Editor—Yamey reports on the decline in suicide rates among men and women in England and Wales in the 1990s.1 Suicide rates in Scotland diverged from those in England and Wales in the late 1970s and early 1980s, with a more rapid increase in rates among men and no clear trend in rates among women.2 A review of suicide and undetermined death rates in Scotland indicates that rates among men in these countries have continued to separate in the 1990s.
Age specific rates among Scottish women, not shown here, have shown slight increases or have remained the same, except in some older age groups where there have been slight decreases. Rates among men in Scotland (figure) give little indication of the declines noted in England and Wales. Compared with 1990, suicide rates among men in 1997 had increased in Scotland in all age groups up to and including 45-54 years.
Similar trends in methods used by men have occurred in Scotland, but the size of the changes differs from England and Wales. Rates of suicide by hanging and strangulation in men increased by 60% between 1990 and 1997, whereas deaths by other causes fell by around 40%. Deaths by solid and liquid substances showed little change over the period as a whole.
Squires et al have said that overall suicide rates may be influenced by a reclassification of deaths previously classified as undetermined cause to dependent and non-dependent use of drugs.3 If this is the case the differences between the countries may be even more marked than we have indicated.
Although trends in causes of death are largely similar to England and Wales, the absolute rates are different. This may be related to differential improvements in social circumstances in Scotland and England, but cultural differences between the two may also be important. Qualitative, as well as quantitative, research will be required to tease out the reasons for these striking differences.
Figure.
Suicide and undetermined death rates for men in Scotland 1990-7 by age group (ICD-9 diagnostic codes E950-E959 or E980-E989 coded as primary cause)
References
- 1.Yamey G. Suicide rate is decreasing in England and Wales. BMJ. 2000;320:75. . (8 January.) [PMC free article] [PubMed] [Google Scholar]
- 2.Crombie IK. Suicide in England and Wales and in Scotland. An examination of divergent trends. Br J Psychiatry. 1990;157:529–532. doi: 10.1192/bjp.157.4.529. [DOI] [PubMed] [Google Scholar]
- 3.Squires T, Gorman D, Arrundale J, Platt S, Fineron P. Reduction in drug related suicide in Scotland 1990-1996: an artefactual explanation. J Epidemiol Community Health. 1999;53:436–437. doi: 10.1136/jech.53.7.436. [DOI] [PMC free article] [PubMed] [Google Scholar]