Epidemiology of suicide in Scotland Stephen Platt University of Edinburgh Presentation to SG National Suicide Prevention Review Group 3 November 2009

22 * per inhabitants aged 15+ years Very high suicide rates: 40,1 (Hungary) –58,0 (Lithuania) High suicide rates: 25,0 (Moldavia) –35,8 (Belarus) Low suicide rates: 3,4 (Albania) –9,9 (Portugal) Data not available Average suicide rates 11,9 (Netherlands) –23,0 (Czech Rep) Suicide in Europe (latest available data)

Age-standardised suicide rates, UK, 1991/ /04, males

Age-standardised suicide rates, UK, 1991/ /04, females

Intentional self harm & undetermined deaths, Scotland, 15+ years,

Intentional self harm & undetermined deaths, by age, Scotland, to , males

Intentional self harm & undetermined deaths, by age, Scotland, to , females

Age-standardised suicide rates by social class, males aged years,

Male suicide risk: effect of educational level and housing tenure (Lorant et al 2005)

European age-standardised rates per 100,000 population: deaths caused by intentional self harm and events of undetermined intent, by deprivation decile (SIMD), Scotland,

Suicide by local area, UK, , men 15+ years

Local areas with highest suicide rates, UK, , men 15+

Suicide by local area, UK, , women 15+ years

Local areas with highest suicide rates, UK, , women 15+

Suicide cluster in Glasgow,

Suicide cluster in Glasgow Significant geographical cluster of suicide among adults aged years was identified in east Glasgow around 1981, 1991 and 2001 censuses All three clusters can be explained by the concentration of socio-economic deprivation in this part of Scotland Possibility that this cluster is caused by contagion (direct/indirect exposure to suicide ‘models’) is dismissed “Scottish suicide prevention strategies should target young adults in east Glasgow” (Exeter D & Boyle P JECH 2007; 61: 731-6)

Public health effect of economic crises (1) Stuckler et al (Lancet 2009; 374; ) used multivariate regression to investigate how economic crisis (defined as rapid and significant changes in employment) affected mortality rates over past three decades 26 EU countries Looked at all-cause mortality and 25 separate causes (including suicide and suicide in people aged <65 years)

Public health effect of economic crises (2) Every 1% increase in unemployment was associated with 0.8% rise in suicide at ages <65 years (similar rise in homicides, 1.4% decline in RTA deaths; but no significant net effect on all-cause mortality) A more than 3% increase in unemployment was associated with 4.5% increase in suicide at ages <65 years (28% [sic] rise in alcohol abuse; again, no significant net effect on all-cause mortality) Adverse effects on suicide were mitigated when investments in active labour market programmes (were high (>$190 per head)

Trends in suicide, Glasgow city, males, to