Explaining the Spatial Pattern of Suicide and Self-Harm Rates: A Case Study of East and South East England
- 211 Downloads
This paper examines the impacts on suicide and self harm rates of latent area constructs (deprivation, fragmentation and rurality), obtained via multivariate analysis of a larger set of census and non-census indicators. A case study involves male and female suicides and self-harm hospitalisations in 3242 small areas (known as wards) in East and South East England, including London. A Poisson regression model is applied to these data allowing for nonlinear effects of constructs and for interaction between them, as well as for Poisson extra-heterogeneity. In particular, the gain in model fit from predicting suicide and self-harm risk using the three constructs is assessed in terms of how far they account for spatially structured variation and for unstructured heterogeneity. Evidence for nonlinear effects and interaction between constructs is obtained, and implications for health resource allocation by regression evaluated.
KeywordsSuicide Self-harm Deprivation Fragmentation Rurality Regression
- Bailey, T. (2001). Spatial statistical methods in health. Cadernos de Saúde Pública, 17, 1083–1098.Google Scholar
- Brown, T. (2006). Confirmatory factor analysis for applied research. New York: Guilford.Google Scholar
- Buglass, D., & Duffy, J. (1978). The ecological pattern of suicide and parasuicide in Edinburgh. Social Science & Medicine, 12, 241–253.Google Scholar
- Carr, J., & Moffett, J. (2005). The impact of social deprivation on chronic back pain outcomes. Chronic Illness, 1, 121–129.Google Scholar
- Chandrasekaran, K., & Arivarignan, G. (2006). Disease mapping using mixture distribution. Indian Journal of Medical Research, 123, 788–798.Google Scholar
- Fahrmeir, L., & Osuna, L. (2005). Structured count data regression. Department of Statistics, Ludwig-Maximilian-Universitaet Munchen. http://www.stat.uni-muenchen.de/~bayesx.
- Farmer, R., Preston, T., & O’Brien, S. (1977). Suicide mortality in Greater London: Changes during the past 25 years. British Journal of Preventive and Social Medicine, 31, 171–177.Google Scholar
- Freeman, H. (1994). Schizophrenia and city residence. British Journal of Psychiatry, 164(Supp.), 39–50.Google Scholar
- Gunnell, D., Peters, T., Kammerling, R., & Brooks, J. (1995). Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation. British Medical Journal, 311, 226–230.Google Scholar
- Majeed, F., Cook, D., Poloniecki, J., Griffiths, J., & Stones, C. (1995). Sociodemographic variables for general practices: Use of census data. British Medical Journal, 310, 1373–1374.Google Scholar
- McCullagh, P., & Nelder, J. (1989). Generalized linear models (2nd ed). London: Chapman & Hall.Google Scholar
- Mollie, A. (1996). Bayesian mapping of disease. In Gilks, W. R., Richardson, S., Spiegelhalter, D. J., (Eds.), Markov chain Monte Carlo in practice (pp. 359–379). London: Chapman & Hall.Google Scholar
- Mountrakis, G., Avruskin, G., & Beard, K. (2005). Modeling rurality using spatial indicators. Geocomputation 2005, Ann Arbor, MI, USA. www.geocomputation.org/2005/Mountrakis.pdf.
- Office of National Statistics (2009). Project on Small Area Population Estimates for England and Wales. http://www.statistics.gov.uk/about/methodology_by_theme/sape/default.asp.
- Ovenstone, I. (1973). Spectrum of suicidal behaviours in Edinburgh. British Journal of Preventive & Social Medicine, 27, 27–35.Google Scholar
- Platt, S. (2008). Socio-economic inequalities in suicide in Scotland: Evidence and challenges for prevention. 12th European symposium on suicide and suicidal behaviour 27th–30th August 2008, Glasgow.Google Scholar
- Platt, S., Boyle, P., Crombie, I., Feng, Z., & Exeter, D. (2007). The epidemiology of suicide in Scotland 1989-2004: An examination of temporal trends and risk factors at national and local levels. Edinburgh: Scottish Government.Google Scholar
- Smith, T. (1995). Differences between general practices in hospital admission rates for self-inflicted injury and self-poisoning: Influence of socioeconomic factors. British Journal of General Practice, 45, 458–462.Google Scholar
- Spiegelhalter, D., Thomas, A., Best, N., & Lunn, D. (2003). WinBUGS user manual, version 1.4. MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2 2SR, UK. www.mrc-bsu.cam.ac.uk/bugs/winbugs/contents.shtml.
- Stark, C., Hopkins, P., Gibbs, D., Belbin, A., & Hay, A. (2007). Population density and suicide in Scotland. Rural and Remote Health 7, 672.Google Scholar
- Sutton, M., Gravelle, H., Morris, S., Leyland, A., Windmeijer, F., Dibben, C., et al. (2002). Allocation of resources to English areas: Individual and small area determinants of morbidity and use of healthcare resources. Report to the Department of Health. Edinburgh: Information and Statistics Division.Google Scholar
- Townsend, P., Phillimore, P., & Beattie, A. (1988). Health and deprivation: Inequality and the North. London: Croom Helm Ltd.Google Scholar
- Wilkinson, D., & Gunnell, D. (1999). Youth suicide trends in Australian metropolitan and non-metropolitan areas, 1988–1997. Australian and New Zealand Journal of Psychiatry, 34, 822–828.Google Scholar