论文部分内容阅读
Background: Until the late 1960s the national suicide rate in Scotland was lower than in many other western European countries, including England.Since then the rate in Scotland has become the highest across the nations of the United Kingdom.The suicide rate in Scotland has increased greatly relative to that in England during recent decades.We therefore aimed to compare changing patterns of suicide rates between these two neighbouring countries through the period 1960 to 2008.Methods: For Scotland and for England and Wales separately, we obtained national aggregated data on suicide event counts and population estimates.Using ICD coding, revisions 7 to 10, we identified all deaths by suicide and unnatural deaths of undetermined intent.Sex-specific directly age-standardised rates were calculated, and we also compared rates by method of suicide.Results: We identified three distinct temporal phases: (i) 1960-1967, when suicide rates in England and Wales were initially higher than in Scotland, but then converged; (ii) 1968-1991, when male suicide rates in Scotland rose slightly faster than in England and Wales; (iii) 1992-2008, when there was a marked divergence in national trends.Much of the recent divergence in rates is attributable to the increase in suicides among young adult Scottish males and in deaths by hanging in Scotland.Introduction of the undetermined intent category into the 8th ICD revision in 1968 had a significant impact on suicide statistics in both countries, especially so for Scotland.Conclusion: Differences in temporal patterns in suicide risk between the two countries are complex.It has previously been suggested that the variation in suicide rates between the countries could be a result of their different ascertainment procedures for unnatural deaths, and perhaps also the differences in their working definitions of suicide.Although such artefacts may have contributed in part to between-country differences, variation in key population-level risk factors, such as socio-economic deprivation, unemployment and alcohol consumption would seem likely to have played a more important role.Further investigation is currently underway to determine why these and other social and behavioural factors appear to have had such a strong impact on suicide risk among young adult Scottish males.Reversal of the divergent trends may require a change in the perception of hanging as a clean, painless and rapid method of suicide that is easily implemented.This important implication also applies to other countries outside of the United Kingdom.