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Related to: Mental Health and Illness, Anxiety and Depression, Self-Harm, People with Multiple Needs, Wellbeing, Emotional Health and Wellbeing of Children and Young People, Ill Health and Disability, Domestic Abuse, Employment and Economic Activity, General Mortality, Major Causes of Mortality, Alcohol, Substance Misuse

Key Facts

  • Suicide is the leading cause of death among men and women aged between 20 and 34 years of age in England and Wales.
  • Suicides are higher in men than women, 78%  were men and 22% were women in the UK in 2013. Since 2007, the female rate stayed relatively constant while the male rate increased significantly. 
  • Studies have indicated that middle-aged men in lower socio-economic groups are at particularly high risk of suicide.
  • In the UK in 2010-12, 75% of people who died by suicide had not had contact with with mental health services within a year before their death. 
  • Local Coroners data from March 2013 shows that most suicide cases in B&NES were males not in current contact with mental health services. It also shows that many of these men had depression and were out of work and with some history of self-harm.
  • The most common method of suicide in the UK in 2013 was ‘hanging, strangulation and suffocation.
  • Except for a recent decline in 2012-14, suicide rates in B&NES have been increasing since 2005-07, from 5.1 per 100,000 population (26 deaths), to 8.9 per 100,000 population (48 deaths) during the period 2012-14 (age-standardised rates).
  • In B&NES in 2012-14, amongst 15-74 year olds, there were 33.7 years of life lost due to suicide per 10,000 of the under 75 year population (3 year average). The local rate was similar to that of the South West (35.6 years) and England (31.9 years). 
  • There were 5 undetermined deaths in U18 year olds between 2011 and Mar 2013 compared to none in the previous 5 years.

If you have been affected by any of these issues then please call the Samaritans on 08457 90 90 90

Definitions

Coroners verdict of suicide -  Deaths of this nature are recorded by coroners, a verdict of suicide should only be recorded if there is clear evidence that the injury was self-inflicted and that the deceased intended to kill him/herself. If there is any doubt about the intentions of the deceased either an accidental or an open verdict should be recorded. There is thus some under-recording of suicide deaths in the recorded suicide figures and it is likely that most open verdicts among adults are cases where suicide occurred but was not proven1.

The National Statistics definition of suicide - includes deaths given an underlying cause of intentional self-harm or an injury/poisoning of undetermined intent. In England and Wales, it has been customary to assume that most injuries and poisonings of undetermined intent are cases where the harm was self-inflicted, but there was insufficient evidence to prove that the deceased deliberately intended to kill themselves. This convention has been adopted across the UK. However, this cannot be applied to children due to the possibility that these deaths were caused by unverifiable accidents, neglect or abuse. Therefore, only persons aged 15 years and over are included in the suicide figures. 2

What does the data say? 

International 

According to the World Health Organisation, more than 800,000 people commit suicide every year, with perhaps 20 times that number attempting suicide. 3

The BRIDGE-II-MIX study - Characteristics and behaviours of people who have attempted suicide4

 The BRIDGE-II-MIX study is a major international study looking at depression and suicide. The researchers evaluated 2,811 patients suffering from depression, of whom 628 had attempted suicide. Each patient was evaluated by a psychiatrist. The parameters studied included previous suicide attempts, family history, current and previous treatment, patients’ clinical presentation, and how they scored on the standard Global Assessment of Functioning scale.

Characteristics and behaviours of those who attempt suicide - The study looked especially at the characteristics and behaviours of those who had attempted suicide, and compared these to depressed patients who had not attempted suicide. They found that certain patterns recur before suicide attempts:

  • Depressive mixed states - A depressive mixed state is where a patient is depressed, but also has symptoms of “excitation”, or mania. This suggests that patients who suffer from mixed depression are at a higher risk of suicide.
  • Risky behaviour (e.g. reckless driving, promiscuous behaviour)
  • Psychomotor agitation (pacing around a room, wringing one's hands, pulling off clothing and putting it back on and other similar actions)
  • Impulsivity (acting on a whim, displaying behaviour characterized by little or no forethought, reflection, or consideration of the consequences)

Implications for treatment - The study therefore concluded that assessing the above symptoms in every depressed patient is extremely important, and has immense therapeutical implications. It also highlighted that fact that most of these symptoms will not be spontaneously referred by the patient, and so clinicians need to inquire about them directly. This is an important message for all clinicians, from the GPs who see depressed patients and may not pay enough attention to these symptoms, which are not always reported spontaneously by the patients, through to secondary and tertiary level clinicians. 

UK 5

6,233 suicides of people aged 15 and over were registered in the UK in 2013, 252 more than in 2012 (a 4% increase).

It is important to note that the figures are for deaths registered in each year, rather than occurring each year. There can be a substantial delay between the date of death and date of registration. Suicide figures in England and Wales are also potentially affected by an increase over time in the use of ‘narrative verdicts’ by coroners.

In 2013, 88% of these inquests concluded with a ‘short form’ verdict such as accident, misadventure, natural causes, suicide or homicide. The remaining 12% were ‘narrative verdicts’ which can be used by a coroner or jury instead of a short form verdict to express their conclusions as to the cause of death. In 2013, 53% of narrative verdicts in England and Wales resulted from an external cause of death (an injury or poisoning) rather than a disease. Some of these narrative verdicts clearly state the intent and method.

Figure 1: Age-standardised suicide rates in the UK: by sex, deaths registered in each year from 1981 to 2013 6

Gender7

Of the total number of suicides in 2013 , 78% were male and 22% were female. The proportion of male suicides to female suicides has increased since 1981 when 63% were male and 37% were female. Since 2007, the female rate stayed relatively constant while the male rate increased significantly. 

Men - When UK male suicide rates are analysed by five broad age groups, the 30 to 44 age group had the highest rate from 1995 to 2012. However, in 2013 the highest rate by broad age group was among men aged 45 to 59, at 25.1 deaths per 100,000, the highest for that age group since 1981. This was the first year that this age group had the highest suicide rate. The rate for 60 to 74 year olds rose significantly from its 2012 level, to 14.5 per 100,000 in 2013. In contrast, the 15 to 29 age group was the only group to have a decrease in the age-specific rate in 2013.

Suicide remains the leading cause of death in England and Wales for men aged between 20 and 34 years of age (24% of all deaths in 2013) and for men aged 35 to 49 years (13% of all deaths in 2013).

Women - Since 2002, the highest rate of female suicide in the UK has been for those aged 45−59; in 2013 the rate for this group was 7.0 deaths per 100,000 population. The lowest rate has been for those aged 15−29, where the 2013 rate was 2.9 deaths per 100,000.

As with men, suicide is the leading cause of death among women aged between 20 and 34 years of age in England and Wales, accounting for 12% of all deaths registered in this age group in 2013. It is the third leading cause of death for those aged 35 to 49 in 2013 (6%).

Method8

The most common method of suicide in the UK in 2013 was ‘hanging, strangulation and suffocation. The proportion of suicides from ‘hanging, strangulation and suffocation’ has increased over time, from 45% in 2002 to 56% in 2013 for men, and from 26% in 2002 to 40% in2013 for women. 

Poisoning was the second most used method of suicide in the UK, for both males and females. For both men and women, the proportion of deaths from poisoning has fallen over the last 11 years, from 28% in 2002 to 20% in 2013 for men, and from 49% in 2002 to 38% in 2013 for women. Drowning, falls and other methods have remained fairly consistent over the past decade.

Socio-economic inequality9

Studies have carried have suggested that the recent recession in the UK could be an influencing factor in the increase in suicides. They have found that local areas with greater rises in unemployment had also experienced higher rises in male suicides.

A review carried out by the Samaritans in 2012 indicated that middle-aged men in lower socioeconomic groups are at particularly high risk of suicide. It pointed to evidence that suicidal behaviour results from the interaction of complex factors such as unemployment and economic hardship, lack of close social and family relationships, the influence of a historical culture of masculinity, and personal crises such as divorce.

Bath and North East Somerset 

Except for a recent decline in 2012-14, suicide rates (15 years +) in B&NES have been increasing since 2005-07, from 5.1 per 100,000 (26 deaths), to 8.9 per 100,000 (48 deaths) during the period 2012-14 (age-standardised rates). Consequently, though B&NES used to have a significantly lower rates of deaths from suicides or undetermined intent than the South West and England (between 2001-03 and 2005-07), since 2006-08 and 2007-09, the rates have not been significantly different to England (8.9 in 2012-14) and South West (10.1 in 2012-14). 10 11

It should be noted that official suicide figures are based on the date that the death is registered and not the date it occured. For deaths from suicide there is typically a 160 day delay between occurance and registration but it can be longer and thus the data on the graph may be delayed by 6 months to a year compared to the actual date of death.

Figure 2: Directly age standardised rates of deaths from suicides or undetermined intent in Bath and North East Somerset,South West and England between 2000-02 and 2012-14 (rolling years) 12

Years of life lost 13

In B&NES in 2012-14, amongst 15-74 year olds, there were 33.7 years of life lost due to suicide per 10,000 of the under 75 year population (3 year average). The local rate was similar to that of the South West (35.6 years) and England (31.9 years). 

Gender 14

Rates of suicide - are higher in men than women:

  • Men - In B&NES in 2012-14 there were 13.9 male suicides (15 years +) per 100,000 of the male population (3 year average), lower than the rate for the South West as a whole (15.2), and the England rate (14.1).
  • Women – There is no equivalent rate for woman in B&NES because the value cannot be calculated as number of cases is too small. However, the rates for the South West and England demonstrate the lower numbers of female suicides. In the South West in 2012-14 there were 5.3 female suicides (15 years +) per 100,000 of the female population (3 year average), very similar to the England rate (4.0). 

Years of life lost due to suicide - is much higher in men than women:

  • Men - In B&NES in 2012-14, amongst male 15-74 year olds, there were 54.1 years of life lost due to suicide per 10,000 of the under 75 year male population (3 year average). The local rate was higher than that of the South West (52.6 years), and England (50.2 years).
  • Women - In B&NES in 2012-14, amongst female 15-74 year olds, there were 13.3 years of life lost due to suicide per 10,000 of the under 75 year female population (3 year average). The local rate was lower than that of the South West (18.6 years), and England (13.7 years).

35-64 year olds 15

The highest rates of suicide are in 35-64 year olds:

  • Men - In B&NES in 2010-14 there were 19.6 suicides in the 35-64 year old male population per 100,000 of the male 35-64 years population (5 year average crude rate), lower than the rate in the South West (22.6) and England (20.5).
  • Women - There is no equivalent rate for woman in B&NES because the value cannot be calculated as number of cases is too small. However, in the South West in 2010-14 there were 7.1 suicides in the 35-64 year old female population per 100,000 of the female 35-64 years population (5 year average crude rate), higher than the England rate of 5.9. 

Older People 16

  • Men - In B&NES in 2010-14 there were 9.5 suicides in the 65 years and over male population per 100,000 of the male 65+ years population (5 year average crude rate), lower than the rate in the South West (14.1) and England (12.4).
  • Women - There is no equivalent rate for woman in B&NES because the value cannot be calculated as number of cases is too small. However, in the South West in 2010-14 there were 5.2 suicides in the 65 years and over female population per 100,000 of the female 65 + years population (5 year average crude rate), higher than the England rate of 4.3.

Younger People  17

  • Men - In B&NES in 2010-14 there were 14.9 suicides in the 15-34 year old male population per 100,000 of the male 15-34 years population (5 year average crude rate), higher than the rate in the South West (13.3) and England (12.3).
  • Women - There is no equivalent rate for woman in B&NES because the value cannot be calculated as number of cases is too small. However, in the South West in 2010-14 there were 4.7 suicides in the 15-34 year old female population per 100,000 of the female 15-34 years population (5 year average crude rate), higher than the England rate of 3.4.

There were 5 undetermined deaths in under 18 year olds between 2011 and Mar 2013. There were no undetermined deaths in under 18 year olds in in the previous 5 years (2006-2010) 18.

Are we meeting the needs?

UK

In the UK in 2010-12, 75% of people who died by suicide had not had contact with with mental health services within a year before their death. 19

B&NES

Proportion of suicides that were of people in contact with Avon and Wiltshire Mental Health NHS Partnership (AWP) - The graph below shows that of all the Local Authorities covered by AWP, B&NES had the highest proportion of suicides that were of people in contact with AWP between 2008-12. However, in B&NES the proportion of suicides that were of people in contact with AWP decreased over this period, from 65% to 41%. This is also means that though the B&NES proportion was much higher than the average in 2008-10 (65% compared to 36%), it was only slightly above average in 2010-12 (41% compared to 35%). 20  21

Figure 3: Proportion of suicides that were of people in contact with Avon and Wiltshire Mental Health NHS Partnership (AWP) for the Local Authorities covered by AWP (2008-12) 22  23

Larger version of Figure 3

Local Coroners data from March 2013 - shows that most suicide cases in B&NES were males not in current contact with mental health services. It also shows that many of these men had depression and were out of work and with some history of self-harm.24.

What can we realistically change?

Each constituent country of the UK has a suicide prevention strategy in place which aims to identify risk factors, take action via cross-sector organisations, and reduce suicide rates.25

In September 2012, the Department of Health launched ‘Preventing Suicide in England: a cross-government outcomes strategy to save lives’. This strategy aims to reduce the suicide rate and improve support for those affected by suicide and was informed by an earlier consultation on preventing suicide in England. The new strategy outlines six areas for action including: reducing the risk of suicide in key high-risk groups (for example, people in the care of mental health services, people with a history of self-harm, people in contact with the criminal justice system, and men aged under 50); reducing access to the means of suicide; and supporting research, data collection and monitoring.26