Suicide risk in small-areas in England and Wales, 1991-1993
Journal
Social Psychiatry and Psychiatric Epidemiology
Date Issued
January 2004
DOI
10.1007/s00127-004-0707-y
Abstract
Background There is growing evidence that
areas characterised by high levels of social fragmentation
have higher suicide rates. Previous ecological studies
have focused on relatively large geographic areas
and/or examined associations in all age groups combined.
Methods Negative binominal regression was used
to assess age- and sex-specific suicide rate ratios for a
range of census-derived indicators of the social, health
and economic characteristics of small areas (mean population
aged ≥ 15: 4500) in England and Wales. Results
Indicators of social fragmentation (e. g. proportion of
people living alone or population mobility) were most
consistently associated with suicide risk. For example,
across quartiles of wards ranked according to increasing
proportions of single-person households, age- and sexadjusted
suicide rate ratios were: 1.00, 1.05 (1.00, 1.11),
1.14 (1.08, 1.19) and 1.42 (1.36, 1.49). Associations were
strongest in 15 to 44 and 45 to 64 year-olds.Associations
with social fragmentation persisted after controlling for
the effect of other area characteristics. Conclusions Targeted
mental health promotion and social policy initiatives
to reduce area-health inequalities in suicide might
usefully focus on areas with high levels of social fragmentation.
areas characterised by high levels of social fragmentation
have higher suicide rates. Previous ecological studies
have focused on relatively large geographic areas
and/or examined associations in all age groups combined.
Methods Negative binominal regression was used
to assess age- and sex-specific suicide rate ratios for a
range of census-derived indicators of the social, health
and economic characteristics of small areas (mean population
aged ≥ 15: 4500) in England and Wales. Results
Indicators of social fragmentation (e. g. proportion of
people living alone or population mobility) were most
consistently associated with suicide risk. For example,
across quartiles of wards ranked according to increasing
proportions of single-person households, age- and sexadjusted
suicide rate ratios were: 1.00, 1.05 (1.00, 1.11),
1.14 (1.08, 1.19) and 1.42 (1.36, 1.49). Associations were
strongest in 15 to 44 and 45 to 64 year-olds.Associations
with social fragmentation persisted after controlling for
the effect of other area characteristics. Conclusions Targeted
mental health promotion and social policy initiatives
to reduce area-health inequalities in suicide might
usefully focus on areas with high levels of social fragmentation.