Suicide-poverty link is reinforced in new study

Strong links between suicide, attempted suicide and poverty have been found in a study of more than 11,000 patients over more than 10 years in Bristol.

The findings suggest that improving the circumstances of the least well- off is at least as important as any activity by the National Health Service if the Government's Health of the Nation target of cutting suicides is to be achieved.

The link between suicide and unemployment, and possible links between suicide and poverty, have been the subject of intense debate. Suicide has been increasing among young men and apparently rising in areas of sudden and high unemployment, although last year's figures do suggest an overall fall in the numbers killing themselves.

But a paper in this week's British Medical Journal shows powerful links, but not causative proof, that deprivation is strongly linked not only to suicides but to parasuicides - attempted suicides - and hospital admissions for acute mental illness.

The findings follow analysis of almost 1,000 suicides in the city over a 10-year period and the examination of thousands of hospital admissions for mental illness and parasuicide.

Suicide and parasuicide rates were between three and eight times higher in the inner city and other deprived wards of Bristol compared with the more pleasant wards, suburbs and surrounding towns. And there was a gradation - the higher the deprivation measures, the higher the suicide and parasuicide rates.

The difference persisted once allowance was made for age and sex differences between the different populations.

David Gunnell, a lecturer in public health medicine at the university, said the way the rates increased as areas became more deprived undermined past arguments that suicide rates were higher in inner cities only because the mentally ill tended to be attracted there by hostels, council housing and the anonymity of inner-city life.

Measures to decrease deprivation may therefore be more effective than health service interventions in preventing suicide, he said.

The link between poverty, suicide and attempted suicide appeared the strongest one, over and above the well-known factors of women and young girls being more likely to attempt suicide and men more likely to succeed, with the highest rates among men in those over 75.

Attempted suicide is 10 to 20 times more common than suicide, although between 30 and 47 per cent of successful suicides have a history of past tries. Between 3 and 10 per cent of parasuicides go on to kill themselves within 10 years of an attempt.

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