Statistics 2: Suicide

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Introduction
Note on interpreting suicide rates
Note on terminology
How many suicides and attempted suicides are there each year?
Which sex is most at risk of suicide?
Which age groups are most at risk of suicide?
Which group has the lowest risk of suicide?
Suicide mortality
Factors that increase the risk of suicide
Suicide and mental health
Suicide and unemployment
Suicide and employment
Suicide and ethnicity
References

Introduction

This factsheet describes some of the key statistics relating to suicide. A more detailed discussion about suicide and the underlying risk factors, and strategies aiming to reduce death by suicide can be found in Mind’s factsheet: Suicide rates, risks and prevention strategies.

Note on interpreting suicide rates
Figures for suicide rates are not usually based solely on those officially classified as having died by suicide. This is because an official verdict of suicide has to show beyond reasonable doubt that suicide was intended – reflecting the fact that, until 1968, suicide was a criminal offence. An alternative verdict of probable suicide or ‘undetermined death’ is given where conclusive evidence is not available. Usually these two figures are combined to give a suicide rate. [1] This applies to the data given in this factsheet.

It is also worth noting that population differences need to be taken into account when comparing figures shown by age or gender. For example, a high rate for young people may be less significant if there are far more young people than other age groups in the population. For this reason, data are given per 100,000 of that population group. For example, in 2005, 74 men and 41 women over 85 years of age died by suicide. So just under twice as many men as women killed themselves. However, because there are far more women than men in this age group, the rates give a different picture. For men aged 85 years and over, as many as 23.3 per 100,000 died by suicide, compared with 5.5 per 100,000 for women. In other words, men of this age group are four times more likely than their female counterparts to end their lives by suicide.

Note on terminology
The language and terminology of psychiatric diagnosis used in this document refers to the original sources used. The use of such language does not imply Mind’s unqualified acceptance of it. The original language has been retained for the sake of accuracy.

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How many suicides and attempted suicides are there each year?

Although the overall rate of death by suicide is falling, more than 4,300 people still die by suicide in England and Wales each year. [2] Many more suicide attempts are made. At least one person in every 100 who ends up in hospital after a suicide attempt will succeed within a year, and up to 5 per cent do so over the following decade. [3] A study looking at figures for attempted suicides from several European countries, including the UK, suggests that the figures might be higher – possibly as many as 2 per cent of people who have attempted suicide will kill themselves within a year of the previous attempt. [4] The study also found that about 7 per cent of people in the study died by suicide within the next decade. A British study found that women who have a history of deliberate self-harm (including overdose) are 15 times more likely to die by suicide compared with other women. The risk is particularly high during the 6 months following deliberate self-harm. [5]

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Which sex is most at risk of suicide?

Suicide rates are higher for men than women of all age groups, and currently men are almost three times more likely than women to die by suicide. This gender gap has widened considerably over the past few decades: in 1979 the female-to-male ratio for suicides was 2:3, but by 2005 it was about 1:3.

Suicide rates for both men and women have varied over the last 30 years, however. Between 1975 and 1990, the rate increased for men but decreased for women whereas between 1990 and 1997 rates decreased for both men and women. [6] Between 1997 and 1999, there were some increases in overall numbers of suicides, and since 2000 the numbers have gone down for men but have remained fairly stable for women. [7]

The gender difference in the suicide rate is particularly striking for young people. Between the ages of 20 and 24 years, men are more than four times more likely than women to kill themselves. [8]

Amongst 15–19-year-olds girls are more likely to attempt suicide, but boys are much more likely to die as a result of a suicide attempt. [9]

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Which age groups are most at risk of suicide?

The group at highest risk of suicide has changed over the years. It used to be men over 65 years of age: 24 per 100,000 population in 1979. [10] In the past decade, the group at highest risk has been men aged 25–34 years. However, in 2002, the risk of suicide in this age group was the same as in men aged 35–44 years: 22 per 100,000 population. During the late 1980s and 1990s, suicide was the most common cause of death for men aged 15–44 years. [11] The suicide rate has gone down since then, however, and suicide is now the second most common cause of death in this age group, behind accidental death. [12] 

In men aged 15–24 years the suicide rate rose from 9 per 100,000 population in 1979 to 13 per 100,000 in 1999; a rise of almost 50 per cent. Since 1999, the figures have shown a downward trend. [13] Among men, the highest rate of suicide since 1997 has been in those aged 15–44 years.

The pattern is different for women. Among women, the highest suicide rate in 2005 was for those aged 45–74 years. [14]

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Which group has the lowest risk of suicide?

Young women in the 15–24 year age group are at the lowest risk. The suicide rate in this group has remained fairly constant since 1979, and is now fewer than 3 per 100,000 population. [15]

Suicide mortality

Mortality from suicide in England and Wales, by gender

Source: ONS, 2007, Mortality statistics, Series DH2 no. 32

Source: ONS, 2007, Mortality statistics, Series DH2 no. 32

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Factors that increase the risk of suicide

The likelihood of a person dying by suicide depends on several factors: [16]

• mental and physical illness
• social problems: particularly family stress, separation, divorce, social isolation, death of a loved one and unemployment
• ease of access to the means of suicide.

According to a World Health Organization working group, there is ample evidence that social conditions that are liable to change (such as the constant risk of losing one’s job) are among the determinants of suicide.

Marital status affects a person’s risk of suicide. In the early 1970s and late 1980s, suicides among men under 45 years of age were linked to remaining single or becoming divorced. [17] More recent research suggests that divorce is still a risk factor for suicide, particularly for men. [18]

Alcohol and drug misuse can also influence suicide risk. [19] Rates of drug and alcohol consumption are higher among men than women, and are particularly high among younger people. [20]

For many people, a combination of factors is more likely to increase their risk of suicide rather than one single cause. [21]

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Suicide and mental health

A number of studies show that as many as 90 per cent of people who die by suicide had one or more psychiatric disorders at the time of death, and that each diagnosed mental illness was associated with an increased suicide risk. In one research study, 36 of 44 disorders considered were associated with significantly higher standardised mortality rates for suicide, leading the authors to conclude that virtually all mental disorders increase the risk of suicide except, possibly, dementia and agoraphobia. [22]  Functional mental disorders such as schizophrenia and depression are associated with the highest risk overall; substance misuse and organic disorders are associated with a lesser degree of risk. The links between mental health and suicide are discussed in more detail in Mind’s Suicide rates, risks and prevention strategies factsheet.

Safer Services reported that one in four people who took their own lives – about 1,000 people each year – were subsequently found to have been in contact with specialist mental health services in the year before death. [23] Of these, 16 per cent were inpatients at the time of their death, and 24 per cent had been discharged from hospital within the previous three months. Many were not fully compliant with treatment when discharged, and in most cases staff perceived the immediate risk of suicide to be low. Safer Services also recorded that about half of the suicides were by people with a history of self-harm and either substance misuse or previous admission to hospital. [24]

Depression
In the case of depression, studies have shown that, on average, the risk of suicide is about 15 times higher than the average for the general population. [25] However, this is likely to be an underestimate, as many who die by suicide may have been experiencing undiagnosed depressive illness.

The Mental Health Foundation estimates that 70 per cent of recorded suicides are by people experiencing depression, [26] often undiagnosed.

Schizophrenia
People with a diagnosis of schizophrenia are at an increased risk of suicide, particularly when they are young. The onset of schizophrenia tends to be between 17 and 25 years of age, at a time when many are struggling to establish an adult identity and relationships. The arrival of distressing symptoms at this time, along with the stigma attached to the diagnosis, increases the risk of suicide. [27] A lifetime risk of up to 10 per cent has been suggested, but even this may be an underestimate, and there is growing concern that suicide risk is increasing. [28] 

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Suicide and unemployment

Links between unemployment and suicide have been clearly demonstrated in several studies. [29] In an international study of male suicides in 22 countries between 1974 and 1988, unemployment was found to be a leading factor. [30] Further studies in the UK confirm the links between unemployment, suicide and attempted suicide. [31] The link between suicide and unemployment appears to be particularly strong for young men. [32]

Suicide and employment

Men in unskilled occupations are four times more likely to die by suicide than are those in professional work. [33] However, certain occupational groups such as doctors, nurses, pharmacists, vets and farmers are at higher risk of suicide. This is thought to be partly because of ease of access to the means of suicide. [34]

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Suicide and ethnicity

Patterns of suicide and attempted suicide among young black and Asian people in Britain do not reflect those in the wider community. The suicide rate amongst young Asian women is twice the national average. Wives who cannot have children or produce only daughters seem to be at greatest risk. Venna Soni, an epidemiologist and a leading expert on Asian suicides, reported that 1,979 women of all races between the ages of 15 and 34 years killed themselves between 1988 and 1992 in England and Wales, 85 of whom were Asian. This is nearly double their proportion of the population. [35]

One study shows that the suicide rate in young Asian women in the UK is three times higher than amongst their white counterparts. [36] However, this situation is reversed for young Asian men, who seem to be at less risk than young white men of British origin. [37]Recording of ethnicity in government statistics on health and other areas has recently been introduced in the UK and currently few official statistics are available. A Birmingham study found that young African-Caribbean women were at increased risk of attempted suicide, and reported rapid increases in the number of black people who died by suicide during the late 1970s. [38]

More recent studies, including the National Confidentiality Inquiry into Suicide and Homicide by people with Mental Illness, suggest that patterns of self-harm and suicide continue to be different for white people and people from minority ethnic groups. [39] Studies suggest higher rates of suicide among women than men in people of Chinese origin, which is in line with reports of suicide in China. Suicide by burning is unusual in England and Wales, but fairly common in South Asian women. [40]

People from ethnic minority groups who die by suicide are more likely to have been unemployed than their white counterparts. [41] They are also more likely to have been diagnosed with schizophrenia. They are less likely to have self-harmed in the past or to have a history of alcohol misuse than the white population. [42] 

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References

[1] Hill, K. 1995, The long sleep – young people and suicide, Virago.
[2] ONS, 2007, Mortality Statistics for England and Wales 2005, Series DH2, no. 32.
[3] Hawton, K., Fagg, J. 1998, Suicide, and other causes of death, following attempted suicide, British Journal of Psychiatry, vol. 152, 359–366.
[4] Owns, D., Horrocks, J., House, A., 2002, Fatal and non-fatal repetition of self-harm, Systematic review, British Journal of Psychiatry, vol. 181, 193–199.
[5] Cooper, J., Kapur, N., Webb, R. et al. 2005, Suicide after deliberate self-harm: A 4-year cohort study, American Journal of Psychiatry, vol. 162, 297–303, published in Evidence-Based Mental Health, 2005, vol. 8, 97.
[6] ONS, 2006, Health Statistics Quarterly 32, winter 2006.
[7] ONS, 2007, Mortality Statistics, DH2, 1996–2005.
[8] NIMHE, 2007, National Suicide Prevention Strategy for England, Annual report on progress 2006.
[9] Hawton, K, (2000), Sex and suicide: Gender differences in suicidal behaviour, The British Journal of Psychiatry, 177: 484-485
[10] ONS, 1998, Social trends vol. 28.
[11] Brook, A., Griffiths, C. 2003, Trends in the mortality of young adults in England and Wales, 1961 to 2001, Health Statistics Quarterly, vol. 19.
[12] ONS, 2007, Mortality Statistics, Series DH2 nos. 30 and 32.
[13] Samaritans, 2004, Information resource pack.
[14] ONS, 2006, Annual Update: Mortality statistics 2004: injury and poisoning, Health Statistics Quarterly vol. 31.
[15] ONS, 2007, Mortality Statistics, Series DH2 nos. 30 and 32.
[16] NIMHE, 2007, National Suicide Prevention Strategy for England, Annual report on progress, 2006.
[17] Charlton, J. et al. 1992, Trends in suicide deaths in England and Wales. Population Trends No. 69. ONS.
[18] NIMHE, 2007, National Suicide Prevention Strategy for England, Annual report on progress, 2006.
[19] Appleby, L., 1999, Safer Services: national confidential inquiry into suicide and homicide by people with mental illness, Department of Health, London.
[20] ONS, 2008, General Household Survey, Smoking and Drinking Among Adults 2006, Crown copyright
[21] NIMHE, 2007, National Suicide Prevention Strategy for England, Annual report on progress, 2006
[22] Harris, E.C., Barraclough, B., 1997, Suicide as an outcome for mental disorders, British Journal of Psychiatry, 170, 205–228.
[23] Appleby, L. 1999, Safer Services: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Department of Health, London.
[24] Appleby, L. 1999, Safer Services: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Department of Health, London.
[25] Cipriani, A., Barbui, C., Geddes, J. R., 2005, Suicide, depression and antidepressants, BMJ 2005, vol. 330, 373-4
[26] Mental Health Foundation 1997, Briefing No. 1 – Suicide and Deliberate Self-Harm.
[27] Hill, K. 1992, The long sleep – young people and suicide, Virago.
[28] Department of Health, 1999, NHS National Service Frameworks for Mental Health – Modern standards and service models.
[29] Department of Health, 2002, National Suicide Prevention Strategy for England.
[30] McDonald, V. 1992, ‘Suicides in young men on the increase’, Sunday Telegraph, 12 January
[31] Department of Health, 2002, National Suicide Prevention Strategy for England.
[32] Department of Health, 2002, National Suicide Prevention Strategy for England.
[33] Department of Health, 1999, National Service Frameworks – modern standards and service models – mental health.
[34] Department of Health, 1999, National Service Frameworks – modern standards and service models – mental health.
[35] Roy, A., 1996, ‘Asian Wives driven to suicide’, The Daily Telegraph, 22 April 1996.
[36] Raleigh, V. S, Balarajan, R. 1992, Suicide and self-burning among Indians and West Indians in England and Wales. British Journal of Psychiatry, vol. 129, 365–368.
[37] Raleigh, V.S., Balarajan, R. 1992, Suicide and self-burning among Indians and West Indians in England and Wales. British Journal of Psychiatry, vol. 129, 365–368.
[38] Burke, A. W., 1992, Sociocultural determinants of attempted suicide among West Indians in England and Wales, British Journal of Psychiatry, vol. 129, 261–266.
[39] Hunt, I., Robinson, J., Bickley, H., et al. 2003, Suicides in ethnic minorities within 12 months of contact with mental health services. National clinical survey. British Journal of Psychiatry, vol. 183, 155–160.
[40] Hunt, I., Robinson, J., Bickley, H., et al. 2003, Suicides in ethnic minorities within 12 months of contact with mental health services. National clinical survey. British Journal of Psychiatry, vol. 183, 155–160.
[41] University of Manchester, 2006, Five year report of the national confidentiality inquiry into suicide and homicide by people with mental illness, Avoidable deaths.
[42] University of Manchester, 2006, Five year report of the national confidentiality inquiry into suicide and homicide by people with mental illness, Avoidable deaths.

This factsheet was written by Inger Hatloy in 2004, and updated by the author in January 2008.