Suicide and deprivation in ScotlandBMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7030.543 (Published 02 March 1996) Cite this as: BMJ 1996;312:543
- Philip McLoone, research fellowa
- Accepted 1 November 1995
In Scotland the analysis of deaths in small geographical areas showed an association between suicide rates and economic deprivation.1 This suggested that the recent increase in rates among young people has been greatest in deprived areas. Because of continuing concerns about rising suicide rates among young men I investigated the association with deprivation further.
Subjects, methods, and results
The General Register Office for Scotland provided data on all deaths by suicide (codes E950-959 in the revision of the International Classification of Diseases) and deaths undetermined whether accidentally or purposely inflicted (codes E980-E989) which had occurred among Scottish residents between 1981 and 1993. Undetermined deaths were considered to be suicide, and death rates were standardised to the World Health Organisation's European population. I investigated the associations with deprivation by using Carstairs deprivation scores to group postcode sectors into three groups described as affluent, average, and deprived.2 The three categories included about 20%, 60%, and 20% of the Scottish population.
Between 1981-3 and 1991-3 suicide rates among men aged 15-29 increased by 66% (table 1), but the rate among those aged 30 showed little change. Rates among young women also increased, but in those aged 30 or more the rate fell by 28%. For men and women and in both age groups there was a gradient in suicide rates across the deprivation categories, with lower rates in more affluent areas. Suicide rates for men and women aged 15-29 rose in all categories, but this rise was greatest in deprived areas. By 1991-3 suicide rates in young men and women living in deprived areas were about twice the rates of those living in affluent areas.
When I examined the method of committing suicide, rates in deprived areas were higher for each method, with the exception of the use of car exhausts. Among men in deprived areas the greatest increase occurred in rates of self poisoning and hanging. In contrast, in affluent areas the largest rise occurred in the use of car exhaust fumes.
Suicide may be characterised as the result of an inability to cope with severe psychological stress and rising rates as an increasing number of people experiencing such stress. To explain the increases in Scotland in the past decade, changes in the wide range of influences associated with an increased risk of suicide and people's different exposure to these influences must be taken into account.3 4 The fact that the greatest rates of increase have occurred among deprived young men and women is clearly important.
There was a significant increase in deaths from car exhaust fumes during the 1980s, particularly in affluent areas, which suggests increased access to the method and knowledge of its effectiveness. Compulsory emission controls are clearly needed.
Although suicide rates are dependent on the availability and effectiveness of the method chosen, they are clearly an indication of the prevalence of considerable distress. Increasing rates may be the result of a more general experience of social malaise. Some part of the increase may reflect fundamental changes in social structure—for example, security of employment, divorce, and homelessness. More direct effects might be changes in mental health services and the consequence of drug and alcohol misuse and of criminal activity. However, suicide is a fairly rare event and its relation to the population at risk cannot easily be estimated.
Educating general practitioners to recognise depression, restricting the availability of drugs used for self poisoning, and modifying car exhaust systems might reduce the numbers of deaths by suicide. Against the background of an association with socioeconomic deprivation,5 however, these measures will not reduce the number of people with a suicidal motivation.
Funding The Public Health Research Unit is supported by the Chief Scientist Office of the Scottish Home and Health Department. The opinions and conclusions expressed are not necessarily those of the department.
Conflict of interest None.