Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation

David Gunnell · Robert M Kammerling

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Suicide and Self-Harm Studies Mental Health Treatment and Access Homicide, Infanticide, and Child Abuse

Abstract

OBJECTIVE: To examine the relations between parasuicide, suicide, psychiatric inpatient admissions, and socioeconomic deprivation. DESIGN: Ecological analysis with data from routine information systems and the 1991 census. SETTING: 24 localities in the area covered by the Bristol and District Health Authority (population 817,000), consisting of aggregations of neighbouring wards, with an average population of 34,000. SUBJECTS: 6089 subjects aged over 10 years admitted to hospital after parasuicide between April 1990 and March 1994; 997 suicides occurring 1982-91; 4763 subjects aged 10-64 years admitted with acute psychiatric illness between April 1990 and March 1994. RESULTS: Localities varied significantly in standardised admission ratios for parasuicide and standardised mortality ratios for suicide (P < 0.001). Spearman's rank correlation coefficient between the standardised mortality ratio for suicide and standardised admission ratio for parasuicide was 0.73 (95% confidence interval 0.46 to 0.88). Correlation between parasuicide and Townsend score was 0.86 (0.70 to 0.94) and between suicide and Townsend score 0.73 (0.46 to 0.88). The partial correlation coefficient between suicide and parasuicide after the Townsend score was adjusted for was 0.29 (-0.13 to 0.62). The correlation between standardised admission ratio for parasuicide and standardised admission ratio for psychiatric illness was 0.76 (0.51 to 0.89) and between standardised mortality ratio for suicide and standardised admission ratio for psychiatric illness was 0.72 (0.45 to 0.87). CONCLUSION: A strong ecological association exists between suicide and parasuicide, with socioeconomic deprivation accounting for much of this relation. This strong association provides supporting evidence for the importance of social policy measures in attaining Health of the Nation targets on mental health.

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References

1987Health and Deprivation: Inequality and the North 1994Prevention of suicide: aspirations and evidence 1988Suicide, and Other Causes of Death, Following Attempted Suicide 1993Socioeconomic differentials in wealth and health.

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2001Cultural factors and international epidemiology 2007Poverty, social stress & mental health.2006Gender, place, and method of suicide 1998Poverty, psychological disorder and disability in primary care attenders in Goa, India 2000The Epidemiology of Suicide and Attempted Suicide among Young Australians 1999Ethnic minority suicide: a small area geographical study in south London 2004The suicidal process; prospective comparison between early and later stages 2010Socioeconomic inequalities in suicidal ideation, parasuicides, and completed suicides in South Korea

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