates were found in

Figure 5

In 1998–2004, geographical differences between local areas appeared more pronounced than in 1991–1997 (Map 2). An increased number (almost two-thirds) of local areas in Scotland in the more recent period had a suicide rate that was 50 per cent or more higher than the overall UK rate. Only three areas in Scotland had suicide rates which did not differ from the UK rate by more than 25 per cent – Stirling, East Renfrewshire and East Lothian. In Northern Ireland, both Belfast North and Belfast West had suicide rates over 50 per cent higher than the UK rate. In comparison, Belfast East had a low rate compared to the UK as a whole (25–49 per cent lower than the UK rate). Very high rates were still seen in Denbighshire in Wales, and also in Blaenau Gwent. In England, very high suicide rates were now observed in Blackpool and Middlesbrough, although no longer in Hastings and Manchester. Higher rates were still however mostly clustered in the North West, the south coast, and inner London, and also in south Wales and coastal areas of northern England. An increased number of areas within central and southern England had rates which were 25–49 per cent lower than the UK rate, and South Bucks, Rushcliffe, Watford, Hart, Castle Point, East Cambridgeshire and South Gloucestershire in England had suicide rates that were 50 per cent or more lower than the UK rate.

Age-standardised suicide rates by local area, men, 1991–1997 and 1998-2004

United Kingdom 60

1991−1997


50

40

30

50% higher 5% higher

0

1991−1997 UK rate

5% Lower

10

50% Lower

0

Local area (ranked lowest to highest)

60

1998−2004


50

40

30

0

50% higher 5% higher 1998−004 UK rate

5% Lower

10

50% Lower

0



12


Map 1 Map

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1: Suicide men over by1991–1997 local area, UK 1991-1997 Suicide inin men agedaged 15 and15 overand by local area,

United Kingdom

Compared to UK overall rate 50% or more higher 25 - 49% higher Up to 25% higher or lower 25 - 49% lower 50% or more lower Fewer than 10 deaths London Inset

See Inset

Scilly Isles

13

National Statistics


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Map 2: Suicide in men aged 15 and over by local area, UK 1998-2004

Map 2

Suicide in men aged 15 and over by local area, 1998–2004

United Kingdom


See Inset

Scilly Isles


14


When local areas were examined ranked by suicide rate (Table 1), in 1991–1997, 14 out of the 20 areas with the highest suicide rates within the UK were in Scotland, and by 1998-2004 this had increased to 17. The highest male suicide rates in the UK in 1991–1997 were in the neighbouring local areas of Glasgow City and West Dunbartonshire (43.0 and 41.8 suicides per 100,000 population, respectively). The highest male suicide rate in England was in Hastings (32.8 suicides per 100,000 population) and four other English areas were also among the twenty with the highest rates: Manchester, Barrow-in-Furness, Brighton and Hove, and Teesdale. Only one Welsh area was among the twenty areas with the highest rates, Denbighshire (31.9 suicides per 100,000 population), while the highest rate in Northern Ireland was in Foyle which ranked 83rd in the UK with a rate of 23.2 suicides per 100,000 population. Although the list of the areas with the highest suicide rates in 19982004 was still dominated by areas in Scotland there were some changes

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in the areas with the very highest rates, for example the rates in the Orkney Islands and Stirling fell by around a third between the two time periods. The highest male suicide rate in the UK in 1998–2004 was in the Shetland Islands (47.5 suicides per 100,000 population). In this period two areas in Northern Ireland were among the twenty areas with the highest male suicide rates: Belfast North and Belfast West had rates of 35.4 and 34.2 suicides per 100,000 population, respectively. These were among the areas with the largest increases in suicide rates between 1991–1997 and 1998–2004. In Belfast North the male suicide rate more than doubled and in Belfast West there was a 94 per cent increase. Large increases were also found in Harlow and Blaenau Gwent where male suicide rates both also rose by 94 per cent. In 1998–2004 only one English area, Blackpool, was among the areas with the 20 highest male suicide rates (32.6 suicides per 100,000 population).The highest rates in Wales were in Denbighshire and Blaenau Gwent (both 30.2 suicides per 100,000 population). These were ranked 23rd and 24th highest in the UK.

Suicide rates in local areas of the UK, women Table 1

Local areas with the highest suicide rates in men aged 15 and over in the United Kingdom, 1991–1997*

Rank 1991–1997 Country Local area 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Scotland Scotland Scotland Scotland Scotland Scotland Scotland Scotland Scotland Scotland England Wales Scotland England Scotland England Scotland England England Scotland

Suicide rate Number Rank per 100,000 of order population LCI UCI suicides 1998–2004†

Glasgow City 43.0 ( 39.9 ; West Dunbartonshire 41.8 ( 33.9 ; Eilean Siar 39.8 ( 26.0 ; Orkney Islands 39.6 ( 22.7 ; Argyll & Bute 39.3 ( 31.6 ; Dundee City 38.4 ( 32.3 ; Moray 38.3 ( 30.5 ; Highland 35.9 ( 31.0 ; Stirling 35.7 ( 27.8 ; Inverclyde 33.6 ( 26.2 ; Hastings 32.8 ( 25.1 ; Denbighshire 31.9 ( 24.6 ; Renfrewshire 31.7 ( 26.6 ; Manchester 30.9 ( 27.6 ; Aberdeenshire 29.3 ( 25.0 ; Barrow-in-Furness 29.0 ( 21.6 ; Edinburgh, City of 28.9 ( 26.0 ; Brighton and Hove 28.3 ( 24.3 ; Teesdale 28.2 ( 15.2 ; North Ayrshire 28.2 ( 22.7 ;

46.2 ) 706 4 49.8 ) 106 5 53.6 ) 32 2 56.5 ) 21 71 47.0 ) 100 22 44.4 ) 156 8 46.1 ) 92 9 40.9 ) 202 3 43.5 ) 79 76 41.0 ) 80 14 40.4 ) 71 99 39.2 ) 73 23 36.8 ) 150 15 34.1 ) 346 54 33.7 ) 175 34 36.4 ) 59 69 31.9 ) 364 65 32.3 ) 192 28 41.2 ) 18 fewer than10 deaths 33.7 ) 101 10

Local areas with the highest suicide rates in men aged 15 and over in the United Kingdom, 1998–2004* Rank Rank order 1998–2004 1991–1997** 1 Scotland Shetland Islands 47.5 ( 30.5 ; 64.5 ) 30 24 2 Scotland Eilean Siar 44.1 ( 29.1 ; 59.1 ) 33 3 3 Scotland Highland 43.4 ( 38.0 ; 48.9 ) 240 8 4 Scotland Glasgow City 41.6 ( 38.4 ; 44.8 ) 664 1 5 Scotland West Dunbartonshire 40.7 ( 32.7 ; 48.6 ) 100 2 6 Scotland East Ayrshire 40.5 ( 33.5 ; 47.5 ) 128 35 7 Scotland Clackmannanshire 38.5 ( 27.7 ; 49.3 ) 49 100 8 Scotland Dundee City 38.4 ( 32.2 ; 44.7 ) 146 6 9 Scotland Moray 36.3 ( 28.8 ; 43.8 ) 90 7 10 Scotland North Ayrshire 35.8 ( 29.5 ; 42.1 ) 124 20 11 N Ireland Belfast North 35.4 ( 27.4 ; 43.4 ) 75 319 12 Scotland Perth & Kinross 34.4 ( 28.2 ; 40.6 ) 119 50 13 N Ireland Belfast West 34.2 ( 26.3 ; 42.2 ) 71 259 14 Scotland Inverclyde 33.7 ( 26.1 ; 41.3 ) 76 10 15 Scotland Renfrewshire 32.6 ( 27.4 ; 37.9 ) 148 13 16 England Blackpool 32.6 ( 26.9 ; 38.3 ) 124 40 17 Scotland Dumfries & Galloway 32.0 ( 26.4 ; 37.5 ) 126 30 18 Scotland Falkirk 31.5 ( 25.9 ; 37.0 ) 124 71 19 Scotland Scottish Borders 30.8 ( 24.2 ; 37.4 ) 84 25 20 Scotland Midlothian 30.8 ( 23.2 ; 38.4 ) 63 79 * Local areas with fewer than 10 suicides in this period have been excluded. † Rank order: 1=Highest rate, 423 = Lowest rate. ** Rank order: 1=Highest rate, 424 = Lowest rate. LCI = Lower 95 per cent confidence interval. UCI = Upper 95 per cent confidence interval.

For women, out of a possible 426 local areas, 369 were included in the analysis in 1991–1997, and 363 in 1998–2004. Of the local areas excluded (because they had fewer than 10 deaths in the periods examined), in 1991–1997, 47 were in England, 3 in Wales, 4 in Scotland and 3 in Northern Ireland and in 1998-2004, 54 were in England, 2 in Wales, 4 in Scotland and 3 in Northern Ireland. Approximately 58 per cent of local areas included in the analysis had a suicide rate equal to or lower than the overall UK rate in 1991–1997 and this had fallen slightly to 56 per cent in 1998–2004 (Figure 6). As seen in men, an increased number of local areas had a suicide rate 50 per cent or more higher than the overall UK rate, from 33 local areas in 1991–1997, to 35 local areas in 1998–2004, and an increased number also had a suicide rate 50 per cent or more lower than the UK rate, from four local areas in 1991–1997 to seven local areas in 1998–2004. High suicide rates for women were found in many local areas in Scotland in 1991–1997 (Map 3). Almost 80 per cent of local areas in Scotland had female suicide rates which were 25 per cent or more higher than the overall UK rate and 11 areas had rates which were more than 50 per cent higher. One local area in Scotland (East Renfrewshire) had a suicide rate between 25 and 49 per cent lower than the UK rate. In Wales, Conwy had a suicide rate for women over 50 per cent higher than the overall UK rate while in Northern Ireland, no local area had a suicide rate which was 25 per cent or more above the UK rate. In England, very high rates were mainly clustered in the North West, inner north and west London, Cornwall, and coastal areas of Sussex. Very low suicide rates (50 per cent lower than the overall UK rate) were found in Epping Forest, Havering, Babergh and South Gloucestershire. In 1998–2004, female suicide rates which were 50 per cent or more higher than the overall UK rate were still found in many Scottish local areas (Map 4) although the geographical distribution of these had changed somewhat from 1991–1997. A smaller number (75 per cent) of local areas had a suicide rate 25 per cent or more higher than the UK rate, but an increased number (13 local areas) had a rate which was 50 per cent or more higher. As with 1991–1997, East Renfrewshire still had a suicide rate between 25 and 49 per cent lower than the UK rate. In Northern Ireland, Belfast West had a very high suicide rate (50 per cent or more above the overall UK rate) and both Belfast East and North had suicide rates between 25 and 49 per cent higher than the UK rate. In contrast Belfast South had a rate between 25 and 49 per cent lower than the rate in the UK. In Wales, very high rates were still seen in Conwy, but were also found in Ceredigion. Caerphilly and Newport in Wales had rates which were 50 per cent or more lower than the overall UK rate. In England, clusters of local areas with very high rates were still found

15

National Statistics


Figure 6

Autumn 2006

Age-standardised suicide rates by local area, women, 1991–1997 and 1998-2004

United Kingdom 0

1991−1997

18


16 14 1 10 50% higher 5% higher 8 1991−1997 UK rate 6 5% Lower

4

50% Lower

0


0

1998−2004

18


16 14 1 10 50% higher 8 6

5% higher 1998−004 UK rate 5% Lower

4

50% Lower

0


in Cornwall, inner north London, and coastal areas of Sussex, although the number of local areas with a rate 50 per cent or more higher than the UK rate had fallen slightly from 23 to 20. The number of areas within England with a suicide rate 25–49 per cent above the overall UK rate also decreased (from 28 to 20). Five areas in England had female suicide rates which were 50 per cent or more lower than the UK rate: Barking and Dagenham, West Wiltshire, Chelmsford, Medway, and Sevenoaks.

The highest female suicide rate in Northern Ireland was in Belfast West which was ranked 33rd in the UK. Areas with the highest increases in female suicide rates between 1991–1997 and 1998–2004 included Epping Forest and East Dorset where rates more than doubled, and Warwick and the Vale of Glamorgan where rates almost doubled. The largest decrease was in Rushmore. This had been the area with the 4th highest rate in 1991–1997 but the rate fell by two-thirds to rank 287th in 1998–2004.

When local areas were ranked, as with men, in 1991–1997 the highest female suicide rate in the UK was in Glasgow City (14.0 suicides per 100,000 population) (Table 2). Nine of the 20 areas with the highest rates were in Scotland in 1991–1997. Camden had the highest female rate in England (13.9 suicides per 100,000 population) while in Wales the highest rate was in Conwy (11.6 suicides per 100,000 population). The highest female suicide rate in Northern Ireland in 1991–1997 was in North Down (7.6 suicides per 100,000 population). This area ranked 80th in the UK.

Suicide rates by deprivation in England and Wales, 1999–2003

Glasgow City also had the highest suicide rate in 1998–2004 (15.8 suicides per 100,000 population). The rate in Glasgow increased by 12 per cent between the two periods. Twelve of the 20 local areas with the highest suicide rates were found in Scotland in 1998–2004. Camden and Conwy again had the highest rates in England and Wales respectively (15.2 and 13.6 suicides per 100,000 population, respectively), their rates increasing by 10 and 17 per cent respectively from 1991–1997.


16

There was an association between suicide rates and Carstairs deprivation category for both sexes in England and Wales, with rates increasing with increasing deprivation (Figure 7). For both men and women, suicide rates for those living in the most deprived areas were double those living in the least deprived, from 11.9 and 3.6 per 100,000, for men and women respectively, in the least deprived twentieth to 25.4 and 7.4 in the most deprived twentieth. Within the regions of England, and Wales, the relationship between suicide and deprivation was still clear with those living in the most deprived fifth of areas having higher suicide rates than those living in the least deprived fifth (Figures 8 and 9). The pattern of gradients between deprivation quintiles was not consistent between regions however, particularly for women.


Map 3 Map

Autumn 2006

Suicide ininwomen aged 15 and over by local area,by 1991–1997 3: Suicide women aged 15 and over local area, UK 1991-1997

United Kingdom


See Inset

Scilly Isles

17

National Statistics


Map 4 Map

Autumn 2006

Suicide inin women aged 15 and over by local area,by 1998–2004 4: Suicide women aged 15 and over local area, UK 1998-2004

United Kingdom


See Inset

Scilly Isles


18


Local areas with the highest suicide rates in women aged 15 and over in the United Kingdom, 1991–1997*

Rank 1991–1997 Country Local area 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Scotland England Scotland England England England England England Wales Scotland England England Scotland Scotland Scotland England Scotland Scotland Scotland England

Glasgow City Camden Dundee City Rushmoor Westminster Carrick Manchester Wansbeck Conwy Highland Brighton and Hove Craven Perth & Kinross Midlothian Stirling Burnley Edinburgh, City of Inverclyde South Ayrshire Kensington & Chelsea

Suicide rate Number Rank per 100,000 of order population LCI UCI suicides 1998–2004† 14.0 ( 13.9 ( 13.1 ( 13.1 ( 12.7 ( 11.9 ( 11.7 ( 11.7 ( 11.6 ( 11.3 ( 11.2 ( 11.2 ( 11.1 ( 10.9 ( 10.8 ( 10.8 ( 10.5 ( 10.5 ( 10.5 ( 10.2 (

12.3 ; 10.8 ; 9.8 ; 8.3 ; 9.9 ; 8.1 ; 9.7 ; 6.7 ; 7.8 ; 8.7 ; 8.8 ; 5.5 ; 7.8 ; 6.7 ; 6.8 ; 6.9 ; 8.8 ; 6.6 ; 7.1 ; 7.3 ;

15.8 ) 258 1 16.9 ) 78 2 16.4 ) 60 10 17.8 ) 29 287 15.5 ) 77 30 15.7 ) 38 50 13.7 ) 128 35 16.6 ) 21 14 15.4 ) 36 3 13.9 ) 71 19 13.6 ) 82 17 16.8 ) 15 132 14.5 ) 43 16 15.1 ) 26 20 14.9 ) 27 66 14.8 ) 29 189 12.3 ) 142 5 14.4 ) 28 7 13.8 ) 37 101 13.1 ) 48 29

Local areas with the highest suicide rates in women aged 15 and over in the United Kingdom, 1998–2004* Rank Rank order 1998–2004 1991–1997** 1 Scotland Glasgow City 15.8 ( 13.8 ; 17.7 ) 248 1 2 England Camden 15.2 ( 12.0 ; 18.4 ) 85 2 3 Wales Conwy 13.6 ( 9.3 ; 17.8 ) 39 9 4 England Eastbourne 13.0 ( 9.0 ; 17.0 ) 41 24 5 Scotland Edinburgh, City of 12.9 ( 10.9 ; 15.0 ) 150 17 6 Scotland North Lanarkshire 12.5 ( 10.1 ; 14.9 ) 102 50 7 Scotland Inverclyde 12.2 ( 7.9 ; 16.4 ) 32 18 8 Scotland Scottish Borders 11.9 ( 7.7 ; 16.1 ) 31 84 9 Scotland South Lanarkshire 11.7 ( 9.3 ; 14.1 ) 93 72 10 Scotland Dundee City 11.5 ( 8.3 ; 14.7 ) 50 3 11 England Kerrier 11.4 ( 7.5 ; 15.3 ) 33 88 12 Scotland Renfrewshire 11.3 ( 8.3 ; 14.2 ) 55 39 13 Scotland West Lothian 10.9 ( 7.7 ; 14.2 ) 43 137 14 England Wansbeck 10.9 ( 5.9 ; 16.0 ) 18 8 15 England Boston 10.8 ( 5.8 ; 15.8 ) 18 187 16 Scotland Perth & Kinross 10.8 ( 7.6 ; 14.0 ) 45 13 17 England Brighton and Hove 10.8 ( 8.4 ; 13.1 ) 80 11 18 England Islington 10.6 ( 7.8 ; 13.3 ) 58 69 19 Scotland Highland 10.4 ( 7.8 ; 13.0 ) 61 10 20 Scotland Midlothian 10.3 ( 6.3 ; 14.2 ) 26 14 * Local areas with fewer than 10 suicides in this period have been excluded. † Rank order: 1=Highest rate, 363 = Lowest rate. ** Rank order: 1=Highest rate, 369 = Lowest rate. LCI = Lower 95 per cent confidence interval. UCI = Upper 95 per cent confidence interval. .

The region with the biggest ratio between deprivation categories for men was the South West where the rate was 2.5 times higher in the most deprived quintile compared to that in the least deprived (Figure 8). The South West also had the highest suicide rate for the most deprived quintile (32.5 per 100,000 population). The area with the least variation between suicide rates in the most and least deprived quintiles was the West Midlands where the rate was 1.5 times higher for those living in the most deprived areas. However, this area had an unusual pattern with the rate in Quintile 4 being higher than the rate in Quintile 5. All regions had suicide rates in the most deprived quintile which were higher than the England and Wales rate. There was generally more geographical variation between rates for the most deprived quintile than the least deprived. For the latter, rates were around 12 suicides per 100,000 population, although London had the lowest suicide rate for the least deprived quintile (8.8 per 100,000) and Wales had the highest (16.8 per 100,000 population). The deprivation gradient was not linear in all regions. In the West Midlands, as discussed above, the suicide rate for Quintile 4 was higher than that

Figure 7

Age-standardised suicide rates by deprivation twentieth and sex, people aged 15 and over, 1999–2003

England and Wales 30 5


Table 2

Autumn 2006

Women

Women − England and Wales rate

Men

Men − England and Wales rate

0 15 10 5 0

1

3

4

5

6

7

8

9 10 11 1 13 14 15 16 17 18 19 0 Deprivation twentieth

for the most deprived, and in Yorkshire and the Humber and London Quintile 2 had a higher suicide rate than Quintile 3. Unlike men, there was large variation in suicide rates between regions for both the least and most deprived categories for women (Figure 9). The East Midlands and the South West had the greatest variation in rates between deprivation categories with the suicide rate for the most deprived quintile double that of the least deprived. As with men, the South West had the highest suicide rate in the most deprived quintile (8.7 per 100,000). The smallest variation between suicide rates for the least and most deprived was in the West Midlands (1.1 times higher rates in the most deprived). However, in this region the highest suicide rate was seen in Quintile 4 and the lowest in Quintile 2 – a ratio of 1.25. Low variation in suicide rates between the most and least deprived was also seen for East of England and Yorkshire and the Humber (1.2 times higher for each region) although suicide rates in the least deprived quintile for Yorkshire and the Humber were higher than rates in all quintiles except for the most deprived. Lower rates than the England and Wales rate were seen for the most deprived fifth of the population in the East of England, which had the lowest suicide rate (4.9 per 100,000) for this quintile, although Quintiles 3 and 4 had higher suicide rates (5.4 per 100,000 each). The North East and East Midlands had the lowest suicide rate for the least deprived quintile (3.6 per 100,000). As seen in men, Wales had the highest suicide rate for the least deprived quintile (5.4 per 100,000), although Quintile 2 had a lower suicide rate (4.8 per 100,000).

Discussion Although suicides represent only 1 per cent of the total number of deaths in the UK in 2004 they have long been recognised as a major public health concern especially in young men. In 2002 the Government launched a National Suicide Prevention Strategy for England with the aim of reducing suicides at all ages by a fifth by 2010.13 This strategy adopted the existing target set in the Our Healthier Nation White Paper14 of 1999, which also became a Public Service Agreement target. Suicide prevention strategies have also been launched in recent years in Scotland and Northern Ireland. In 2002, the Scottish Executive launched ‘Choose Life’ – a national strategy and action plan to prevent suicide in Scotland with the goal of reducing suicide rates by 20 per cent by 2013.15 The ‘Protect Life’ draft strategy in Northern Ireland particularly focuses on males and those most at risk16 and part of the work is to investigate if there is any link between suicide/attempted suicide and civil unrest in Northern Ireland. 19

National Statistics


Figure 8

Autumn 2006

Figure 9

Age-standardised suicide rates by deprivation quintile, men aged 15 and over, 1999–2003

Government Office Regions of England, and Wales

Age-standardised suicide rates by deprivation quintile, women aged 15 and over, 1999–2003

Government Office Regions of England, and Wales

35

10 9

30



8 5 0 15 10

7 6 5 4 3

5

1

Q1 Least deprived

Q3

Q5 Most deprived

Q1 Least deprived

Q3

Q5 Most deprived

Q

Q4

England and Wales rate

Q

Q4

England and Wales rate

The strategy document for England noted that factors associated with suicide include ‘social circumstances, biological vulnerability, mental ill-health, life events and access to means’ while risk factors include ‘being male, living alone, unemployment, alcohol and drug misuse and mental illness’. Such factors lead to considerable socio-economic and geographical variations in suicide rates, as illustrated in this article. While suicide rates have generally been decreasing in recent years in the UK, this decline has not been seen for all areas, and all age groups. Between 1991 and 2004 suicide rates increased for both males and females in Scotland and for men in the North East of England. Many local areas also saw substantial increases in their suicide rates, such as Belfast North where the male suicide rate more than doubled between 1991–1997 and 1998–2004. However, as many rates for local areas are based on fairly small numbers of deaths they should be interpreted carefully. Suicide rates fell at older ages (45–74 and 75 and over) across all countries of the UK and regions of England between 1991–1997 and 1998–2004, with particularly considerable decreases for the oldest age group. This was not the case for suicides among young adults though, where rates rose in Wales, Scotland and Northern Ireland for both men and women. Although rates in England remained stable for both sexes among those aged 15–44, there were increases in some regions. In the North East, and East and West Midlands suicide rates rose for those aged 15–44 for both sexes, and there were also increases in female rates in the South West and East of England. This analysis has shown that the strong association between suicide and deprivation shown in previous studies,2 still exists in the 21st century, with rates in deprived parts of England and Wales being double those in the least deprived areas.


20

s ale W

Mi dla nd s es tM idl an Ea ds st of En gla nd Lo nd on So uth Ea st So uth W es t W

W

e

st Y th orks e H hi um re & Ea ber st

rth No

No

rth

Ea

st

s ale W

Mi dla nd s es tM idl a Ea nd st s of En gla nd Lo nd on So uth Ea st So uth W es t

0

W

e

st Y th orks e H hi um re & Ea ber st

W rth

No

No

rth

Ea

st

0

Key findings The UK suicide rate peaked in men in 1998 but has since fallen, whilst the suicide rate in women was stable between 1991 and 2004. The highest suicide rates in the UK were seen in young men aged 15–44 from 1998 onwards, and in elderly women aged 75 and over across the period. l Scotland had the highest suicide rates of the constituent countries of the UK for both sexes. In men, the rate was 50 per cent higher than the overall UK rate across the period and in women the rate was almost double. l For men in 1991–1997 the highest suicide rates were in Scotland in those aged under 75 and in the East Midlands in men aged 75 and over. However, by 1998–2004, Scotland had the highest suicide rates in men of all age groups. l For women in 1991–1997, the highest suicide rates were in Scotland in those of all age groups. By 1998–2004, although Scotland still had the highest suicide rate for women aged under 75, London had the highest rate in the 75 and over age group. l In 1998–2004, an increased number of local areas had a suicide rate which was 50 per cent or more higher or lower than the overall UK rate in both men and women compared to 1991–1997. l In 1991–1997, Glasgow City had the highest suicide rate in the UK for both men and women. In 1998–2004, although Glasgow City still had the highest suicide rate in women, the Shetland Islands had the highest rate in men. l There was an association between suicide and deprivation in England and Wales, with suicide rates in both men and women living in the most deprived areas double those in the least deprived. l


Autumn 2006

References 1. General Register Office (1872) Thirty-third report of the Registrar General, HMSO: London. 2. Fitzpatrick J, Griffiths C, Kelleher M and McEvoy S (2001) Chapter 10: Descriptive analysis of geographic variations in adult mortality by cause of death, in Griffiths C and Fitzpatrick J (eds.) Geographic Variations in Health (DS No 16), HMSO: London. 3. Uren Z and Fitzpatrick J (2001) Chapter 11: Analysis of mortality by deprivation and cause of death, in Griffiths C and Fitzpatrick J (eds.) Geographic Variations in Health (DS No 16), HMSO: London. 4. Adelstein A and Mardon C (1975) Suicides 1961–1974. Population Trends 02, 48–55. 5. Brock A and Griffiths C (2003) Trends in suicide by method in England and Wales, 1979–2001. Health Statistics Quarterly 20, 7–18. 6. General Register Office for Scotland. (2001) Registrar General’s Annual Review 2000. Appendix 2. The introduction of ICD10 for cause of death coding in Scotland. Available at: www.gro-scotland. gov.uk/statistics/library/annrep/00annrep/00app2.html. 7. dos Santos Silva I (1999) Appendix 6.1: Confidence intervals and significance tests for epidemiological measures, in Cancer Epidemiology: Principles and Methods, International Agency for Research on Cancer: Lyon, France. 8. Office for National Statistics (2005) Population Estimates UK population approaches 60 million. Available at: www.statistics.gov. uk/CCI/nugget.asp?ID=6&Pos=1&ColRank=1&Rank=374 9. General Register Office for Scotland. Revised Mid-year Population Estimates 1982–2000. Available at: www.gro-scotland.gov.uk/ statistics/library/poptest/revised-mid-year-est.html 10. Northern Ireland Statistics and Research Agency. Mid-year population estimates. Available at: www.nisra.gov.uk/demography/default. asp?cmsid=20_21_24&cms=demography_population%20statistics_Mi d%2Dyear+population+estimates&release 11. 2001 Carstairs scores for ST wards, England and Wales. Available at: www.statistics.gov.uk/STATBASE/ssdataset.asp?vlnk=9047 12. Morgan O and Baker A (2006) Measuring deprivation in England and Wales using the 2001 Carstairs scores. Health Statistics Quarterly 33, 28–33. 13. Department of Health (2002) National Suicide Prevention Strategy for England, Department of Health Publications: London. 14. Department of Health (1999) Saving Lives: Our Healthier Nation, TSO: London. 15. Choose Life. A national strategy to prevent suicide in Scotland. Available at: www.chooselife.net/web/site/home/home.asp 16. Department of Health, Social Services and Public Safety (2006) Suicide Prevention Strategy “Protect life – A Shared Vision” Consultation. Available at: www.dhsspsni.gov.uk/showconsultations? txtid=15454.

21

National Statistics


Appendix A

Autumn 2006

Age-standardised suicide rates (with 95 per cent confidence intervals) for men and women by country of the UK and Government Office Region of England, three-year rolling averages 1991–1993 to 2002–2004 Rates per 100,000 population

1991/93

LCI

UCI

1992/94 LCI

UCI

1993/95 LCI

UCI

1994/96 LCI

UCI

1995/97

LCI

UCI

1996/98

LCI

UCI

Men North East 18.9 ( 17.3 ; 20.4 ) 18.5 ( North West 21.4 ( 20.4 ; 22.4 ) 20.4 ( Yorkshire and the Humber 19.6 ( 18.5 ; 20.7 ) 19.2 ( East Midlands 19.6 ( 18.3 ; 20.8 ) 19.0 ( West Midlands 18.5 ( 17.5 ; 19.6 ) 18.2 ( East of England 19.1 ( 18.0 ; 20.2 ) 17.5 ( London 19.0 ( 18.0 ; 19.9 ) 18.3 ( South East 19.7 ( 18.8 ; 20.6 ) 18.9 ( South West 20.6 ( 19.4 ; 21.8 ) 19.0 ( England 19.7 ( 19.3 ; 20.0 ) 18.8 Wales 22.4 ( 20.8 ; 24.0 ) 21.7 Scotland 29.1 ( 27.7 ; 30.5 ) 30.4 Northern Ireland 18.1 ( 16.2 ; 20.1 ) 18.3 United Kingdom 20.7 ( 20.4 ; 21.1 ) 20.1

1997/99

LCI

UCI

16.9 ; 20.0 ) 19.4 ; 21.4 )

19.5 ( 17.9 ; 21.0 ) 19.7 ( 18.7 ; 20.7 )

19.8 ( 18.2 ; 21.4 ) 20.0 ( 18.4 ; 21.6 ) 20.5 ( 18.9 ; 22.1 ) 19.4 ( 18.5 ; 20.4 ) 19.8 ( 18.9 ; 20.8 ) 21.0 ( 20.0 ; 22.0 )

18.1 ; 20.4 ) 17.8 ; 20.2 ) 17.1 ; 19.2 ) 16.5 ; 18.5 ) 17.4 ; 19.3 ) 18.0 ; 19.8 ) 17.9 ; 20.1 )

18.8 ( 18.1 ( 17.7 ( 16.9 ( 17.8 ( 17.7 ( 18.1 (

18.6 ( 17.7 ( 16.3 ( 16.7 ( 17.3 ( 17.2 ( 18.5 (

( 18.5 ; 19.2 ( 20.2 ; 23.3 ( 29.0 ; 31.8 ( 16.4 ; 20.3 ( 19.8 ; 20.5

1998/2000 LCI

17.7 ; 16.9 ; 16.7 ; 15.9 ; 16.9 ; 16.8 ; 17.0 ;

19.9 19.2 18.8 17.9 18.7 18.5 19.2

) 18.2 ( 17.8 ; 18.5 ) 21.3 ( 19.7 ; 22.8 ) 31.2 ( 29.8 ; 32.6 ) 18.1 ( 16.2 ; 20.1 ) 19.6 ( 19.3 ; 20.0

UCI

1999/2001 LCI

) ) ) ) ) ) )

17.5 ; 16.5 ; 15.3 ; 15.7 ; 16.4 ; 16.3 ; 17.4 ;

19.7 ) 18.9 ) 17.3 ) 17.8 ) 18.2 ) 18.0 ) 19.6 )

) 17.8 ( 17.5 ; 18.2 ) 21.4 ( 19.8 ; 22.9 ) 30.2 ( 28.8 ; 31.6 ) 17.7 ( 15.8 ; 19.6 ) 19.2 ( 18.9 ; 19.6

UCI 2000/02 LCI

18.5 ( 16.6 ( 15.9 ( 16.0 ( 17.0 ( 16.8 ( 18.4 (

17.4 ; 15.5 ; 14.9 ; 15.0 ; 16.2 ; 16.0 ; 17.3 ;

19.6 ) 17.8 ) 16.9 ) 17.0 ) 17.9 ) 17.7 ) 19.5 )

19.3 ( 17.2 ( 16.5 ( 16.2 ( 18.1 ( 17.1 ( 18.1 (

18.2 ; 20.4 ) 16.1 ; 18.4 ) 15.5 ; 17.6 ) 15.2 ; 17.2 ) 17.2 ; 19.0 ) 16.3 ; 18.0 ) 17.0 ; 19.2 )

) 17.6 ( 17.2 ; 17.9 ) 18.1 ( 17.8 ; 18.5 ) 20.6 ( 19.1 ; 22.2 ) 20.1 ( 18.6 ; 21.6 ) 30.8 ( 29.4 ; 32.3 ) 31.2 ( 29.8 ; 32.7 ) 17.0 ( 15.2 ; 18.9 ) 17.2 ( 15.3 ; 19.1 ) 19.0 ( 18.7 ; 19.3 ) 19.5 ( 19.2 ; 19.8

UCI 2001/03

LCI

UCI 2002/04

LCI

) ) ) ) )

UCI

North East 20.6 ( 19.0 ; 22.3 ) 21.8 ( 20.1 ; 23.5 ) 21.0 ( 19.4 ; 22.7 North West 22.4 ( 21.3 ; 23.4 ) 23.0 ( 21.9 ; 24.1 ) 22.0 ( 21.0 ; 23.1 Yorkshire and the Humber 20.4 ( 19.3 ; 21.6 ) 20.1 ( 18.9 ; 21.3 ) 18.5 ( 17.4 ; 19.6 East Midlands 17.5 ( 16.4 ; 18.7 ) 18.6 ( 17.4 ; 19.8 ) 18.7 ( 17.5 ; 19.9 West Midlands 18.1 ( 17.0 ; 19.1 ) 19.6 ( 18.5 ; 20.7 ) 20.0 ( 18.9 ; 21.1 East of England 16.1 ( 15.1 ; 17.1 ) 16.4 ( 15.4 ; 17.4 ) 15.5 ( 14.5 ; 16.4 London 18.5 ( 17.6 ; 19.4 ) 18.2 ( 17.2 ; 19.1 ) 16.7 ( 15.8 ; 17.6 South East 17.5 ( 16.7 ; 18.4 ) 17.6 ( 16.8 ; 18.5 ) 17.0 ( 16.1 ; 17.8 South West 18.3 ( 17.2 ; 19.4 ) 19.0 ( 17.9 ; 20.2 ) 19.2 ( 18.0 ; 20.3

) 20.7 ( 19.1 ; 22.4 ) 20.5 ( 18.9 ; 22.2 ) 21.1 ( 19.4 ; 22.7 ) ) 20.2 ( 19.2 ; 21.2 ) 18.7 ( 17.8 ; 19.7 ) 17.8 ( 16.9 ; 18.8 )

England 18.7 ( 18.4 ; 19.1 ) 19.2 Wales 21.6 ( 20.1 ; 23.2 ) 23.0 Scotland 32.3 ( 30.8 ; 33.7 ) 32.8 Northern Ireland 17.8 ( 15.9 ; 19.7 ) 19.7 United Kingdom 20.2 ( 19.9 ; 20.6 ) 20.8

) 17.6 ( 17.3 ; 18.0 ) 22.4 ( 20.8 ; 24.0 ) 32.4 ( 30.9 ; 33.8 ) 21.4 ( 19.3 ; 23.5 ) 19.4 ( 19.1 ; 19.8

1991/93

LCI

UCI

( 18.8 ; 19.5 ( 21.4 ; 24.7 ( 31.4 ; 34.3 ( 17.7 ; 21.7 ( 20.4 ; 21.1

1992/94 LCI

) 18.4 ( 18.1 ; 18.8 ) 23.6 ( 21.9 ; 25.3 ) 32.6 ( 31.1 ; 34.1 ) 20.7 ( 18.7 ; 22.8 ) 20.2 ( 19.8 ; 20.5

UCI

1993/95 LCI

) ) ) ) ) ) )

UCI

17.4 ( 18.0 ( 19.2 ( 15.5 ( 16.1 ( 16.5 ( 18.3 (

16.4 ; 18.5 ) 16.8 ; 19.2 ) 18.1 ; 20.3 ) 14.5 ; 16.5 ) 15.2 ; 16.9 ) 15.7 ; 17.3 ) 17.2 ; 19.4 )

1994/96 LCI

17.0 ( 17.3 ( 18.2 ( 15.6 ( 15.8 ( 16.4 ( 17.5 (

15.9 ; 16.1 ; 17.1 ; 14.7 ; 15.0 ; 15.6 ; 16.4 ;

18.0 ) 18.5 ) 19.3 ) 16.6 ) 16.7 ) 17.2 ) 18.6 )

17.1 ( 16.6 ( 17.0 ( 15.6 ( 15.5 ( 16.2 ( 16.9 (

16.0 ; 15.5 ; 15.9 ; 14.7 ; 14.7 ; 15.4 ; 15.9 ;

18.2 ) 17.7 ) 18.0 ) 16.6 ) 16.3 ) 17.0 ) 18.0 )

) 17.1 ( 16.7 ; 17.4 ) 16.7 ( 16.3 ; 17.0 ) 22.5 ( 20.9 ; 24.2 ) 22.4 ( 20.7 ; 24.0 ) 30.7 ( 29.2 ; 32.1 ) 30.0 ( 28.6 ; 31.4 ) 19.8 ( 17.8 ; 21.8 ) 18.3 ( 16.4 ; 20.2 ) 18.8 ( 18.4 ; 19.1 ) 18.3 ( 18.0 ; 18.6

UCI

1995/97

LCI

UCI

1996/98

LCI

) ) ) ) )

UCI

Women North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South West

6.4 ( 6.8 (

5.5 ; 7.3 ) 6.3 ; 7.4 )

6.7 ( 6.2 (

5.8 ; 5.7 ;

7.6 ) 6.7 )

6.0 ( 6.1 (

5.2 ; 5.6 ;

6.9 ) 6.6 )

5.6 ( 6.0 (

4.8 ; 5.5 ;

6.4 ) 6.6 )

5.4 ( 6.5 (

4.6 ; 5.9 ;

6.2 ) 7.0 )

5.7 ( 6.5 (

4.8 ; 6.0 ;

6.5 ) 7.1 )

6.4 5.3 5.6 5.5 7.4 6.6 6.2

( ( ( ( ( ( (

5.8 4.7 5.0 5.0 6.8 6.1 5.6

; ; ; ; ; ; ;

7.0 6.0 6.2 6.1 8.0 7.1 6.8

) ) ) ) ) ) )

6.1 ( 5.0 ( 5.3 ( 5.0 ( 6.9 ( 6.2 ( 6.1 (

5.5 ; 4.4 ; 4.7 ; 4.5 ; 6.4 ; 5.7 ; 5.5 ;

6.7 ) 5.6 ) 5.8 ) 5.5 ) 7.5 ) 6.7 ) 6.7 )

5.9 ( 5.1 ( 5.0 ( 4.8 ( 6.4 ( 6.0 ( 5.9 (

5.3 ; 4.5 ; 4.4 ; 4.3 ; 5.8 ; 5.5 ; 5.3 ;

6.5 5.7 5.5 5.3 6.9 6.5 6.4

) ) ) ) ) ) )

5.9 ( 5.4 ( 4.9 ( 4.6 ( 5.7 ( 6.0 ( 6.0 (

5.3 ; 4.8 ; 4.3 ; 4.1 ; 5.2 ; 5.5 ; 5.4 ;

6.5 ) 6.0 ) 5.4 ) 5.1 ) 6.2 ) 6.4 ) 6.6 )

5.7 ( 5.3 ( 4.8 ( 4.7 ( 5.8 ( 6.2 ( 5.8 (

5.1 ; 4.7 ; 4.3 ; 4.2 ; 5.3 ; 5.7 ; 5.2 ;

6.3 ) 6.0 ) 5.3 ) 5.2 ) 6.3 ) 6.7 ) 6.4 )

5.5 ( 5.1 ( 4.7 ( 4.9 ( 6.2 ( 6.1 ( 5.9 (

4.9 ; 4.5 ; 4.1 ; 4.3 ; 5.7 ; 5.6 ; 5.3 ;

6.0 ) 5.7 ) 5.2 ) 5.4 ) 6.7 ) 6.6 ) 6.5 )

England Wales Scotland Northern Ireland United Kingdom

6.3 5.7 9.5 5.5 6.6

( ( ( ( (

6.1 4.9 8.8 4.4 6.4

; 6.5 ; 6.5 ; 10.3 ; 6.6 ; 6.8

) ) ) ) )

5.8 ; 6.2 ) 4.8 ; 6.3 ) 9.3 ; 10.9 ) 3.8 ; 5.8 ) 6.2 ; 6.5 )

5.7 ( 5.1 ( 9.9 ( 5.7 ( 6.1 (

5.5 ; 5.9 ) 4.4 ; 5.8 ) 9.2 ; 10.7 ) 4.6 ; 6.8 ) 5.9 ; 6.3 )

5.6 ( 5.0 ( 9.8 ( 5.4 ( 6.0 (

5.4 ; 5.8 ) 4.3 ; 5.7 ) 9.0 ; 10.6 ) 4.4 ; 6.5 ) 5.8 ; 6.2 )

5.7 ( 5.2 ( 9.8 ( 5.2 ( 6.0 (

5.5 ; 5.8 ) 4.5 ; 6.0 ) 9.1 ; 10.6 ) 4.2 ; 6.2 ) 5.9 ; 6.2 )

5.7 ( 5.7 ( 10.1 ( 4.9 ( 6.1 (

1997/99

North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South West

6.3 ( 6.9 (

5.4 ; 7.1 ) 6.3 ; 7.4 )

6.3 ( 6.6 (

5.4 ; 6.0 ;

7.1 ) 7.1 )

5.7 ( 6.5 (

5.2 4.9 4.9 4.6 6.5 5.6 6.0

( ( ( ( ( ( (

4.7 4.3 4.4 4.1 6.0 5.2 5.4

; ; ; ; ; ; ;

5.8 5.5 5.5 5.1 7.0 6.1 6.6

) ) ) ) ) ) )

5.5 ( 5.1 ( 5.5 ( 4.7 ( 6.4 ( 5.5 ( 6.5 (

5.0 ; 4.5 ; 4.9 ; 4.2 ; 5.9 ; 5.1 ; 5.9 ;

6.1 ) 5.7 ) 6.0 ) 5.2 ) 7.0 ) 6.0 ) 7.1 )

England Wales Scotland Northern Ireland United Kingdom

5.7 5.9 9.9 4.8 6.1

( ( ( ( (

5.5 5.1 9.1 3.8 5.9

; ; ; ; ;

5.9 6.7 10.6 5.8 6.3

) ) ) ) )

5.8 5.7 9.6 5.5 6.2

5.6 ; 6.0 ) 5.0 ; 6.5 ) 8.8 ; 10.3 ) 4.5 ; 6.5 ) 6.0 ; 6.3 )

LCI

UCI

6.0 5.6 10.1 4.8 6.4

( ( ( ( (

1998/2000 LCI

( ( ( ( (

LCI = Lower 95 per cent confidence interval. UCI = Upper 95 per cent confidence interval.


22

UCI

1999/2001 LCI

5.5 ; 5.9 ) 5.0 ; 6.5 ) 9.3 ; 10.9 ) 3.9 ; 5.9 ) 5.9 ; 6.3 )

UCI 2000/02 LCI

UCI 2001/03

LCI

UCI 2002/04

LCI

UCI

4.9 ; 6.0 ;

6.6 ) 7.1 )

5.3 ( 6.3 (

4.5 ; 5.8 ;

6.1 ) 6.8 )

5.0 ( 6.2 (

4.3 ; 5.7 ;

5.8 ) 6.7 )

5.9 ( 5.8 (

5.1 ; 5.3 ;

6.8 ) 6.4 )

5.3 ( 5.3 ( 5.8 ( 4.7 ( 6.0 ( 5.4 ( 5.8 (

4.8 ; 4.7 ; 5.2 ; 4.2 ; 5.5 ; 4.9 ; 5.3 ;

5.9 5.9 6.3 5.2 6.5 5.8 6.4

) ) ) ) ) ) )

5.3 ( 5.2 ( 5.2 ( 4.8 ( 5.8 ( 5.7 ( 5.8 (

4.8 ; 4.6 ; 4.7 ; 4.3 ; 5.3 ; 5.2 ; 5.2 ;

5.9 ) 5.8 ) 5.8 ) 5.3 ) 6.3 ) 6.2 ) 6.3 )

5.0 ( 5.2 ( 4.8 ( 4.8 ( 5.8 ( 5.3 ( 5.3 (

4.4 ; 4.5 ; 4.3 ; 4.3 ; 5.3 ; 4.8 ; 4.7 ;

5.5 ) 5.8 ) 5.3 ) 5.3 ) 6.3 ) 5.7 ) 5.8 )

5.2 ( 5.3 ( 4.9 ( 5.0 ( 5.7 ( 5.3 ( 5.7 (

4.7 ; 4.7 ; 4.3 ; 4.5 ; 5.2 ; 4.9 ; 5.1 ;

5.8 ) 6.0 ) 5.4 ) 5.5 ) 6.2 ) 5.7 ) 6.3 )

5.6 ( 5.2 ( 9.8 ( 4.8 ( 6.0 (

5.4 ; 5.8 ) 4.5 ; 6.0 ) 9.0 ; 10.6 ) 3.9 ; 5.8 ) 5.8 ; 6.2 )

5.5 ( 5.5 ( 10.0 ( 5.4 ( 6.0 (

5.3 ; 5.7 ) 4.7 ; 6.2 ) 9.2 ; 10.8 ) 4.4 ; 6.4 ) 5.8 ; 6.1 )

5.3 ( 5.8 ( 10.3 ( 4.8 ( 5.8 (

5.1 ; 5.5 ) 5.0 ; 6.6 ) 9.5 ; 11.1 ) 3.9 ; 5.8 ) 5.6 ; 6.0 )

5.4 ( 6.0 ( 10.0 ( 5.6 ( 6.0 (

5.2 ; 5.6 ) 5.3 ; 6.8 ) 9.3 ; 10.8 ) 4.6 ; 6.7 ) 5.8 ; 6.2 )