Abstract
Ecological studies of suicide and self-harm have established the importance of area variables (e.g., deprivation, social fragmentation) in explaining variations in suicide risk. However, there are likely to be unobserved influences on risk, typically spatially clustered, which can be modeled as random effects. Regression impacts may be biased if no account is taken of spatially structured influences on risk. Furthermore a default assumption of linear effects of area variables may also misstate or understate their impact. This paper considers variations in suicide outcomes for small areas across England, and investigates the impact on them of area socio-economic variables, while also investigating potential nonlinearity in their impact and allowing for spatially clustered unobserved factors. The outcomes are self-harm hospitalisations and suicide mortality over 6,781 Middle Level Super Output Areas.
Highlights
Ecological studies of suicide and self-harm investigate geographical variations in risk and their association with explanatory variables, some of which may be measured and some unobserved
The difference between the DIC for this model (26,488.5) and the closest competitor (26,489.1, for a model including both spatial and heterogeneity effects) is admittedly small, but a preference for this model can be justified in wider parsimony terms, that a model with better fit and fewer parameters is to be preferred
The worse fitting model in this comparison has nearly 7,000 extra parameters, and none of these effects is significant in terms of 90% credible intervals excluding zero
Summary
Ecological studies of suicide and self-harm investigate geographical variations in risk and their association with explanatory variables, some of which may be measured and some unobserved. Boyle et al [1] present evidence of contrasting area suicide mortality according to area socioeconomic status, as measured by area deprivation scores. A number of studies of suicide and psychiatric morbidity establish the role of area household structure and population turnover, as summarized in the so-called social fragmentation index [2]. Urban-rural variation in suicide outcomes is well documented [3].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
