BMJ 1999;319:1034-1037 ( 16 October )

Papers

Ecological study of social fragmentation, poverty, and suicide

Elise Whitley, lecturer in medical statistics, ^a David Gunnell, senior lecturer in epidemiology and public health medicine, ^a Daniel Dorling, reader in geography, ^b George Davey Smith, professor of clinical epidemiology. ^a

^a Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ^b School of Geographical Sciences, University of Bristol

Correspondence to: E Whitley elise.whitley{at}bristol.ac.uk

Objectives: To investigate the association between suicide and area based measures of deprivation and social fragmentation.
Design: Ecological study.
Setting: 633 parliamentary constituencies of Great Britain as defined in 1991.
Main outcome measures: Age and sex specific mortality rates for suicide and all other causes for 1981-92.
Results: Mortality from suicide and all other causes increased with increasing Townsend deprivation score, social fragmentation score, and abstention from voting in all age and sex groups. Suicide mortality was most strongly related to social fragmentation, whereas deaths from other causes were more closely associated with Townsend score. Constituencies with absolute increases in social fragmentation and Townsend scores between 1981 and 1991 tended to have greater increases in suicide rates over the same period. The relation between change in social fragmentation and suicide was largely independent of Townsend score, whereas the association with Townsend score was generally reduced after adjustment for social fragmentation.
Conclusions: Suicide rates are more strongly associated with measures of social fragmentation than with poverty at a constituency level.

Key messages Place of residence may affect health, and mortality from most common diseases tends to be higher in areas characterised by low socioeconomic position Research dating back over 100 years suggests that social fragmentation may influence suicide In the 1980s and 1990s, parliamentary constituencies with high levels of social fragmentation had high rates of suicide, independent of deprivation Constituencies with the greatest increases in social fragmentation between 1981 and 1991 also had the greatest increases in suicide rates over the same period Any targeting of suicide prevention may be more effective if aimed at socially fragmented rather than deprived areas

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