title: Neurotic symptoms, stress, or deprivation: which is most closely associated with incidence of suicide? An ecological study of English Health Authorities.
abstract: BACKGROUND
  Suicide rates, anxiety/depression scores and stress scores are routinely used as mental health indicators in populations, but their inter-relationships have not been explored. Our aim was to explore the association of suicide rates with anxiety/depression and stress scores, while also referring to deprivation scores, which are known to be linked to suicide rates.
  
  
  METHODS
  We undertook an ecological analysis of English Health Authorities, regressing suicide rates (1993-1994), on General Health Questionnaire and stress scores (1994), and also on Jarman deprivation scores (1991).
  
  
  RESULTS
  Overall, Jarman deprivation score was a better predictor of suicide rate than the psychological distress measures. There were no statistically significant associations between suicide rates and GHQ scores, although there was a weak association between suicide rate and mean stress level in women.
  
  
  CONCLUSIONS
  Suicide rates, though important in themselves, are not reliable indicators of the levels of neurotic symptoms or stress in populations. Suicide rates are more strongly associated with area-based measures of social disadvantage, though a possible stress-suicide relationship in women could be investigated further.
authors.affiliation: Department of Social Medicine/MRC Health Services Research Collaboration, University of Bristol.
authors.forename: C J
authors.initials: CJ
authors.lastname: Bartlett
authors.forename: D
authors.initials: D
authors.lastname: Gunnell
authors.forename: G
authors.initials: G
authors.lastname: Harrison
authors.forename: L
authors.initials: L
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D015994:Incidence; D009497:Neurotic Disorders / Q000150:complications / Q000523:psychology*; D012044:Regression Analysis; D012931:Social Environment; D012944:Social Support; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology*; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology