HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Middleton, N. Articles by Gunnell, D. Search for Related Content PubMed PubMed Citation Articles by Middleton, N. Articles by Gunnell, D. Topic Collections Relevant Article

The geography of despair among 15–44-year-old men in England and Wales: putting suicide on the map

Department of Social Medicine, University of Bristol, Canynge Hall, Bristol, UK

Correspondence to:
Correspondence to:
N Middleton
Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK; nmitlett{at}hsph.harvard.edu

Objective: To investigate the spatial patterning and possible contributors to the geographical distribution of suicide among 15–44- year-old men.

Design: Small-area analysis and mapping of geo-coded 1988–94 suicide mortality data and 1991 census data using random-effects smoothing.

Setting: 9265 electoral wards in England and Wales (mean population of men aged 15–44- years: about 1220).

Main results: Two main patterns emerged: (a) in all of the 10 most densely populated cities studied, suicide showed a "bull’s-eye" pattern with rates highest in the inner-city areas and, in some cases, low rates in the peripheries, and (b) suicide rates were high in coastal areas, particularly those in more remote regions. Possible indicators of social fragmentation, such as the proportion of single-person households in an area, were most strongly and consistently associated with rates of suicide in both urban and rural areas. Levels of unemployment and long-term illness accounted for some of the coastal patterning. Although characteristics of areas accounted for more than half of the observed variability, substantial between-area variability in rates remained unexplained.

Conclusions: The area characteristics investigated here did not fully account for the higher suicide rates observed in the most rural or remote areas. Alongside social and economic aspects, rural life itself may have an independent effect on the risk of suicide. A greater understanding of local geographies of suicide, and particularly the possible interactions between characteristics of people and their environments, might assist the design of prevention strategies that target those areas (and their characteristics) where risk is concentrated.

Abbreviations: SMR, standardised mortality ratio

Relevant Article

In this issue

Carlos Alvarez-Dardet and John R Ashton
J Epidemiol Community Health 2006 60: 1005. [Extract] [Full Text] [PDF]