Abstract
Suicide rates among men have increased in Scotland while falling in neighbouring countries. A national suicide prevention strategy has been produced. Previous work found that some rural areas of Scotland had higher than average rates of male suicide and undetermined deaths. This article describes the association between population density and suicide and undetermined death rates in Scotland. Anonymised information on deaths from suicide and undetermined cause in Scotland were obtained from the General Registrar Office for 1981-1999, including information on postcode sector. Each postcode sector was assigned a deprivation and population density score. Loglinear models were used to examine the effects of time period (grouped into four periods), deprivation quintiles, population density (grouped into four categories) and their interactions in each sex in three age groups. A significance level of 5% was used throughout. Adjusted rate ratios and 95% confidence intervals were based on models that included only significant factors and interactions. In men, there were higher rate ratios in the most densely populated and least densely populated quartiles, with intermediate rate ratios in other areas. There was no association with population density in women aged less than 25 years, a similar pattern to men in 25-44 year old women, and lower rates in rural areas in older women. Higher levels of deprivation were associated with higher rate ratios of suicide in both sexes and all age groups. Rate ratios over time increased in younger men and women, remained stable in older men, and declined in older women. Deprivation is associated with higher rates of suicide and undetermined deaths at all levels of population density and in all age groups. The highest rates of suicide among men are in the most and least densely populated areas, after adjusting for deprivation. The effect is different among women, with no effect among younger women, and lower rates among older women in areas with lower population density.
Highlights
Suicide rates among men have increased in Scotland while falling in neighbouring countries
Time period was independently significant in all groups other than men aged over 45 years
Population density was independently associated with the rates of suicide and undetermined deaths in both sexes and in all age groups other than younger women
Summary
Suicide rates among men have increased in Scotland while falling in neighbouring countries. Previous work found that some rural areas of Scotland had higher than average rates of male suicide and undetermined deaths. Conclusions: Deprivation is associated with higher rates of suicide and undetermined deaths at all levels of population density and in all age groups. Deprivation is associated with increased rates of suicide[2,3], and rates in Scotland have changed over time, with an increase among younger men and a decrease in most age groups among women[4]. Levin and Leyland[3] reported that small remote rural communities have higher standardised mortality ratios than urban areas, but no information has been available on the relationship between population density and suicide in Scotland
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