Suicide rates in young men in England and Wales in the 21st century: time trend studyBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39475.603935.25 (Published 06 March 2008) Cite this as: BMJ 2008;336:539
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The answer to the question on the front cover "Have catalytic converters helped prevent suicide" is probably no. In New Zealand we don't have catalytic converters but have seen a similar decrease in the rate of suicide in young men.
In the late 1980's and early 1990's the UK had Thatcherism and New Zealand had Rogernomics. As a clinician seeing people who self harmed during these years it seems that the changes consequent on these political phenomenon reduced hope in young men leaving school and entering the work force. Women's roles weren't so affected and their suicide rates did not change. This is just a clinical impression and not supported by any research evidence.
One of the reasons for the lack of evidence is the unhelpful grouping together of 15-24 year olds, as in the Biddle article. A 15 year old is very different to a 24 year old and they are subject to different laws, health services, psychological development and work/school role. To group such disparate ages together means that important correlations with social forces are likely to be missed. A much more sensible grouping would be to look at 15-19 year olds and 20-24 year olds separately. This may help to make links between the tragedy of suicide and social risk factors clearer.
Competing interests: None declared
Competing interests: No competing interests
Biddle et al pose an interesting question with their recent paper on suicide rates in young men1. While rates have clearly been falling over the last decade, none of the factors they look at – divorce rates, unemployment, alcohol consumption or antidepressant prescribing – appears adequately to explain this decline. The answer may lie in a phenomenon reported by Shaw et al in 2002: that suicide rates tend to rise under Conservative governments, and to fall when Labour is in power2. They provided figures to show that this holds true for every UK administration of the 20th century with the exception of Edward Heath’s Conservative government of 1970-1974 - a discrepancy they explain by the national switch from coal gas to less lethal natural gas at this time. A similar trend has been noted in Australia3: when both Federal and State governments were Conservative the relative risk of suicide was 1.17 (p<0.001) for men and 1.40 for women (p<0.001) compared to when both governments were Labour.
The data presented by Biddle et al is another good illustration of this principle. They show a steady increase in suicides among young British men from the 1970s to the 1990s – a period of Conservative administration, under first Margaret Thatcher, then John Major. They then show a similarly steady decline in suicides since 1998; Labour have been in power since 1997. They also point out that by 2005, rates in 15-24 year-olds and 25-34 year-olds were the lowest they had been since 1974 and 1978, respectively. This was, of course, the last time the UK had a Labour government, under Harold Wilson (1964-70 and 1974-76) and James Callaghan (1976-1979).
Previous authors have speculated that the greater enthusiasm of Labour governments for instituting social reforms makes people more hopeful – that more of society lives in hope when Labour are in charge3. Others have wondered whether greater income inequality under Tory governments increases suicidality2; however, the UK’s Gini coefficient – a measure of income inequality – has remained largely unchanged since the late 1980s4.
One thing, however, seems clear – that psychiatrists may have to start considering “current party of government” when assessing their patients’ risk of self harm. Given that a key part of psychiatric practice is risk reduction, this has clear implications for how mental health workers should cast their votes. But since the GMC does not, yet, have control over doctors’ political allegiances, this must be left to conscience.
1 Biddle L, Brock A, Brookes ST, Gunnell D. Suicide rates in young men in England and Wales in the 21st century: time trend study. BMJ 2008;336:539-542
2 Shaw M, Dorling D, Davey Smith G. Mortality and political climate: how suicide rates have risen during periods of Conservative government, 1901–2000. J Epidemiol Community Health 2002;56:723-725
3 Page A, Morrell S, Taylor R. Suicide and political regime in New South Wales and Australia during the 20th century. J Epidemiol Community Health 2002;56:766-772.
4 Office for National Statistics. Income Inequality. Office for National Statistics, 17 May 2007. http://www.statistics.gov.uk/
Competing interests: Tends to vote Lib Dem
Competing interests: No competing interests