Changes in the geography of suicide in young men: England and Wales 1981--2005.
BACKGROUND
Suicide rates changed considerably in men aged <45 years in England and Wales between 1980 and 2005. The impact of these changes on the geographic distribution of suicide is unknown.


METHODS
Mapping of geo-coded standardised mortality ratios for suicide in 1113 census tracts (mean population 46 000) in England and Wales, smoothed using Bayesian hierarchical models, for 15-44 year old men during 1981-1985, 1991-1995 and 2001-2005.


RESULTS
Young male suicide rates rose by 50% between the early 1980s and the 1990s but declined to pre-1980 levels by 2005. The spatial distribution of suicide changed markedly over these years. The 'bull's-eye' pattern of increases in suicide rates from the suburbs to the centre of London was abolished, although they persisted in other major cities. Suicide rates among young men in Wales changed from being relatively lower than other regions to being considerably higher. Similarly, by 2001-2005 suicide rates in northern and south western regions were relatively higher than elsewhere with the predominant feature being a north-west/ south-east divide in suicide. These changes in the spatial epidemiology of suicide were not explained by changes in area levels of single person households, unemployment or the unmarried population.


CONCLUSIONS
There has been a marked change in the spatial epidemiology of suicide in young men in the last 25 years, particularly in central London where the RR of suicide has declined and Wales where risks have risen. These changes do not appear to be explained by recognised suicide risk factors and require investigation to inform prevention strategies.
School of Social and Community Medicine, University of Bristol, Bristol, UK. d.j.gunnell@bristol.ac.uk
D
D
Gunnell
B
B
Wheeler
S-S
SS
Chang
B
B
Thomas
J A C
JA
Sterne
D
D
Dorling
D000293:Adolescent; D000328:Adult; D004739:England / Q000453:epidemiology; D005843:Geography; D006801:Humans; D008297:Male; D013405:Suicide / Q000639:trends*; D014852:Wales / Q000453:epidemiology; D055815:Young Adult