A study of the geographical distribution of suicide rates in England and Wales 1989-92 using empirical bayes estimates

In order to achieve the suicide reduction targets proposed by the U.K. Government's The Health of the Nation document, it is necessary to determine its geographical distribution. This objective is approached using district level data for England and Wales, aggregated for 1989-92. Two techniques are used, and compared. The first is the traditional method of mapping Standardized Mortality Ratios (SMR), expressed as relative risks. The second technique employed is the relatively new method of empirical Bayes estimates (EBE). It is shown that this is a superior measure for an initial investigation of the distribution of suicide, as relative risks for this comparatively rare condition are highly dependent on the population size of the areas studied. Discernible trends of high risk are shown in high population density, urban areas for both sexes, and in economically depressed agricultural, rural areas for men. The effects of economic hardship, unemployment and social disintegration are suggested as contributing to this distribution in an initiatory or exacerbatory capacity, for those suffering from psychiatric vulnerability or existing mental illness. Suggestions are made for more detailed analyses of high risk areas.