Male suicide trends and inequalities in Scotland 1980–2015: a population-based study

Abstract

BackgroundIn Scotland, male suicide rates increased substantially in the 1980s and 1990s with higher rates in more deprived areas. We aimed to examine trends in male suicide in Scotland on an extended time scale (1980–2015) by method of suicide and individual socioeconomic position. MethodsRecords of suicide deaths for 1980–2015 were obtained from National Records Scotland. National Statistics socioeconomic classification (NS-SEC, 2001) was used to assess inequalities in 2000–02 for ages 20–59 years. Standardised death rates were calculated by age with the European population 2013 as reference, and Poisson regression used to determine the significance of trends. Inequalities were assessed with the slope of index of inequality (SII). Findings12 281 suicide deaths were recorded between 1980 and 2015. At all ages, no significant linear trend was observed over time, but suicide rates (per 100 000 person-years) increased from 21 to 27 between 1980 and 2002 (p<0·0001), and decreased from 27 to 20 between 2002 and 2015 (p<0·0001). No significant trend was observed for poisoning, but suicide by hanging, suffocation, and strangulation increased over time (p<0·0001), and decreased for other suicide (p<0·0001). There were significant differences in suicides rates between the NS-SEC groups, and by suicide method (all p<0·0001). The suicide rate in 2000–02 was 27 per 100 000 person-years and the SII (78 per 100 000) showed the difference between social class extremes. Suicide by hanging, suffocation, and strangulation (SII 34 per 100 000) accounted for 44% of the inequalities. InterpretationDecline in male suicide rates may be attributed to suicide prevention strategies introduced by the Scottish Government from 2002 (such as Choose Life). Despite decreasing trends of male suicide, suicide by hanging, suffocation, and strangulation increased over time. Limitations are that trends in inequalities were not available, and the 13% of deaths in the NS-SEC categories, never worked and long term unemployed and not classified, were excluded from the analysis assessing inequalities since the interpretation of results for this group was ambiguous. What effect this omission would have on the estimation of inequalities is unclear. Policy should be directed at reducing deaths from hanging, suffocation, and strangulation. FundingUK Medical Research Council (MC_ UU_12017/13) and Chief Scientist Office (SPHSU13).