Abstract
Individual- and area-level risk factors for suicide are relatively well-understood but the role of macro social factors such as alienation, social fragmentation or 'anomie' is relatively underresearched. Voting choice in the 2016 referendum on the UK's membership of the European Union (EU) provides a potential measure of anomie. To examine associations between percentage 'Leave' votes in the EU referendum and suicide rates in 2015-2017, the period just prior to, and following, the referendum. National cross-sectional ecological study of 315 English local authority populations. Associations between voting choice in the EU referendum and age-standardised suicide rates, averaged for the years 2015, 2016 and 2017, were examined. Overall there was a weak, but statistically significant, positive correlation between the local authority-level percentage 'Leave' vote in 2016 and the suicide rate 2015-2017: Pearson's correlation coefficient, r = 0.17; P = 0.003. This relationship was explained by populations having an older age distribution, being more deprived and lacking ethnic diversity. However, there was divergence (likelihood ratio test for interaction, χ2 = 7.2, P = 0.007) in the observed associations between London and the provincial regions with Greater London having a moderately strong negative association (r = -0.40; P = 0.02) and the rest of England a weak positive association (r = 0.17; P = 0.004). Deprivation, older age distribution and a lack of ethnic diversity seems to explain raised suicide risk in Brexit-voting communities. A greater sense of alienation among people feeling 'left behind'/'left out' may have had some influence too, although multilevel modelling of individual- versus area-level data are needed to examine these complex relationships. The incongruent ecological relationship observed for London likely reflect its distinct social, economic and health context.
Highlights
Individual- and area-level risk factors for suicide are relatively well-understood but the role of macro social factors such as alienation, social fragmentation or ‘anomie’ is relatively underresearched
By considering voting ‘Leave’ as a potential marker of anomie at population level, we aimed to examine the association between voting in favour of Brexit and suicide risk in the 3-year period surrounding the referendum (2015–2017)
To examine the associations that were specific to the local authority populations within Greater London versus those in the rest of England, we initially fitted a binary interaction indicator in the full national model, and we evaluated evidence of an interaction between Greater London and the rest of the country via a likelihood ratio test
Summary
Individual- and area-level risk factors for suicide are relatively well-understood but the role of macro social factors such as alienation, social fragmentation or ‘anomie’ is relatively underresearched. Following the 2008–2009 recession in the UK, suicides rose significantly among middle-aged men.[4] Area-based associations with suicide risk are well characterised,[5] but the role of macro social factors such as alienation, social fragmentation or ‘anomie’ is relatively underresearched. The degree to which an area can be characterised as being social fragmented has been measured using Congdon’s ‘anomie score’, which is essentially a compositional measure of census-based variables indicating a higher likelihood of social incohesion, isolation and instability.[8] The most socially fragmented areas during the 1980s and 1990s were found to have the highest suicide rates, even after accounting for deprivation.[9,10] Recent findings from the Netherlands suggest associations may be more complex, with differences observed in potential influences of social fragmentation by gender and according to individual-level characteristics.[11]
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